What is hip pain? Causes, Symptoms, Treatment
1. An overview
The hip is the junction connecting the upper with the lower part of the body. The hip region is the joint between the femur and acetabulum, the pelvis (femur is a thigh bone and acetabulum is the deep cup-shaped structure that encloses the head of the femur. The pelvis is the bony cavity of the abdomen).
The primary function of the hip is to support the weight of the body in both static (such as standing/sitting/lying) and dynamic postures (walking/running and other movements of the body at work or exercise).
The hip is a ball and socket joint and is the largest weight-bearing joint in the body. A healthy hip joint consists of femur /acetabulum/ femoral head (it is the largest part of the femur or thigh bone).
Whenever one uses the hips (through walking/running and other movements), a cushion of cartilage helps prevent friction as the hip bone moves in the socket (cartilage is the whitish elastic tissue forming part of the skeleton). Despite its durability, the hip joint is not indestructible. With both age and use, the cartilage may wear down and in consequence, becomes damaged. Over and above, bones in the hip can break (during a fall or injury). Additionally, if the hips are sore, they may cause pain and discomfort in the hip. Any of these conditions may result in hip pain.
Conclusively, pain in the hip may be coming from various structures and different directions. Pain may be short-lived or chronic. Pain may be mild or moderate or even serious.
2. Hip Pain Causes
Many medical causes are responsible for hip pain. These are stated below.
Arthritis is inflammation in the joints which can cause pain and swell in the body’s different parts. There are several types of arthritis—osteoarthritis and rheumatoid arthritis are the most common causes leading to hip pain, especially in old age. In the wake of arthritis, the pain gradually gets worse. People (with arthritis) also feel stiffness and have a reduced range of motion in the hip. (osteoarthritis occurs with aging. when the cartilage, that cushions and protects the bones, may wear away. Rheumatoid arthritis is a long term autoimmune disorder that primarily affects the joints. It typically results in warm/ swollen/ painful joints).
2.2) Hip fractures
With age, the bones can become weak and brittle. Weakened bones are more likely to break during a fall.,
Bursae are sacs of liquid found between the tissues (such as, in the bones/muscles/ tendons). They ease the friction from these tissues rubbing together. Bursitis is a condition when bursae get inflamed causing pain. Inflammation of bursae is usually due to repetitive activities in the wake of overuse (that irritate the hip joint )
Tendons are the thick band of tissues (that attach bones to the muscles). Tendinitis is the inflammation or irritation of the tendons. It is usually caused by repetitive stress from overuse.
2.5) Muscle or tendon strain
Repetitive use (through daily activities) can put a strain on the muscles/ tendons/ ligaments (that support the hips). When they become inflamed (due to overuse), they can cause pain and prevent the hips from working normally.
2.6) Hip labral tear
This is a rip on the ring of cartilage (called the labrum that follows the outside rim of the socket of the hip joint)). While cushioning the hip joint, the labrum acts like a rubber seal (to help hold the ball lying at the top of the thigh bone securely within the hip socket). Athletes (as well as the people performing repetitive twisting movements) are at higher risk to develop the problem of hip pain.
3. Hip pain Symptoms
Symptoms associated with hip pain are:
- limping (walking unsteadily)
- Pain in the joint.
- Pan in the groin.
- Loss of motion of the hip.
- Swelling on the hips.
- Tenderness of the hips.
- Difficulty while sleeping on the hips.
If hip pain does not show any sign of improvement, then it is essential to consult a doctor. Before going to the doctor, it is well-advised to note down all the relevant points (such as, when and what type of movements and postures worsen the symptoms --- sitting /standing/walking /running/twisting / climbing up and down the stairs). After listening to all the relevant points, the doctor will recommend the following tests.
It is often considered the best way to find out what is wrong with the hip, as it detects the condition of the bones. An X-ray may also show the problem in the pelvis. (which could explain the pain).
