Hip Pain

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Hip Pain 2017-08-03T15:51:59+00:00

What Is Hip Pain?

If you suffer from hip pain, you know how it can impact every part of your day.

Thankfully, there are ways to find relief.

This post covers traditional, complementary, and cutting-edge techniques for relieving your pain. The treatment that works best for you will depend. But, for the large majority of patients, there are treatments that can get you back to your life.

Hip anatomy

The hip joint is a crucial part of your human anatomy. This structure allows for normal everyday movements, like standing upright, sitting, and walking.

The hip joint also plays an important role in:

  • Supporting and balancing your torso
  • Bending
  • Jumping
  • Twisting
  • Compound movements that involve one or more of these

The hip is a ball and socket type joint, which is one of the most common joints in the human body. The “socket” in question is the acetabulum, a shallow bowl-like feature of the pelvis. This lines up with the top of the femur, a round (“ball”-like) mass of bone. These structures are coated with protective material called the articular or hyaline cartilage.

Hip Pain Anatomy | PainDoctor.com

Cartilage is a resilient, flexible material that is similar to connective tissue. It is rich in a protein called collagen. In addition, bag-like structures containing a material called synovial fluid surround the joint. These prevent friction resulting from direct contact between the bone surfaces as above, and protect against shocks and blunt force acting on the joint. This contributes to the prevention of chronic pain and reductions in the normal function and movement of the joint.

The pelvis is connected to the thighbone by ligaments. Under normal, disease-free circumstances, the hip joint has a varied range of flexibility and motion. This range is defined by general pelvic structure. Hip motion is also limited by the labrum that surrounds the joint.

Why Do I Have Pain In My Hip?

Your pain may be associated with damage to or disorders to any of the tissues in and around the hip joint. Many people assume that pain in your hips only affects older people. But, in reality, it affect individuals of many age groups.

Many forms of pain are localized to the joint itself. However, some conditions may also result in pain that radiates further down the leg. Your pain may intensify in response to normal activities such as walking. And, it could progress to the point that you can no longer engage in those activities without pain.

Hip pain may be associated with one or more of the tissues that comprise the joint, including:

  • Hip bones
  • Cartilage
  • Muscles
  • Ligaments
  • Tendons

The following video talks about different causes of pain, with a brief overview of treatments.

Hip Pain Video

Find all of our videos on YouTube.

Hip Pain Causes

Depending on your age, there are various reasons for your pain. Causes and conditions associated with hip pain include:

  • Joint degeneration
  • Osteoporosis-related fractures
  • Osteoarthritis
  • Genetic conditions, such as cerebral palsy
  • Accidents, fractures, or sports injuries
  • Hip bursitis
  • Irregular hip bones or other structures in the pelvis
  • Gynecological issues
  • Sacroiliac joint damage
  • Sciatica
  • IT band syndrome
  • Femoroacetabular impingement (FAI)
  • Slipped capital femoral epiphysis (SCFE) in children

Here’s just a few things that could be happening.

Hip pain in seniors

Many cases of pain are associated with damage that is progressive, or increases over time. Some research indicates that one person in every four will actually experience this by the time they reach the age of 85. This is known as joint degeneration.

Degeneration is affected by a number of variables or risk factors, including:

  • Structural abnormalities in your bones that become advanced over time
  • The loss of tissues, or molecular structures, that makes up bones (this may also be progressive)
  • Reductions in or impairments of normal joint movement
  • Increased weaknesses in the muscles and other tissues that support and surround the joint, due to less exercise or more sedentary activity

These variables may contribute to persistent pain, increased disability, or reduced activity over time. Older adults are also at an increased risk of falls or hip injuries. These can seriously affect your quality of life and contribute to pain.

Those with osteoporosis (progressive bone density loss) are at a particular risk for falls. This condition is associated with advancing age, particularly in women.

Likewise, osteoarthritis is another condition associated with advancing age that may be a source of arthritis hip pain. This disorder affects approximately one in ten people in the developed world. It is an autoimmune disease. Components of the immune system target tissues within joints as if they were foreign or infective particles. This leads to inflammation and pain in the joint. This condition is not related to bone loss, however, it is a prominent cause of hip replacements.

