Hip Stiffness
Hip stiffness is a common problem that can make everyday activities such as putting on shoes and socks, getting in and out of a car, sitting comfortably, or exercising increasingly difficult. It may develop gradually with age, but persistent or worsening stiffness can also be a sign of an underlying hip condition such as osteoarthritis, femoroacetabular impingement (FAI), previous injury, or changes in the shape of the hip joint. Understanding the cause of the stiffness is important, as treatment depends on whether the problem arises from the joint itself, the surrounding muscles and tendons, or occasionally from another area such as the lower back.
Introduction
Do you find it difficult to put on your shoes and socks, cross your legs, or get in and out of the car?
Hip stiffness is extremely common, and while some loss of flexibility can occur as we get older, increasing stiffness can sometimes be one of the earliest signs of a problem within the hip joint.
In this video, I’ll explain what causes hip stiffness, what symptoms to look out for, and when it might be worth having your hip assessed.
What do we mean by hip stiffness?
When we talk about hip stiffness, we generally mean a loss of the normal range of movement of the hip.
The hip is a ball-and-socket joint designed to move in several directions. It allows us to bend the hip, straighten it, move the leg out to the side, and rotate it inwards and outwards.
When some of that movement is lost, you may not initially notice a problem with the hip itself.
Instead, you notice difficulty doing particular activities.
Putting on shoes and socks is a classic example. You might find yourself bringing your foot up in a different way or struggling to reach it.
Getting into a low car, sitting in a low chair, crossing your legs, cutting your toenails or getting down onto the floor can also become more difficult.
What causes hip stiffness?
There are many possible causes.
One of the most common is osteoarthritis of the hip.
As the cartilage within the hip becomes damaged, the joint space narrows and the body can form additional bone around the edges of the joint, called osteophytes.
The joint can then progressively lose movement.
Interestingly, some patients with hip arthritis notice stiffness before they develop significant pain.
Another common cause is simply the shape of the hip.
In femoroacetabular impingement, or FAI, the shape of the ball, the socket, or sometimes both can restrict movement. This is particularly noticeable when the hip is deeply flexed or rotated.
This tends to occur in younger and more active patients and may be associated with groin pain during activities such as running, squatting or sport.
Previous injuries or surgery around the hip can also result in stiffness.
And sometimes the sensation of a stiff hip isn’t actually coming from the hip joint at all.
Tight muscles and tendons, problems around the pelvis, or stiffness in the lower back can all make the hip feel less mobile.
When should I be concerned?
Hip stiffness isn’t necessarily a sign that something is seriously wrong.
What matters is whether it is progressing or interfering with your life.
If you’ve noticed that your hip is becoming progressively stiffer, particularly if it’s associated with groin pain, a limp, reduced walking distance or night pain, then it’s worth having it assessed.
A significant difference between your two hips can also be useful information.
How is hip stiffness assessed?
The first step is understanding when you notice the stiffness and how it’s affecting you.
I’ll then examine the hip and compare its movement with the opposite side.
One of the movements that commonly becomes restricted with problems inside the hip joint is internal rotation.
I also look at hip flexion and external rotation, as well as the way you walk.
The examination helps determine whether the stiffness is actually arising from the hip joint or whether another area may be responsible.
If we suspect a structural problem within the hip, a plain X-ray is usually the first investigation.
An X-ray can show arthritis, changes in the shape of the hip associated with impingement, previous injuries and other structural abnormalities.
An MRI or CT scan may occasionally be useful, but most patients don’t need advanced imaging as their first investigation.
Can hip stiffness be improved?
That depends very much on the cause.
If the stiffness is predominantly related to the muscles and soft tissues around the hip, physiotherapy, stretching and strengthening can often improve mobility.
Maintaining regular activity is also important.
However, if the movement is physically restricted by significant arthritis, osteophytes or the underlying shape of the bones, simply stretching harder may not restore normal movement.
In that situation, treatment needs to address the underlying problem rather than just the stiffness itself.
This is why identifying the cause is important.
Does a stiff hip mean I need surgery?
No.
Many people with hip stiffness can be managed without surgery.
Treatment depends on the underlying diagnosis, the amount of pain you’re experiencing, your activity level and how much the problem is interfering with everyday life.
For arthritis, treatment might initially include activity modification, exercise, physiotherapy and appropriate pain relief.
For younger patients with symptomatic impingement, treatment will depend on the anatomy of the hip, the degree of cartilage damage and the patient’s symptoms and goals.
If there is advanced hip arthritis causing substantial pain, stiffness and loss of function despite non-operative treatment, then hip replacement may eventually become an option.
Conclusion
Hip stiffness is common, but it shouldn’t simply be dismissed as part of getting older.
If you’re gradually losing movement, struggling to put on your shoes and socks, having difficulty getting into a car or finding that stiffness is beginning to interfere with exercise or everyday activities, there may be an underlying reason.
The important thing is to determine where the stiffness is coming from and what’s causing it.
Once we understand that, we can decide whether you simply need to work on mobility and strength or whether there’s an underlying hip condition that requires more specific treatment.