HIP PAIN

What is Hip Pain

Hip pain is a very commonly occurring painful condition that can greatly affect a person’s quality of life. Hip pain refers to any pain or discomfort felt in or around the hip joint, where the femur (thigh bone) meets the pelvis. Depending on the cause, it can be in the groin, thigh, buttocks, or hip joint. 

Hip pain is typically classified as anterior, lateral, or posterior based on location. It is a common complaint in adults across various age groups and activity levels.

Prevalence:

In the general population, the prevalence of hip pain is 10% with the elderly and women being highly affected. 

Hip and groin injuries are common in non-elite adult soccer players, accounting for 28% to 45% of all injuries in women and 49% to 55% in men. Cam deformity, (femoroacetabular impingement), is found in 41% of male soccer players and 17% of male nonathletes.

In adults over the age of 45 years, 6.7% to 9.7% have hip osteoarthritis (OA), and about 1 in 4 will develop symptoms of hip OA in their lifetime. 

What are the risk factor for Hip pain?

hip pain Risk factor

Non-Modifiable factors

  • Age
  • Gender
  • Family/Genetic predisposition
  • Structural abnormalities
  • Previous injury & Interventions

Systemic risk factor

  • Inflammatory conditions like RA, AS
  • Metabolic disorders (diabetes, gout)
  • Systemic diseases like lupus, chronic kidney disease
  • Bone health- Osteoporosis, AVN

Potentially modifiable

Biomechanical factors

  • Reduced hip range of motion
  • Hip muscle weakness & Imbalance
  • Type, level, and volume of sport high impact sports
  • Repetitive overuse

Lifestyle factors

  • Sedentary lifestyle
  • Smoking (avascular necrosis)
  • Obesity
  • Nutritional deficiency

What are the Causes of Hip pain?

The hip pain is usually located in one of these three locations- anterior, lateral, or posterior. The specific location of the hip pain often provides valuable clues about its underlying cause.

causes of hip pain

Anterior hip pain

  • Osteoarthritis
  • Fractures- Proximal femur & Femoral neck
  • Hip dislocation
  • Avascular necrosis of femoral neck
  • Femoroacetabular impingement
  • Labral tear
  • Iliopsoas bursitis
  • Hip flexor muscle strain
  • Inflammatory arthritis
  • Hip dysplasia

Posterior hip pain

  • Piriformis syndrome
  • Deep gluteal syndrome
  • Proximal hamstring tendinopathy
  • Ischiofemoral impingement
  • Referred pain from Lumbar spine issue
  • Sacroiliac joint dysfunction

Lateral hip pain

  • Greater trochanter pain syndrome 
  • Bursitis
  • Gluteus medius tendinopathy or tear
  • Iliotibial band syndrome 
  • Meralgia paraesthetica
  • Snapping hip syndrome

Differential Diagnosis:

Osteoarthritis: Deep aching pain and stiffness, reduced range of motion, pain in weight-bearing and activity, relieved by rest.

 

Femoral neck fracture/ dislocation: Severe pain, swelling, pain on palpation of the greater trochanter, and pain worsening with weight bearing or movements. The limb may appear shortened because of femur rotation (internal or external). It can be confirmed with a radiograph.

 

Femoroacetabular impingement: Deep pain, pain with standing after prolonged sitting, getting in and out of the car. It can be confirmed by positive FABER and FADIR tests.

 

Avascular necrosis of femoral neck: Gradual onset of pain in hip and groin area, severe pain, and progressive restriction in joint mobility, audible clicking or popping sounds.

 

Labral tear: Dull or sharp pain with weight-bearing, catching, or painful clicking, Trendelenburg or antalgic gait, loss of internal rotation, positive FADIR and FABER tests.

 

Iliopsoas bursitis: Deep, referred pain; intermittent catching, snapping, or popping with the extension of the hip from a flexed position.

 

Hip flexor muscle strain: Severe pain in the hip or groin area, swelling, bruising, and tenderness.

 

Piriformis syndrome:  Buttock pain with posterior thigh radiation, tenderness over the sciatic notch.

 

Deep gluteal syndrome: Persistent buttock pain, often radiating to the posterior thigh and/or lower leg which worsens with prolonged sitting or hip flexion. Trendelenburg gait.

 

Proximal hamstring tendinopathy: Buttock pain, pain with direct pressure, Ischial tuberosity tenderness, ecchymosis.

 

Ischiofemoral impingement:  Deep, aching pain in the posterior hip, groin, or buttock, often radiating to the thigh, that worsens with hip extension or adduction, reduced hip range of motion, tenderness in the Ischiofemoral space.

 

Referred pain from Lumbar spine issue: Pain in the lower back (above L5) and hip/buttock, history of lumbar spinal problems

 

Sacroiliac joint dysfunction: Pain radiates to the lumbar back, buttock, and groin, sacroiliac joint line tenderness

 

Greater trochanteric pain syndrome: Pain with direct pressure radiation down the lateral thigh, positive Trendelenburg gait.   