You can learn more about osteoarthritis in the following video. For more on arthritis hip pain, you can also visit the Arthritis Foundation’s page on it.

 

Pediatric hip pain

As mentioned earlier, this type of pain does not only affect seniors. Pain in younger people may be associated with risk factors, including:

  • Occupational hazards
  • Accidents and other trauma
  • Additional forces or wear and tear on the joint
  • Anomalies in the structure of the joint
  • Certain conditions and disorders
  • Increased body mass

Persistent or acute pain can also be related to disorders or diseases experienced as a child. Some hip damage may occur in children in the course of normal activity. In severe cases, this may require later corrective surgery or therapy.

Pediatric pain may also be associated with other conditions. These may be the result of genetic mutations or hereditary conditions. For example, cerebral palsy and Down’s syndrome are associated with hip joint instability.

Infants may also be subject to structural hip anomalies. This is not necessarily a source of pain if addressed with adequate and timely corrective procedures. In this population, the head of the thighbone is still elongating at a point called the growth plate. This may be subject to damage, in a disorder known as slipped capital femoral epiphysis (SCFE). This is often linked to chronic pain in young people. SCFE is also associated with serious complications, such as avascular necrosis (or tissue death related to disruptions in blood flow) of the femur and juvenile arthritis. Therefore patients with SCFE may require total hip replacement to treat or prevent these conditions. SCFE is associated with some risk factors, including extensive physical activity and trauma.

Hip pain in teenagers and young adults

Teenagers and young adults may suffer from pain in the hip caused by:

This age group may also be at risk of hip dislocation or fractures.

The hip joint, along with the pelvis and lower back, may be adversely affected by the regular use of shoes that impose additional stress and forces on these bones. A prominent example of this is footwear with high heels.

Hip pain from running

One of the leading causes of hip issues is hip bursitis, especially among runners. Hip bursitis is caused when bursa or tiny fluid-filled sacs that occurs when your joints become inflamed or irritated. When this occurs, they are no longer able to reduce friction in the joints and will cause pain. You can learn more about hip bursitis here, at Arthritis-Health.com, or in the video below.

 

Another common condition is femoroacetabular impingement (or FAI). This condition causes excessive friction between the bony surfaces of the joint. This results in pain and increased disability. FAI is often a consequence of the greatly increased movement of the hip while engaging in athletic activities. This may be sustained while running and other similar activities during training or playing sports.

There are some major sub-types of FAI. “Cam” impingements occur when excessive bone growth takes place around the edge of the femoral head. This results in increased difficulty and pain when trying to move it within the acetabulum.  “Pincer”-type impingements occur due to increased bone growth within, or structural anomalies in, the “socket” of the joint.

Again, this may result in increased difficulty in moving your joint. But, these impingements can also result in labral tears. The labrum is a band of cartilage located around the two main bones of the joint.

Runner’s World and Active.com both share more information about pain from running.

Additional risk factors

There are many other risk factors for this type of pain, including:

The sacroiliac joint connects part of the spine with the pelvis. It contains nerves that are responsible for parts of the body below this point. Therefore, damage to the sacroiliac joint may be felt as pain in the hip joint. Inadvertent injury to nervous tissue sustained in the course of surgery on the lower back can have a similar effect. Irregular hip bones can also lead to pain conditions.

Some central nervous system anomalies also result in pain. An example of this is heterotopic ossification, or the growth of additional bone tissue in the head of the femur. This may result in pain in a similar fashion to that associated with FAI. Heterotropic ossification can be associated with inflammation.

Hip pain after surgery 

Finally, many people experience pain after surgery and during recovery. This can become chronic pain that persists beyond the time frame normally associated with recovery. This can take place during procedures that were meant to help your pain in the first place.