4.2) CT Scan (Computer Tomography Scan)
It can be helpful to detect if the hip joint has an unusual shape. CT scan uses an x-ray to show the section or the slices of the hip. The computer then puts (CT scan and x-ray) together to form a 3-dimensional image of the hips. There may be conditions where the socket of the hip can be very shallow which the CT scan can show.
4.3) MRI Scan (Magnetic Resonance Imaging Scan)
MRI scans use radio waves to build a picture to show what is happening to soft tissue (such as, muscles and the tendons inside the hip). They are particularly helpful for diagnosing the painful condition which reduces the flow of blood to the ends of the bone (causing the bone to collapse).
4.4) Blood test
If the doctor thinks that hip pain is due to infection or rheumatoid arthritis, then blood the test is essential.
5. Hip Pain Treatment
The following are the treatment procedures to relieve hip pain.
Exercise is the best natural way to relieve pain through strengthening hip health (for people with mild or moderate hip pain). Also Exercise helps maintain a range of motions and strengthens the muscles that support the hip functions.
Various studies reveal the fact that people with a regular exercise program are less likely to need medications or replacement surgery. Veritably, regular exercise prevents or delays medication or hip surgery.
Medications are an important part of treatment to soothe hip pain problems. Also Medications help pacify pain/ relieve inflammation/ slow bone loss/ prevent joint Damage. The type of medications commonly used is described below.
5.2.1) NSAID (Non-steroidal anti-inflammatory drugs)
The medications are mainly used to help ease arthritis pain, inflammation and all other forms of painful hip problems. Most NSAIDs are taken orally. Among the recently approved drugs, important are Voltarein / Gel / Pennzoil.
These quick-acting drugs are used to control inflammation. If the inflammation is due to systemic autoimmune disease (such as rheumatoid arthritis polymyalgia), then the doctor may prescribe oral Corticosteroids.
If the inflammation is limited to the hip or inflamed burse, then the doctor may inject a Corticosteroids preparation (directly into the inflamed hip joint).
These are among the most commonly used drugs for treating hip arthritis. They may also be used to relieve pain from hip injury and surgery. The drugs are safe for pain relief (especially, for those people who are unable to take NSAIDs on account of allergies or stomach problems).
5.2.4) DMARD (Disease-modifying anti-rheumatic drugs)
They are drugs that work slowly (to treat the different stages of inflammatory disease).
Different types of DMARDs may be used to treat arthritis of the hip (including rheumatoid arthritis/ lupus / ankylosing spondylitis /psoriatic arthritis).
5.2.5) Gout medications
Some medications for gout, are diagnosed to reduce the level of uric acid in the blood (to prevent the future attack of joint pain and inflammation)
5.2.6) Biologic response modifiers
The biologic agents are used in the treatment of rheumatoid arthritis and some inflammatory forms of hip arthritis. There are currently 8 such agents approved by FDA (Food and Drug Administration), USA.
5.2.7) Osteoporosis medications
These are used to slow the loss of bones (or help the body build new bones). The new bones built, are strong. And so, new bones are less prone to fracture.
Hip pain surgery may be needed when hip joint pain is not healed by other treatment procedures (such as natural remedies like correct physical exercise in addition to medications). Under the condition, total Hip joint Replacement or Hip Resurfacing and other types of hip surgery may be necessary.
5.3.1) Total Hip joint Replacement
This is the most common hip surgery. It is a surgical procedure in which the the damaged hip is removed and replaced with prosthesis ceramic or plastic components The hip is the 2nd most commonly replaced joint (after the knees). Hip replacement becomes indispensable when irreparable joint damage interferes with the normal hip function ( and besides, it causes constant pain that cannot be alleviated by conservative therapies).
5.3.2) Hip Resurfacing
Hip resurfacing is an alternative to hip replacement (for those who are young and active). Also hip resurfacing does not require removal of the femoral head and replacement of a ball of metal or ceramic material (unlike the total replacement). Instead, the damaged femoral the head is reshaped and filled with a metal covering (that fits into the socket.).
