Hip Pain 101 (What causes it and how to treat it)
What is hip pain?
Hip pain is felt when the tissue around the hip (joints, muscles, nerves, etc) is under threat of damage. However, pain is a symptom and may be disproportionate to any actual damage. You can experience it on one or both hips in the front, side, or back. It can also extend into the groin and sometimes into the leg/s (especially if a nerve is being irritated). It is very rarely an emergency but seek help immediately if you have a fever, a red and swollen joint, leg weakness, and/or lose control of your bowel/bladder function.
Why does it happen?
A variety of factors can threaten your hip. The most common causes of hip pain in adults are osteoarthritis, muscle strains, impingement/bursal syndromes, and fractures (elderly folk, mostly). Children are more likely to have congenital malformations, avulsion fractures, or bone-growth disorders.
Pain in front: Most commonly caused by arthritis or labral/ligament injury; also might be hip-flexor bursitis, groin strain (“Sportsman’s hernia”), nerve entrapment (“meralgia paraesthetica”), fracture, loose bodies in the joint (cartilage usually), or osteonecrosis (“bone degeneration”)
Pain on side: Most commonly caused by issues with the greater trochanter (“bony bump on the side”) e.g. bursitis, trochanteric pain syndrome, snapping hip syndrome, glute strain/tear
Pain at the back: Often pain referred from the lower back or sacroiliac joint, but also piriformis, glute or hamstring muscle pain, ischiofemoral impingement, or (rarely) vascular claudication
What causes my hip pain?
Genetics: family history, large leg length difference
Muscle imbalances: abductor vs adductor mismatch; abdominal weakness; hip flexor weakness
Physical activity: previous injury; sudden increase in volume/intensity; uneven running surface; sudden change of direction
General Health: high BMI/obesity; pregnancy; degenerative disease e.g. arthritis; smoking; cortisone; alcoholism
How do I find out what the problem is?
Though I respect the power of self-education and the internet, your best bet is to consult a professional. Chiropractors and physiotherapists are probably the most appropriate, but biokineticists, occupational therapists, and general practitioners are also trained to assess you. Assessment will likely involve an interview (Q&A) and examination (tests include FABER, FADIR, log roll, Ober, and SLR) but may occasionally require some other tests like imaging (e.g. x-ray) or bloodwork.
When do I need more testing?
Your doctor may order an x-ray if they suspect you have a fracture/dislocation, arthritis, or other internal joint issue.
If the x-ray shows nothing wrong but treatment is not providing relief then an ultrasound (for bursa/tendon) or MRI (for small fractures, osteonecrosis, other) may be done. Labral/ligament issues are best checked by MRA.
How do I treat my hip pain?
Your treatment depends on your pattern of symptoms as well as your particular causes. That usually includes a combination of activity modification, active treatments (stretching, mobilizing, and strengthening), manual therapy (muscle massage, joint mobilization/manipulation), and symptom relief (heat/cold, gels/patches, dry needling, medication, etc). It is also helpful to learn more about your condition and get treatment for any other physical and/or mental health issues.
More chronic cases may need an interdisciplinary approach (multiple practitioners e.g. chiro/physio, pharmacist, specialist, psychologist). This allows us to manage all aspects of your condition simultaneously. This seems to produce better and faster results than trying one, then another, then another, etc.
What happens if I don’t treat my hip pain?
The pain (and cause/s) may go away on its own. But if you don’t/can’t remove the cause, it has a moderate to high chance of happening again. And the more severe the pain, the more it affects your life. And the longer it goes on, the less likely it is to “fix itself”. In some, it can become steadily worse and eventually disabling. In a larger group of people, chronic or recurrent pain can worsen mental health and reduce activity levels which are associated with an increased risk of metabolic diseases such as diabetes or heart disease.
So, to summarise…
Hip pain is a very common area of pain.
The most common cause is mechanical joint & muscle strain
Symptoms include joint pain and stiffness in the hip/groin area, but may include joint swelling and tenderness, and sometimes pain, tingling and/or numbness in the legs and/or feet
Seek help immediately if you have a fever, a red and swollen joint, leg weakness, and/or lose control of your bowel/bladder function
Hip pain can have a negative effect on various other aspects of your health
Diagnosis is often based on an interview and examination, but only sometimes requires other tests such as x-rays, blood tests, or nerve conduction studies
Hip pain is manageable, and we recommend a comprehensive treatment plan – this may include physical therapy, medication, and lifestyle changes, and more chronic cases require more than one healthcare practitioner e.g. GP, physiotherapist, trainer, psychologist, rheumatologist, etc.
Only very specific types of hip pain may require surgical intervention