Typically, hip replacement surgeries involve the total or partial replacement of your joint surfaces with prostheses. This procedure is known as hip arthroplasty. These prostheses are constructed of medical-grade acrylic or high-quality metal, such as titanium. Pain following your procedure can be related to:

  • The materials used and their effect on your body
  • Migration of the prosthesis
  • Failure of the prosthesis to integrate with the rest of your bone
  • Septic failure of the new prosthesis, in which the implant becomes infected

Hip Pain Diagnosis

Diagnosing your pain can be difficult and complicated in some cases. Your pain specialist or physician will start the process by asking you:

  • Where you’re experiencing pain
  • The duration of your pain
  • Its severity
  • Whether your pain is constant or fluctuating
  • About your risk factors
  • If you’re experiencing hip pain at night or primarily during the day

Your subjective assessment of your pain ratings also helps your doctor diagnosis the cause of your pain. Your doctor will use the following tools to help with their assessment:

  • Hip Outcome Score-Activities of Daily Living (HOS-ADL)
  • Non-Arthritic Hip Score (NAHS)
  • Harris Hip Score

Further, your doctor can visualize the hip joint with imaging technology, such as ultrasound, X-ray in limited cases, or magnetic resonance imaging (MRI). These techniques enhance the detection of fractures or other conditions. Computerized tomography (CT) is another imaging method used. Next, your pain doctor or physician will physically examine your hip. A skilled doctor can detect conditions, such as labral tears, that go undiagnosed by imaging techniques.

What Can I Do To Prevent Hip Pain?

There are steps you can take to reduce your chances of pain. This often involves reducing your exposure to the environmental or occupational risk factors that cause pain. For example, people involved in high-volume training may avoid over-exerting the joint with poor techniques or poor gait styles. You can talk to your doctor or a knowledgeable running store about performing a gait analysis.

Hip damage can also be associated with cartilage, ligament, or muscle strain or tearing. This can be avoided through:

  • Adequate warming-up, stretches, and cooling-down
  • Reducing the amount of potentially harmful behaviors done during training, such as running down steep inclines
  • Adhering to training programs that include measures to avoid injury or wear-and-tear on the joint

Your doctor, physical therapist, or highly-trained personal trainer will have more advice about the best options for you. Even though improperly-performed running and activity can exacerbate pain, it’s important to keep up with exercise for prevention. Exercise plays a crucial role in both prevention and maintenance of pain if you’re already suffering. A moderate regimen of flexibility and resistance training is recommended for those who wish to prevent future pain.

What's Causing My Hip Pain? | PainDoctor.com

What Can I Do For Hip Pain?

If you suffer from pain, there are treatments that work. Whether your pain is caused by something like hip bursitis, an irregularity in your hip bones, or arthritis hip pain, a pain specialist can determine what type of treatment will work best for you.

Hip pain treatments may involve:

  • Physical therapy and rehabilitation
  • TENS units therapy
  • Medications
  • Nerve blocks
  • Radiofrequency ablation
  • Spinal cord stimulation
  • Surgery

Physical therapy and rehabilitation

If you suffer from hip bursitis or pain caused by an injury, physical therapy is a great option for fixing your gait and helping with your pain.

Physical therapy involves specific:

  • Exercises
  • Stretches
  • Training
  • Conditioning

Constrained movement therapy and kinesitherapy are newer forms of this treatment. Physical therapy may work for athletes or sportspeople recovering from corrective surgeries. This can contribute to a return to full performance after recovery.

Further, if you do undergo surgery, recovery from a hip replacement may be associated with reductions in normal activity and function. This in turn can actually increase your risk of further disability if you limit your moving and activity due to pain. A great physical therapist can help prevent this from occurring, with specific stretches and hip pain exercises.

TENS units

Your spinal nerves can actually be modulated through stimulation delivered outside your body. Transcutaneous electrical nervous stimulation (TENS) involves the placement of pads containing electrodes on your skin above nerves. These electrodes then emit electrical impulses to block pain signals.

The main advantages of TENS are that it is non-invasive and associated with mild side effects. These include redness, burning, or stinging in the skin under the pads, and temporary muscular pain.

This treatment can also be offered to older patients who suffer from osteoarthritis or osteoporosis. A clinical trial assigned either TENS or a placebo treatment to 68 patients recovering from surgery. Fentanyl intake in the group receiving TENS was significantly decreased compared to the placebo group. This indicates the potential of this treatment in cases of pain from hip surgery.

What's Causing My Hip Pain? | PainDoctor.com

Drug therapy

Conventional medications to reduce pain, or analgesics, are commonly used after a diagnosis.

