Hip Pain

Hip pain can occur in people of any age, causing discomfort and limiting daily activities. This common issue ranges from mild aches to severe, debilitating pain that interferes with movement and quality of life. Many individuals experience hip pain on one side, lower back hip pain, or pain inside the hip joint, making it crucial to understand the underlying causes and available treatments. This article offers a detailed analysis of hip pain, covering its various causes, symptoms, and treatment options. 

What is Hip Pain?

Pain inside the hip joint is a common musculoskeletal issue affecting people of all ages, particularly as they age. It involves discomfort or pain in or around the hip joint, where the thigh bone (femur) connects to the pelvis. This joint is one of the largest in the body and is crucial in movement, weight support, and balance maintenance.

Hip pain may be felt close to the surface above or around the hip, often indicating a problem with muscles, tendons, or ligaments. Alternatively, the pain might be deeper inside the hip joint, suggesting an issue with bones or cartilage. Hip pain can sometimes radiate to other areas, such as the lower back or groin.

The location and nature of hip pain can provide clues about its cause. The pain inside the hip joint might indicate a different problem than lower back hip pain or hip pain on one side. Some individuals experience hip pain when sitting or performing specific movements, while others feel discomfort throughout the day or at night.

Causes of Hip Pain

Hip pain can stem from various conditions and factors, such as:

• Arthritis: It leads to inflammation in the joints. Osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis are arthritis types that can cause hip pain, swelling, and stiffness. 
• Injuries to the Hip Joint: These can occur due to repetitive strain, sports activities, or accidents.
• Hip Muscle Strains: Strains, particularly hip flexor strains, are frequent culprits. 
• Sciatica: Sciatica or a pinched nerve can cause hip pain.
• Other Injury-related Causes: These include iliotibial band syndrome, hip labral tears, bone fractures, and hip dislocations.
• Bursitis: It involves the swelling of small, fluid-filled sacs called bursae, which cushion the spaces around bones and tissues. The two most common types affecting the hip are iliopectineal bursitis and trochanteric bursitis. 
• Structural Issues: Some people are born with conditions like femoroacetabular impingement (FAI) or developmental dysplasia of the hip (DDH), which affect the shape of their hips and may result in hip pain.
• Other Causes: Other hip pain causes include hip bone cancer,  avascular necrosis, fibromyalgia, infection (septic arthritis), and pregnancy.

Symptoms of Hip Pain

Hip pain can manifest in various ways, ranging from a sharp, intense sensation to a dull ache. Common symptoms associated with hip issues include:

• Tenderness or pain in the hip joint
• Discomfort in the groin, outer hip, thigh, or buttocks
• Difficulty moving the hip or legs
• Trouble sleeping on the affected hip joint
• Hearing snapping or clicking sounds in the hip (crepitus)
• Limping or reduced range of motion
• Stiffness, especially after periods of inactivity

The pain might come and go, often worsening with movement and improving with rest. Some people experience more severe hip pain while sitting or walking, while others notice increased discomfort at night or upon waking in the morning.

Diagnosis

Diagnosing hip pain involves a thorough assessment of the patient's medical history, physical examination, and often imaging tests. 

• Patient History: Doctors ask about the nature of the pain, its location, and any factors that worsen or alleviate the discomfort, any previous injuries, family history of hip problems, and the impact of the pain on daily activities.
• Physical Examination: Doctors observe the patient's gait and posture. They assess the range of motion in the hip joint, perform muscle strength tests, and palpate the affected area. 
• Imaging Tests: X-rays are typically the initial choice. Doctors may sometimes suggest more advanced imaging techniques like MRI or CT scans to detect soft tissue injuries or subtle bone abnormalities.

For patients with suspected intra-articular hip problems, ultrasound-guided anaesthetic injections can be used for both diagnostic and therapeutic purposes. These injections help pinpoint the source of pain and may provide temporary relief.