It is a minimally invasive surgical procedure (performed by inserting a lighted scope and narrow instruments through small incisions in the skin over the joint). Arthroscopic surgery has been recently used in hip pain treatment (for correcting problems, such as labral tears).
Conclusively, the success of many arthroscopic surgeries has been controversial.
It is a major surgery in which the damaged portion of the hip is removed. And the joint is reshaped or repositioned to correct deformity and ensure improvement alignment and proper function of the hip. An osteotomy may be appropriate for a person who has arthritis (in the hip joint).
6. Some vital issues relevant to hip pain
6.1) Hip pain during pregnancy
Hip pain is a common symptom that is experienced during pregnancy, specifically during the 3rd trimester (Pregnancy period is divided into 3 trimesters. The 1st trimester starts from the 1st week and lasts till the 12rh week. The 2nd trimester starts from the 13th and lasts till the 26th week of pregnancy period. And the 3rd trimester starts from the 27th week and lasts till the end of the pregnancy period.). Hip pain during pregnancy occurs because the body prepares itself for labor. Soreness and acute pain is often felt (on the side where the baby tends to lie in the uterus).
6.1.1) Causes of hip pain during pregnancy
126.96.36.199) During pregnancy, the body releases hormones that allow connective tissues to relax and soften (hormones are special chemical messengers in the human body. They control most of the major body functions from simple system ‘hunger’ too complex system ‘reproduction’. Too much or too little hormones can pose a serious health problem). As a result, the Joints and the ligaments (between the bone and the pelvis) begin to loosen. But increasing flexibility in these bones is essential for allowing the body to move (during labor). Lower back pain (as well as the changes in the posture and a heavier uterus) may contribute to the soreness experienced.
188.8.131.52) Another cause of hip pain during pregnancy is increased pressure on the sciatic nerve (it is the largest nerve in the body providing a sensory and motor function to the lower extremities. The sciatic nerve runs under the uterus up to the legs. The sciatic nerve pain is thought to be associated with pressure on the nerve caused by the development of the baby. There are 2 sciatic nerves in the body that run from the lower back, up to the feet When an enlarged uterus puts pressure on the nerves, then the pain and numbness or a tingling sensation in the buttocks are felt. This medical problem is termed sciatica).
But, as the pregnant woman gets closer to the due date, the baby accordingly changes position in the uterus. This is likely to reduce discomfort.
184.108.40.206) Another possible cause of hip pain during the 2nd trimester of pregnancy is Round ligament pain. It is caused by sharp pain in the abdomen/hip/groin area. The pain may intensify with rapid changes in the position of the baby.
6.1.2) Treatment of hip pain during pregnancy
- Exercise program (that strengthens both the back muscles as well as abdominal muscles) is likely to reduce hip pain. One effective exercise is elevating the hips above the chest level (while lying on the back for a couple of minutes).
- Taking a warm bath or applying warm compresses (to the sore area), can reduce the pain.
- A massage can reduce soreness
- As the pregnant woman gets closer to the delivery date, it is essential to sleep on the side and not on the back (keeping the legs and the knees bent).
- Using pillows (to support the abdomen and upper leg) can alleviate discomfort while sleeping
- If side sleeping worsens the symptoms, then a pillow may be placed at the back (to sleep leaning against the; pillow)
Advice: If hip pain is accompanied by pressure/soreness in the pelvic area (that radiates towards the thighs before the 37th week of pregnancy period), then it is important to consult a physician. Because this can be a sign of preterm labor (it is also known as premature labor. It is a condition when the body starts getting ready for birth too early- earlier than 37th week of pregnancy period)
6.2) Cancer-related to hip pain
In rare cases, hip pain can be caused by cancer. Tumors that start in the bone or spread to the bone can cause pain in the hips (as well as in other parts of the body). Some type of cancer causes hip pain as a symptom. These are:
6.2.1) Primary bone cancer
It is malignant but rare. Cancer originates from the bone. The American Cancer Society in a study (2019), estimates that less than 0.2% of all cancers are bone cancer.