Non-steroidal anti-inflammatory drugs (NSAIDs, e.g. indomethacin or aspirin) can help with acute cases of pain. These drugs can inhibit inflammation in joints and other tissues. They are commonly taken after a sports-related activity or injury. However, NSAIDs are associated with side effects, including the increased risk of gastric ulcers, acid reflux, and kidney damage. Because of this, these medications can be harmful when taken for long periods of time.

Your pain doctor will try many different therapies to treat your pain. If all other therapies have failed to work, they may consider opioid painkillers. These are a class of powerful painkillers that include well-known drugs such as morphine and oxycodone. However, these are best used only when other options have failed. These medications are highly addictive and dependence-forming. Other adverse effects associated with opioids include respiratory distress and organ damage. A physician or pain specialist will comprehensively assess a patient’s suitability and risks of adverse events before prescribing these medications.

Nerve blocks

A nerve block can inhibit the pain signals of spinal nerves that serve the hip region. These can actually both treat and diagnose pain. These involve an injection of local anesthetics (e.g. bupivacaine or lidocaine) directly into the outer regions of the spinal cord. Steroids, which can effectively reduce inflammation, may also be included in the injection.

Before a nerve block is administered, the specialist or physician will numb your skin to reduce discomfort. They’ll then guide the needle in with imaging techniques to ensure accurate and safe injection of the drugs. These injections target the hip joint directly, and may effectively reduce pain and inflammation emanating from within the joint.

Nerve or joint injections are relatively non-invasive. This makes them a good alternative to surgery. Pain-blocking injections can also prevent or postpone the need for invasive procedures.

Nerve blocks are associated with some risks and side effects, including:

  • Acute headache
  • Temporary numbness
  • Increased irritability
  • Changes in bodyweight
  • Immune system suppression
  • Changes in skin pigmentation
  • Swelling after the procedure

More severe side effects are related to inaccurate needle placement or injection. This may result in damage to structures or regions that were not the target of the injection or tendon rupture. It can also result in reduced motor control, numbness, and discomfort.

Steroids are also linked to increased risks of osteoporosis and arthritis. This is why only a few injections, at most, are recommended annually.

Radiofrequency ablation

Radiofrequency ablation is another highly-effective procedure in which nerves are prevented from sending painful signals. This is achieved using thermoelectric (or radiofrequency) energy to disrupt the ability of the nerve to do this.

Following the administration of a local anesthetic to the skin over the targeted nerve, a long, thin probe is extended toward this tissue. The probe will emit just enough energy to disrupt the parts of the nerve responsible for pain signals. This should leave other nervous functions, such as sensation, intact. These specific regions of nerve tissue can be identified and targeted using imaging technology.

The risks associated with radiofrequency ablation include bleeding and discomfort in the area of the skin punctured to reach a nerve. This skin may also become infected unless covered and cleaned adequately. Other adverse events may be related to inaccurate probe placement. These include numbness, motor impairments, and discomfort.

Radiofrequency ablation is safe and effective in the majority of cases, however, and may provide pain relief that lasts a number of months. You can watch a radiofrequency ablation procedure performed live in the video below.

 

Spinal cord stimulation

If the options mentioned above prove ineffective, a patient may consider other forms of pain relief that are more permanent. One of these options is spinal cord stimulation (SCS). This involves the placement of a device within a targeted area of the spine.

The implant includes long, thin electrodes. These emit a small electrical signal that is similar to the normal signals sent by nerves responsible for a region, such as the hip joint. These signals override (or modulate) the pain signals of these same nerves. The device is often connected to leads that run outside the body to a control device. The patient can activate this device to generate pain-correcting signals at need. SCS may effectively treat many types of chronic pain.

This procedure is associated with some risks. This includes the accumulation of scar tissue around the device, which may result in chronic pain. The electrodes may also migrate away from their optimal location. This can result in the absence of pain relief, new-onset pain, or neurological complications. These adverse events are rare, however.

Minimal incision arthoplasty

A minimal incision replacement procedure is known as arthroplasty. These are distinct from standard arthroplasties in terms of the position and numbers of incisions made to place an implant.

Minimal incision arthroplasty is associated with reduced blood loss and recovery times compared to standard procedures. However, pain severity or duration is similar to that of standard arthroplasty.

Another alternative to standard arthroplasty is reconstruction of the femoral head, in which missing bone tissue is replaced with acrylic cement. This approach has not resulted in appreciable differences in pain intensity.

