Hip Pain

Hello and welcome back to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. In this blog we are going to take an overall look at hip pain, the general anatomy of the hip and some causes of hip pain. This will be a bit of a broad overview of issues at the hip and in subsequent blogs we will look at each specific cause of hip pain in more detail.

Usually, when we are examining a new condition in our physiotherapy blog I start by defining exactly what the condition is. For hip pain, because this is such a broad concept I think it is easier firstly to have a think about the structures involved and then consider what is going on at the hip that might be causing pain.

What is the Hip?

So, as with all aspects of physiotherapy it is important to know your anatomy and with the hip this is doubly important because it is where the femur (thigh bone) meets the pelvis. The hip itself is a ball and socket joint between the femur (thigh bone) and the acetabulum of the pelvis (socket part of the joint). It has a fibrous capsule that goes around the joint itself and keeps fluid in the joint. It is a very mobile joint and there is cartilage between the socket and the ball which acts as a shock absorber and helps the joint move better. There are an array of muscles and ligaments that connect with the hip and enable it to rotate and move in all directions. The primary muscles at the hip joint are the flexors of rectus femoris and ilapsoas and the gluteal (bum) muscles of gluteus maximus, gluteus medius and gluteus minimus. In combination with the adductor group these muscles allow the hip to move in all directions and to propel you forward at great speed.

What Do We Mean by Hip Pain?

I appreciate that this sounds like a silly question but as a physiotherapist when someone says my hip hurts I always ask them to point to where the pain is because people mean many different things when they say: “my hip hurts”! So, for the purposes of this article, hip pain will mean pain high up on the front of the thigh, on the outside of the hip itself and buttock pain (but as we shall see pain in the buttocks is a tricky one as often it isn’t the hip that is the problem).

Who Can Get Hip Pain?

Well, anyone with a hip can obviously get pain around the hip but there are some groups of people who are more prone to having painful hips:

1. Runners: due to the intense nature of running and the volume of time on their feet, runners are especially prone to developing hip pain. Particularly at risk are those who have just started running or those who are building up their training towards a goal such as a marathon.
2. Hill & Long-Distance Walkers: anyone who spends a long time in the mountains walking or anyone who enjoys doing long distance walks can be prone to developing some hip pain.
3. Older People: a simple of fact of life is that as we age we tend to get more aches and pains and as such anyone who is older tends to be at more risk of developing some hip pain.

What Causes Hip Pain?

The causes of hip pain are quite broad and I think the best way to look at this is to examine what might cause pain in each area of the hip. We will cover each of the conditions and causes of hip pain in more detail in later blogs.

Lateral (Outside of the Hip Pain):

This is when a patient has pain on the outside part of their hip (and maybe a bit in the outside part of their buttocks). Sometimes the pain will also radiate down the outside of their leg to the knee. Probably the most common cause of pain in this area is Gluteus Medius Tendinopathy, which used to be called Trochanteric Bursitis. Now, this sounds complicated but is in fact reasonably simple: gluteus medius is a large muscle of the bum that attaches to the outside part of the hip and sometimes gets overloaded (either through overuse or through lack of strength in the hip) and this then causes inflammation and pain. It used to be called trochanteric bursitis (in fact most people still use this title) as the bursa that is over the greater trochanter of the hip (the bony prominence you can feel on the outside of your hip) would be inflamed. However, it is now thought that the primary driver of the pain and inflammation is the gluteus medius tendon and overload.

Front of the Hip Pain

This is much less common than pain on the outside of the hip and in this case there are usually two potential causes:

Hip Flexor Strain:

The hip flexors are the muscles that lift your thigh and leg up and sometimes these can get strained, this usually happens close to the hip and groin area where they are mostly tendon. Pain is usually quite localised and actions such as lifting the leg up or walking can be very painful.

Osteoarthritis

Although more commonly presenting with groin pain, osteoarthritis of the hip can give pain at the front of the hip and near the groin which radiates down the thigh. Osteoarthritis is when the cartilage in the ball and socket joint wears out and becomes inflamed.