Conclusively, for diagnosis of primary bone cancer (which is considered as one of the causes of hip pain), Percutaneous Biopsy is safe and accurate. ( Percutaneous The biopsy is a computed tomography-guided biopsy which is an indispensable device to evaluate pulmonary abnormalities – a condition resulting from deposition of calcium or other high attenuation materials).
It is a type of primary bone cancer that is most likely to be found in the hip. The cancer tends to grow in the flat bones (lying in the hip/ shoulder blades/ pelvis).
6.2.3) Metastatic cancer
It is a malignant tumor that spreads from one point to another. Metastatic cancer can spread to any part of the body and one of the most common parts of the body is ‘hip’.
It is another type of cancer that results in the overproduction of white blood cells. These cells are produced in the bone marrow (located in the center of the bones).
When these white blood cells overcrowd the bone marrow, it causes pain on the bone (lying in the arms and the legs and later in the hip).
6.3) Hip pain at night
Osteoarthritis is a common cause of hip pain at night (Osteoarthritis occurs at the hip joint. It usually arrives in old age in the wake of wear and tear of tissue- which is known as cartilage). Hip pain moving around the buttocks and running up to the legs (that seriously affects mobility), mostly arrives at night.
Cause of hip pain at night is mainly due to incorrect sleep position (A mattress that is too soft or too hard could trigger pressure joints which may lead to a sore hip. It is, therefore, good to sleep on the side that does not hurt. Additionally, a pillow should be placed to keep the knees aligned)
6.4) Hip pain while sitting
To many, sitting (instead of being a comfort), invites the trouble of hip pain. The cartilage of the hip joint is designed to pad, protect and ease our movements (while performing dally home and job responsibilities). But as one age, the cartilage begins to thin causing painful rubbing and inflammation. More importantly, sitting for long or sitting in an incorrect posture, may cause pain in the hip.
6.5) Hip pain while running and walking
Hip pain on account common injury hurts many athletes (especially, the runners). In fact, a runner may experience pain in the hip joint (in the wake of hip injury from running).
The incidence of hip arthritis, among the runners, is common. Pain suffered due to hip arthritis usually worsens well after running and prolonged walking (for the obvious reason for rotation or twisting of the hip joint. The hip joint may feel stiff while walking for the 1st couple of hours in the morning).
Conclusively, for the runners (with mild hip osteoarthritis), it is essential to continue a modified running regime. But for those (with moderate to severe hip osteoarthritis), the effect of running could be damaging. In that case, it is highly recommended to choose low impact activities (which don’t load the hip joints significantly, such as cycling/swimming / low impact aerobatics).
6.6) Outer hip pain
Pain on the inside of the hip is usually caused by the problems with hip joint Itself. But, the pain (on the outer part of the hip) is typically caused by the problems with the soft tissues (such as, ligaments/tendons/muscles that surround the hip joint- but not the hip joint itself).
Treatment of outer hip pain typically includes the RICE method (Rest/ Ice use/Compression/ Elevation).
7. Concluding remarks
In fact,“ No human organ (including hip) raises a false alarm”. So, if one feels pain in the hip, due attention should be paid in time (rather than delaying or ignoring it).
Further, if hip pain is chronic, then it is essential to consult a physician instead of sticking to “ wait and see “.
- H= HIP (is the junction between the upper and the lower part-oh the body)
- I= IGNORING (hip pain- mild or serious, maybe dangerous)
- P= PRIMARY (the function of hip is to support the weight of the body)
- P= PAIN (in the hip, maybe short-lived or chronic/ mild or serious)
- A= ARTHRITIS (is inflammation in the joints--- a major cause of hip pain)
- I= IMPORTANT (part of treatment for hip pain is exercise)
- N= NIGHT (hip pain is mainly due to incorrect sleep position)