Synovial fluid replacement

Many cases of pain are related to synovial fluid loss, and thus increased contact between the bones of the joint. This is associated with conditions such as FAI and arthritis. Synovial fluid replacement (or viscosupplementation) may be performed using sterile biomaterials such as hyaluronic acid. This is currently under evaluation as a treatment option in cases of osteoarthritis.

Arthroscopy

Another alternative treatment similar to arthoplasty is arthroscopy, in which damage to a joint is surgically visualized and sometimes corrected. This is associated with significant improvements in functional status and pain scores for patients, according to some research.

Arthroscopy is completed using an endoscope to reduce invasion and damage to tissues. This procedure can be completed using nerve blocks, (as described above) a similar injection into the femoral nerve, or a general anesthetic. The surgeon may have to dissociate the joint slightly using traction. This allows access to and visualization of the interior of the hip. This is enhanced using imaging techniques such as fluoroscopy.

Disorders such as labral tears or FAI can benefit from arthroscopy. In cases where there are impingements, your doctor will shave off the excess bone on the femoral head or acetabulum with a small drill-like tool. The labrum may be replaced using grafts or repaired. Arthroscopy may also be used in the correction of hip abnormalities in infant.

This procedure may result in positive effects on the duration and intensity of pain in recovery. Research has demonstrated that patients treated for injuries and damage incurred while training, using arthroscopy, experience a significant decrease in the time taken to regain their form, compared to conventional procedures.

Arthroscopy is associated with some adverse events and side effects, however. These are mainly related to general anesthetics, if used. After-effects may include respiratory depression, nausea, and difficulty urinating. If nerve blocks are used as alternative anesthesia, this may result in the adverse effects described earlier. More severe complications include nerve damage or infection.

However, arthroscopy has been shown to be effective in many cases, and may have potential in the treatment of hip pain associated with other sources, such as implant failure following arthroplasty.

What's Causing My Hip Pain? | PainDoctor.com

Nerve growth factor

Another potential target in pain management research is nerve growth factor (NGF). This protein controls the differentiation of stem cells into nerve cells. It also contributes to the regulation of pain signals from cell to cell. Clinical trials of new compounds that antagonize these actions have demonstrated potential in cases of pain. These studies have compared these NGF blockers to NSAIDs, and found the new drugs were superior in effect.

However, they have also found that anti-NGF formulations may be associated with an increase in symptom severity in patients with osteoarthritis when taken with NSAIDs. This interaction has resulted in the need for hip replacement in some cases. Therefore, NGF blockers may be used as an alternative for older drugs, pending full clinical development and approval. These drugs are associated with their own panel of side effects, including sensory abnormalities, however.

Glucosamine injections

Glucosamine may be another alternative treatment for arthritis damage. This molecule is a variation on a natural amino acid and is also a component of cartilage. Glucosamine is currently available as a supplement. It has been linked to positive effects on joint movement and function in some markets.

However, glucosamine was not associated with significant differences in the progression or severity of arthritis-related pain when investigated in clinical studies. Other research found this molecule was not associated with positive effects on joint function or movement. Therefore, glucosamine may not gain approval as an alternative therapy in the management of pain.

Conclusion

Hip pain can be be a significant source of disability and debility for many patients. It’s often associated with other conditions, like osteoarthritis, occupational hazards, various forms of tissue damage, and genetic disorders. This type of pain is popularly linked to more senior age groups, but can also affect younger people.

There are many treatment options for pain in the hips. These include:

  • Physical therapy
  • Conventional painkillers
  • Nerve blocks
  • Radiofrequency ablation
  • Spinal cord stimulation
  • Transcutaneous electrical stimulation
  • Hip replacement, or arthroscopy

Emerging treatments with promising application to cases of pain include arthroscopy and NGF-blocking drugs. Education and training in the prevention of hip damage may also contribute to reductions in the risk of this type of pain in the future.

Always know that if you’re suffering from hip pain, there is help. Talking to a pain specialist who has experience working with hip pain patients can help you get the diagnosis and treatments you need to relieve your pain and get back to your life. You can find a pain doctor in your area by clicking the link below. You can also sign up for our newsletter to get up-to-date information on hip pain research and treatments.

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