Treatment

The hip pain treatment depends on its underlying cause and severity. 

• RICE Method: Rest, Ice, Compression, and Elevation. This approach is particularly effective within the first 24 to 48 hours after the onset of hip pain. Resting the affected hip, applying ice packs for 15 minutes every few hours, using compression wraps, and elevating the hip above the heart level can help reduce swelling and pain.
• Medications: Over-the-counter pain reducers can help reduce inflammation and discomfort.
• Physical Therapy: A physiotherapist can tailor an exercise plan to strengthen the muscles surrounding the hip joint, improve flexibility, and maintain range of motion. 
• Ultrasound-guided Cortisone Injections: These can provide significant relief for some patients when injected into the hip joint. These injections can also help confirm whether the hip joint is the source of pain.
• Surgery: For severe cases that don't respond to conservative treatments, surgery might be necessary. Hip arthroscopy (a minimally invasive surgical procedure) allows surgeons to repair damage inside the hip joint. 
• Hip Replacement: In cases of advanced osteoarthritis or severe hip fractures, a total hip replacement might be recommended to restore hip joint function and alleviate pain.

When To Call the Doctor

While hip pain is common, one requires immediate medical attention if:

• You've been managing hip pain at home for two weeks without improvement
• Pain interferes with daily activities or sleep 
• You have persistent stiffness in your hip for more than 30 minutes after waking up 
• You experience severe hip pain that starts suddenly without any apparent injury.
• You have warning signs, including swelling and warmth around the hip, changes in skin colour near the affected area, or hip pain accompanied by fever or chills. 

For more serious situations, reach out to emergency as soon as possible. This includes: 

• Sudden, severe hip pain after a fall or injury
• Inability to sit, walk, or put weight on your leg 
• Any tingling sensation or loss of feeling in your hip or leg following an injury

FAQs

1. Is walking good for hip pain?

Walking is generally beneficial for hip pain. Regular physical activity keeps the muscles around the hip strong and flexible, which can control swelling around a damaged joint. Movement also keeps the joint lubricated and the muscles active. However, for those with severe arthritis or debilitating symptoms, walking may worsen pain. It's best to consult a doctor about your exercise routine if you have hip pain.

2. Sudden hip pain without injury: what causes it?

Sudden hip pain without injury can occur due to various reasons. Osteoarthritis can sometimes cause pain to come on suddenly. Conditions like bursitis or tendinitis can also lead to sudden hip discomfort. Hip pain might be referred to as pain from other areas, such as the lower back or abdomen.

3. What is the most common cause of hip pain?

Hip pain can have many causes, and the most common reason can vary based on age and lifestyle factors. Osteoarthritis is a common cause of continuous, dull pain in the hip, especially in older adults. Other frequent causes include bursitis, tendinitis, and structural issues like hip impingement.

4. What should you not do if your hip hurts?

While it's generally good to keep your joints moving even when dealing with pain, there are some activities you should avoid. High-impact exercises and weightlifting can increase pain for people with hip arthritis. Sports involving sudden stops and movements, such as tennis and baseball, can put heavy stress on the joints. It's best to avoid exercises that cause excessive pain and consult a doctor for guidance.

5. Can hip pain be cured?

The treatment and potential for cure depend on the underlying cause of hip pain. In many cases, hip pain can be managed effectively through various treatments, including medications, physical therapy, and lifestyle modifications. Some conditions may require surgery for long-term relief. 

6. Why is hip pain worse at night?

Hip pain can often worsen at night due to several factors. Your sleep position can play a key role, especially if you sleep on your side, as this puts pressure on the hip joint. A mattress that's too soft or too hard can also cause pressure points that make your hips sore. Additionally, lying down can increase inflammation in the joint, leading to more discomfort. Changing your sleep position or using supportive pillows helps alleviate nighttime hip pain.

Dr. Romil Rathi

MBBS, MS (Orthopedics)
Ganga CARE Hospital Limited, Nagpur

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