Understanding Hip Pain: Common Causes and How to Identify Them

Understanding hip pain  

Hip pain is one of the common complaints of all ages, where an individual will feel discomfort around the hip joint. A joint is where the two bones meet in your body. The hip joint, the largest joint in the body, is the structure that connects your thigh bone to your pelvis. This joint is constantly used for movement, supporting your weight and maintaining balance. Hip pain while sitting for prolonged periods of time indicates impingement that occurs when there is abnormal contact between the hip’s joint bones, leading to pain and limited movement. Understanding common causes of hip pain and learning to identify them can help in early diagnosis and treatment.  

Common causes of hip pain

Hip pain can arise from various conditions and injuries. Here are some of the common causes:

• Osteoarthritis: This is a common cause, especially in older adults. It occurs when the cartilage that cushions the hip bones wears down, leading to pain and stiffness.  
• Hip fractures: These are more likely as bone becomes weaker with age. Fractures can result from false or repetitive stress.  
• Bursitis: Inflammation of bursae, which are small fluid-filled sacs that cushion the bone, tendons and muscle near the joints.
• Tendinitis: It is characterised by the inflammation of tendons due to overuse.
• Hip labral tear: A tear or break in the ring of cartilage that follows the outer rim socket of the hip joint.
• Sciatica: It refers to the pain that triggers along the path of the sciatic nerve, which runs from the lower back down each leg.  
• Muscle or tendon strain: Overuse or injury can cause strains in the muscles or tendons around the hip
• Avascular necrosis: This happens due to deprivation of blood supply, which leads to necrosis or death of bone tissue.
• Inguinal hernia: Tissue bulges through a weak spot in the abdominal muscles, sometimes causing hip pain.

Symptoms  

It is important to identify symptoms of hip pain or hip joint pain, as early diagnosis can benefit from better treatment outcomes. Some symptoms include:

• Gradual onset of pain and stiffness
• Pain that worsens with activity
• Swelling and tenderness around the joint
• Persistent lower back and hip pain
• Sharp pain on the outer hip
• Deep hip or groin pain  
• Sharp or burning pain that arises from the lower back to the hip and leg
• Pain that interferes with daily activities
• Swelling, redness or feel of heat at the hip region

Diagnosis

When you visit your doctor for hip pain, they will ask detailed questions such as what movements make pain worse, how it started, how it affects your daily activities and whether you experience pain at night. Pain when bending your hip, going up or down stairs or putting on socks indicates a hip problem.

Your doctor will perform a physical examination, wherein they examine your hip to determine its range of motion and identify any pain points. This initial examination usually provides enough information to plan your treatment. However, additional tests may be needed to diagnose specific conditions.

Diagnostic Tests

• X-rays: X-rays are the first-line imaging examination to diagnose hip problems as they show the condition of the bones and can reveal issues in the pelvis that might explain your pain.
• Computed tomography (CT) scans: A CT scan provides detailed images of the hip joint, showing sections or ‘slices’ of the hip. This helps identify unusual shapes or shallow hip sockets. CT scans are particularly helpful for assessing the bone structure and detecting abnormalities.
• Magnetic resonance imaging (MRI) scans: MRI scans use radio waves to generate detailed images of the soft tissues, such as tendons, muscles and cartilage inside your hip. MRI scans are especially useful for diagnosing conditions like avascular necrosis, which reduces blood flow to the bone ends, causing them to collapse.
• Blood tests: If your doctor predicts an infection or rheumatoid arthritis is the cause of your pain, blood tests can help confirm the diagnosis. Blood tests can detect markers of inflammation or infection and specific antibodies related to rheumatoid arthritis.

Treatment

The healthcare provider will provide treatment recommendations based on underlying cause and severity. Here are some of them:

• RICE method: Hip pain is often treatable at home using the RICE method.  
• Rest: Avoid the activity that caused the pain.
• Ice: Apply an ice pack or cold compress every hour for 10 to 15 minutes on the first day. Then, apply ice every three to four hours. Wrapping or covering an ice pack in a towel or cloth can prevent direct contact with your skin.
• Compression: Wrap a compression bandage on your hip to decrease blood flow and swelling. Compression shorts or pants may also be beneficial.
• Elevation: If you are able, drape your hips and lower body on top of pillows, blankets or cushions above heart level.
• Hip pain medications: Your healthcare provider may recommend medications to treat hip pain and other symptoms.
• Physical therapy: If the pain stems from a structural condition like arthritis or a physical abnormality, your provider may refer you to physical therapy. A physiotherapist can advise and show you stretches and techniques that can strengthen and improve the stabilisation around your hip and reduce pain.
• Surgery to treat the hip: Most individuals with hip pain do not require surgery. However, if the pain is significant and other treatments have not improved the pain, you may require surgery to fix or repair the hip fracture or structural problem. Common surgeries include:
• Hip arthroscopy: This is a common procedure that involves making small incisions in the hip and placing an arthroscope (an instrument with a camera and light) to examine and repair any damage inside the hip joint.
• Hip replacement (Hip arthroplasty): When pain or symptoms severely impact your ability to stand, walk or move, your surgeon may suggest replacing the entire hip with an artificial implant (prosthesis).

Prevention

To prevent hip pain, the following measures can be helpful:

• Always warm up prior to exercising and cool down afterwards. Make sure to stretch your quadriceps and hamstring.
• Avoid running down hills.
• Avoid running on hard surfaces like cement and opt for running on smooth surfaces like track.
• Choose swimming instead of running as it puts less strain on your hips.
• Reduce the exercise duration when you feel pain.

Conclusion

Hip pain is common and comes with different causes. The treatment of hip pain depends on its cause. Seek a healthcare provider immediately if you notice persistent hip pain that affects your daily activities.