Hip Pain
Hip pain is common and can affect people of all ages. It may develop gradually or follow an injury, and can arise from the hip joint itself or from the muscles, tendons and other structures around it.
Understanding the cause of your hip pain is the first step towards effective treatment. This section explains some of the most common hip conditions, how they are diagnosed, and the treatment options available.
Introduction
Hip pain is very common, but not all hip pain is caused by arthritis.
Where you feel the pain, when it occurs, and which activities bring it on can give us important clues about where the problem is coming from.
Where does hip pain occur?
Pain coming from the hip joint itself is most commonly felt in the groin.
It can also be felt at the front of the thigh and sometimes travel down towards the knee.
Pain over the outside of the hip is more commonly related to the muscles and tendons around the hip, particularly the gluteal tendons.
Pain in the buttock can sometimes come from the hip, but it can also originate from the lower back.
So, the location of your pain is important, but it doesn’t always tell us the whole story.
What are the common causes?
One of the most common causes of hip pain, particularly as we get older, is osteoarthritis.
As the cartilage within the joint wears, patients can develop pain, stiffness and progressive loss of movement. Everyday activities such as walking, getting in and out of a car, or putting on socks and shoes can become increasingly difficult.
In younger and more active patients, femoroacetabular impingement, or FAI, can cause pain when the hip is flexed or rotated. This is often felt in the groin and may be associated with damage to the labrum, the rim of cartilage around the hip socket.
Pain over the outside of the hip may be caused by greater trochanteric pain syndrome. This can involve irritation or tearing of the gluteal tendons and is often painful when lying on that side, climbing stairs or walking longer distances.
There are also less common causes of hip pain, including hip dysplasia, avascular necrosis, inflammatory conditions and injuries around the hip.
How do we diagnose the problem?
The first step is understanding your symptoms.
I’ll ask where the pain occurs, what brings it on, how long you’ve had it and how it’s affecting your everyday activities.
Examination of the hip helps determine whether the pain is coming from inside the joint or from the structures surrounding it.
For many patients, a simple X-ray provides most of the information we need.
An MRI or other investigations may occasionally be useful, particularly when we’re looking for problems involving the labrum, cartilage or tendons.
How is hip pain treated?
Treatment depends on the cause of your pain. Many hip conditions can initially be managed without surgery. Treatment may include activity modification, physiotherapy, strength and conditioning, medications and, in selected cases, injections. For some structural problems in younger patients, hip arthroscopy may be appropriate. If advanced arthritis is causing significant pain and interfering with everyday life despite non-operative treatment, hip replacement or, in selected patients, surgery may be considered. This can include both hip resurfacing and hip replacement.
When should I have my hip assessed?
If hip pain is persistent, becoming progressively worse, disturbing your sleep, or stopping you from doing the things you normally enjoy, it’s worth having it assessed.
The important thing is that hip pain is a symptom, not a diagnosis.
Working out where the pain is coming from and what’s causing it allows us to choose the most appropriate treatment.
Where is hip pain usually felt?
Pain arising from the hip joint is most commonly felt in the groin or front of the thigh. It can sometimes travel towards the knee. Pain over the outside of the hip is more commonly associated with the muscles and tendons around the hip, while pain in the buttock may sometimes originate from the lower back.
How do I know if my hip pain is arthritis?
Hip arthritis commonly causes groin pain, stiffness and reduced movement. You may notice difficulty walking longer distances, getting in and out of a car, or putting on socks and shoes. An X-ray can usually determine whether significant osteoarthritis is present.
Can hip pain occur without arthritis?
Yes. Hip pain can have many causes other than arthritis, including femoroacetabular impingement (FAI), labral tears, hip dysplasia, gluteal tendon problems, greater trochanteric pain syndrome and injuries around the hip.
Why does my hip hurt when I lie on my side?
Pain directly over the outside of the hip, particularly when lying on that side, is commonly associated with greater trochanteric pain syndrome. This often involves irritation or injury of the gluteal tendons rather than the hip joint itself. This is often not caused by osteoarthritis.
Why does my hip hurt in the groin?
Groin pain is one of the most common symptoms of a problem within the hip joint. Causes include osteoarthritis, hip impingement, labral injuries and hip dysplasia. However, not all groin pain originates from the hip, so examination is important.
Can hip pain come from my back?
Yes. Problems in the lower back can cause pain around the buttock, hip and thigh. Occasionally, patients have problems involving both their hip and their spine. A clinical examination can often help distinguish between the two.
Do I need an MRI for hip pain?
Not necessarily. For many hip problems, plain X-rays are the most useful initial investigation. An MRI may be helpful when looking for particular problems involving the labrum, cartilage, tendons or other soft tissues.
Can physiotherapy help hip pain?
Yes. Physiotherapy and an appropriate strength and conditioning program can be effective for many causes of hip pain. The type of rehabilitation should be tailored to the underlying diagnosis rather than simply treating all hip pain in the same way.
When should I see an orthopaedic surgeon about hip pain?
Consider seeking an assessment if your pain is persistent, progressively worsening, affecting your sleep, limiting walking or exercise, or interfering with everyday activities. An assessment does not necessarily mean you need surgery.
Does hip pain mean I need a hip replacement?
No. Most people presenting with hip pain do not automatically require a hip replacement. Hip replacement is generally considered when advanced arthritis is causing significant pain and loss of function and non-operative treatment is no longer providing adequate relief.