 

Iliotibial band syndrome: Sharp or burning pain on the outer side of the knee, worsened by activity, tenderness is felt over the lateral femoral epicondyle.

 

Meralgia paraesthetica: Paresthesia, anterior thigh hypesthesia.

How to prevent Hip Pain?

To prevent hip pain, we should incorporate various strategies, including lifestyle modification and exercises, to improve hip joint health and minimize the strain on the tissues around the hip joint.

 

  • Gradually increase physical activity intensity to avoid overloading the hip joint.
  • Quitting alcohol and smoking.  
  • Building up muscle strength and improving load tolerance.
  • Avoiding repetitive overloading beyond tolerance, especially in overhead activities.
  • Providing adequate rest and recovery.
  • Proper rehabilitation of sports injuries to prevent recurrence. 
  • Involving in regular physical activity and staying healthy.
  • Practice proper form and techniques during weight lifting, throwing, and overhead activities.
  • Maintaining a healthy weight
  • Treating underlying causes such as diabetes, and arthritis.

What are the treatments for Hip Pain?

Hip pain can be managed through various treatment strategies. The choice of treatment depends on the underlying cause of the pain.

The key factors of effective treatment are thorough assessment and a clear understanding of the patient’s specific needs and goals, which facilitates the design of a tailored treatment program.

Non-surgical Intervention:

D. Probst et al. concluded in a meta-analysis that people with hip pain responded satisfactorily to non-operative treatment, which includes pharmacological and physiotherapy management.

1)Pharmacological treatment:

NSAIDs like ibuprofen and naproxen are used for short-term pain relief, especially in the post-operative period. Corticosteroid injections are also used to temporarily relieve inflammation. However, the effectiveness of other treatments like Visco supplementation and platelet-rich plasma remains unclear.

 

2)Physiotherapy treatment:

Physiotherapy for hip pain involves patient education, activity modification, individualized exercise therapy, and home exercise programs.

Strengthening Exercises to improve stability and mobility of the muscles in and around the hip joint is an effective management strategy for hip pain as reported in a study done by Skou, Søren T., et al. in 2018. 

It also involves lifestyle modification as well such as improving physical activity, quitting smoking, and proper diet.

Surgical Intervention:

Surgical intervention for hip pain is indicated only when conservative management fails or when there is an absolute need for surgery as in fractures, dislocations, labral tears, avascular necrosis, etc.

 

1)Hemiarthroplasty: Replacement of the femoral head, often for fractures in elderly patients.

 

2)Total Hip Replacement: For severe arthritis, fractures, or avascular necrosis. 

 

3)Arthroscopy: Minimally invasive surgery for labral tears, femoroacetabular impingement, or synovitis.

 

4)Osteotomy: Corrective surgery for structural deformities, such as hip dysplasia.

All the surgical interventions are followed by properly programmed physiotherapy rehabilitation to restore joint function. 

How to Strengthen the Hip?

To strengthen the hip joint, incorporating targeted exercises to build strength in the muscles around the hip joint and to enhance overall stability. Focus should be given to balance training and mobility training which improve joint control and mobility. Low-impact cardio, such as swimming or cycling, supports joint health without overloading it. Aim for consistent practice, gradually increasing intensity, and prioritize proper form to prevent injury.

How do we approach Hip injury and Pain

We provide patient-centered care by optimizing the treatment outcomes to align with the patient’s needs and goals. An effective treatment approach starts with a comprehensive assessment.

Comprehensive assessment:

 History taking (obtaining information about the pain or injury).

 

  • Spending enough time to listen to the patient (it is very important because half of the diagnosis is made here)
  • Ruling out serious pathology/red flag conditions.
  • Assessing the psychosocial factors.
  • Avoiding unnecessary radiological imaging unless required
  1. When serious pathology is suspected or
  2. Poor outcome with conservative management or
  3. Unexplained exacerbation of signs and symptoms
  • Physical examination including the assessment of mobility, muscle strength, and neurological examination.

Treatment approach:

  • Educating the patient about their condition, management options, potential outcomes, and anticipated treatment timeline. 
  • Addressing the psycho-social part
  • Designing an appropriate treatment addressing the root cause.  
  • Evaluating the patient’s progression with outcome measures.
  • Aiming to relieve pain and restore daily activities and work without discomfort by improving physical activity.
  • Home programs aimed at preventing the recurrence of pain/injury and enhancing physical and mental health.

Conclusion:

Hip pain is always not a serious problem with proper treatment and care most of the individual recover fully. But it is important to identify the root cause and treat accordingly. So, it is essential to consult a qualified physiotherapist before beginning any new exercise routine.

At Exercise Prescriptor Clinic, we provide professional assessment that will help to determine the root cause of your pain and ensure that the given exercises are appropriate and tailored to your specific needs, reducing the risk of further injury or complications.

Schedule a consultation today to take the first step toward a healthy and pain free life.