Back of the Hip Pain

So, pain at the back of the hip is very often not caused by the hip itself and is one of the reasons that as a physio I always ask my patients to point to where their pain is. In general there are a few main causes of pain at the back of the hip/in the bum.

Nerve Irritation in the Low Back

Sometimes one of the nerves or the discs in the low back becomes irritated and this can cause pain in the buttocks and the general area at the back of the hip. Sometimes sciatica (irritation of the sciatic nerve) can cause pain in the buttocks and back of the hip.

Piriformis Syndrome

This is mostly known as deep gluteal pain syndrome nowadays, but piriformis syndrome is its more widely know name. The sciatic nerve passes through the piriformis muscle deep in the gluteal (bum) area and sometimes it can become irritated or compressed in this region which can cause pain in the buttocks and back of the hip.

Okay, I think we have now covered the main causes of hip pain and I think we now need to look at how each cause is diagnosed.

How is the Cause of Hip Pain Diagnosed?

Usually and in the majority of cases the underlying cause of hip pain will be diagnosed through a combination of the symptoms of the patient and a physical assessment by a physiotherapist. In general, there isn’t a need for imaging such as an ultrasound scan or MRI, although if needed the physio will be able to advise on this. Often, patients will firstly attend their GP with hip pain and then be referred on to a physiotherapist. As with most injuries it is best to get an early diagnosis of the cause of your hip pain as this allows the best management and treatment plan to be devised. Delaying a diagnosis and letting things worsen will only lengthen the rehab process needed for your hip pain.

Treating Hip Pain

As hip pain has a wide range of causes it isn’t easy to be exact about what the best treatment is, as this will depend upon the underlying cause of the pain at your hip. However, below are some general treatment principles and ideas when thinking about the best treatment for a painful hip:

1. Rest: as with most conditions that have an element of overload there does unfortunately need to be a period of rest to let symptoms and pain settle down. This mainly means stopping doing the action that has been irritating your hip. This will have been identified in your assessment with the physio. You don’t need to rest for ever rather just enough to let things settle down a bit.
2. Exercises: for hip pain usually you will need to complete some strengthening exercises that will allow your hip to build up strength in specific areas. It is important to have an assessment with a physio to know which exercises to complete.
3. Activity Modification: one of the best approaches to dealing with hip pain is to try to modify or change some of the activities that are irritating your hip. This is especially important if part of your work is irritating your hip e.g. if you are a builder. Examples of this could be reducing the amount of stairs that you are doing by staying on the ground floor. This can sometimes take a bit of trial and error and will involve you discussing this with your physiotherapist.
4. Other Treatments: a corticosteroid injection can sometimes be helpful if despite rest and specific exercises you cannot get your pain under control.

How Long Will It Take for My Hip to Heal?

As there are quite an array of underlying causes of hip pain, it is impossible to give an answer to this question, as it will depend upon the cause of your hip pain and how much you can avoid irritating it.

How Can ThreeSpires Physiotherapy Help with My Hip Pain?

Physiotherapy can be extremely useful if you have started to develop hip pain and one of our physiotherapists will be able to help with:

1. Assessment & Diagnosis of Hip Pain: this as mentioned earlier is a vital part of healing your hip and the sooner you have an assessment the sooner you will know what you are dealing with. Our physiotherapists will be able to comprehensively assess your hip and make a diagnosis of the underlying cause of your hip pain.
2. Management Plan: once a diagnosis of the underlying cause of your hip pain has been made it is vital that you get a clear and comprehensive plan to begin healing and recovering.
3. Exercises for Hip Pain: your physiotherapist will be able to determine which are the most appropriate exercises for your hip pain and will be able to prescribe the optimum number and frequency to promote recovery.
4. Treatment for Hip Pain: In conjunction with load management and exercises your physio will be able to use soft tissue and hands on techniques to treat any areas that have become overloaded and tight.

Okay, I hope that you have found this article about hip pain helpful, over the next few months we will be doing a series of further articles about each of the specific causes of hip pain. Should you or anyone you know have developed hip pain please get in touch and one of our physios would be happy to help.