When we talk about hip pain, just like in real estate, it comes down to location, location, location! The term “hip” means a lot of different things to a lot of different people. When you ask patients to point to their hip, some point to the side of their leg, some will point to their groin, and others point to their low back or buttock. While all of these are thought of as part of the hip region, only groin pain is “true” hip pain as this is where your hip joint is found.
The hip joint is where the pelvis and femur (or thigh bone) come together. It is a ball and socket type joint, designed to move in multiple directions. Inside of the joint is cartilage, synovial fluid, and a ligament which helps with stability and houses blood vessels to the hip. Surrounding the outside of the joint is the hip labrum, various ligament, and muscles that work together to provide stability of the hip while the femur, and by extension the rest of the leg, moves. These muscles are also important in supporting the pelvis and lower back as well.
There are many components of the hip and all can be pain generators. Osteoarthritis is the most common cause in older individuals. In younger, more active patients, hip impingement or muscle strains tend to be more common. Finally, weakness or strain in the gluteal, or buttock muscles can cause pain where they attach, along the outside of the hip at the boney prominence called the greater trochanter. It is important to know that some hip pain isn’t actually from the hip at all. Some common sources of pain will radiate to the hip and come from pinched nerves in the spine, arthritis in the spine, or dysfunction in the sacroiliac joint.
The location and character of hip pain symptoms may vary and give us clues as to what is causing the problem. These include:
At your initial consultation, your physician will take a comprehensive history and physical exam. These are the most important pieces of information to help narrow down all of the causes of your pain
Next, an x-ray of the hip is important to understand the boney contours and alignment of the joint. You can identify misalignment of the joint, fractures, dislocations, and subluxations, and osteoarthritis, to name a few conditions that cause hip pain.
A CT scan is a more advanced kind of x-ray that gives much more detailed information about the bones and joint spaces. You can also get more information about soft tissue structures like muscles or blood vessels than with standard x-rays
An MRI uses magnetic fields to better detail all of the soft tissues structures of the shoulder like muscles, tendons, ligament, nerves, and blood vessels. You also get details on the quality of the cartilage and if there is stress in the bone potentially causing symptoms
Ultrasound is an imagined modality that uses sound waves to create pictures of all of the superficial structures in the hip. The advantage of this modality is to get real-time information about the hip; both while you are sitting still and while you are moving. All of the above image modalities cannot provide any of the same information an ultrasound can while you are moving!
Blood work can sometimes be useful to determine if there is an underlying medical issue causing your hip pain, such as autoimmune conditions or infections.
Preventing hip injury by addressing risk factors: This includes excessive weight and correcting muscle imbalances and weakness. Being obese increases stress on the hip by a factor of 10 or more even during routine activities. Obesity has been correlated with accelerated osteoarthritis. Certain sports place higher demands on your hip. By building the appropriate strength, conditioning, and flexibility throughout the body before playing your sport, risk to injuring your hip can be significantly decreased.
Physical Therapy: Once you have a hip problem, physical therapy is vital in understanding how you body moves and compensates for the hip problem, and what exercises need to be practiced to help reduce pain and improve function. Physical therapists can also use different modalities like ultrasound or E-stim to help reduce pain and swelling to facilitate activity
Pain medication: At times symptoms may be severe enough to warrant taking medications. NSAIDs like ibuprofen or naproxen are the medications of choice to treat the inflammation of hip pain.
Steroid Injections: When oral medications aren’t enough, a corticosteroid injection, as well as an aspiration of joint fluid, may be needed to reduce symptoms. Corticosteroids are strong anti-inflammatory medications used to treat inflammatory pain associated mainly with arthritis or bursitis/tendonitis.
Hyaluronic Acid: Another option to use for arthritis is hyaluronic acid, or “gel” injections. These injections mimic normal joint fluid in the hip and help lubricate the joint. It may be beneficial at times to combine a steroid injection with hyaluronic acid to get a greater effect.
Regenerative medicine: PRP, Stem Cells, and Microfragmented Adipose injections are some of the regenerative medicine techniques that can be used to treat a variety of hip complaints. These medications are derived from the patient’s own body, minimally processed to isolate concentrated growth factors to stimulate healing when injected back into the site of injury.
Surgery: Ultimately, there are some hip problems that require surgical intervention