Hip pain

Definition

Considerations

Hip-related pain is not always felt directly over the hip. Instead, you may feel it in the middle of your thigh or in your groin. Similarly, pain you feel in the hip may actually reflect a problem in your back, rather than your hip itself. See low back pain.

Common Causes

Two possible causes of hip pain are fractures and insufficient blood flow to the hip (aseptic necrosis).

A hip fracture can change the quality of your life significantly. Fewer than 50% of those with a hip fracture return to their former level of activity. In addition, while recovering from a hip fracture, several possible complications can be life-threatening. These include pneumonia and a blood clot in the leg, which can dislodge and travel to cause a clot in the lungs. Both are due to immobility following a hip fracture and hip surgery.

Hip fractures become more common as people age because falls are more likely and bones become less dense. People with osteoporosis can get a fracture from simple, everyday activities, not just a dramatic fall or injury.

Aseptic necrosis can happen if you have been on steroids for a long time or you have sickle cell anemia. Injury and regular use of alcohol also increase your risk.

Legg-Calve-Perthes disease is a type of aseptic necrosis that happens in children.

Other possible causes of hip pain include:

• Arthritis -- often felt in the front part of your thigh or in your groin.
• Trochanteric bursitis -- inflammation of the bursa that sits on the outside of your hip joint. This hurts when you get up from a chair, walk, climb stairs, and drive.
• Tendinitis from repetitive or strenuous activity.
• Strain or sprain.
• Low-back pain such as sciatica.
• Infection.

Home Care

• Try to avoid activities that aggravate the pain.
• Take over-the-counter pain medication, like ibuprofen or acetaminophen.
• Sleep on your non-painful side with a pillow between your legs.

A hip fracture is considered a medical emergency. Therefore, if suspected, you should be seen right away.

As the pain improves, gradually begin to exercise. It is best to work with a physical therapist to learn proper exercises and how to advance your activity. Swimming may be a good option because it stretches the muscles and builds good muscle tone without straining your hip joint. However, swimming does not build bone mass. When you are ready (a physical therapist can help determine that), slowly and carefully resume walking or another activity against the resistance of gravity.

Call your health care provider if

Go to a hospital or call 911 if:

• Your hip pain is caused by a fall or other injury.
• Your hip is misshapen, badly bruised, or bleeding.
• You are unable to move your hip or bear any weight.

Call your doctor if:

• Your hip is still painful after 1 week of home treatment.
• You also have a fever or rash.
• You have sudden hip pain, plus sickle cell anemia or long-term steroid use.
• You have pain in both hips or other joints.

What to expect at your health care provider's office

Your health care provider will perform a physical examination, with careful attention to your hips, thighs, back, and gait.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Do you have pain in one or both hips?
• Do you have pain elsewhere like your lower back or thigh?
• Do you have pain in other joints?
• Did your pain begin suddenly, or slowly and mildly?
• Did the pain begin after an injury, fall, or accident?
• Does any particular activity make the pain worse?
• Have you done anything to try to relieve the pain? If so, what helps?
• Are you able to walk and bear weight?
• What other medical problems do you have? Osteoporosis or other signs of bone loss? Sickle cell anemia?
• Do you take any medications? If so, which ones? If on steroids, for how long have you been on them?

X-rays of the hip may be necessary.

Your doctor may tell you to take a higher dose of over-the-counter medication, or give you a prescription anti-inflammatory medication.

Surgical repair or hip replacement may be recommended for aseptic necrosis. Hip replacement is necessary for hip fracture and severe arthritis. With current technology, an artificial hip should last at least 10 to 15 years. Expect recovery from surgery to take at least 6 weeks.

Complications can occur from surgery. A blood clot in the leg is the most common complication, which can lead to a blood clot in the lungs.

Prevention

• Avoid activities that raise one of your hips above the other for extended periods of time, like running on an uneven surface. Running on a treadmill can keep your hips level.
• Warm up before exercising and cool down afterward. Stretch your hips, low back, and thighs.
• Avoid falls.
• Wear hip pads for contact sports like football and hockey. For those at high risk for a hip fracture, pads with a streamline design can be worn in undergarments.
• Learn how to prevent osteoporosis.

References

Wong TK, Lee RY. Effects of low back pain on the relationship between the movements of the lumbar spine and hip. Hum Mov Sci. 2004; 23(1): 21-34.

Dohnke B, Knauper B, Muller-Fahrnow W. Perceived self-efficacy gained from, and health effects of, a rehabilitation program after hip joint replacement. Arthritis Rheum. 2005; 53(4): 585-592.

Tak E, Staats P, Van Hespen A, Hopman-Rock M. The effects of an exercise program for older adults with osteoarthritis of the hip. J Rheumatol. 2005; 32(6): 1106-1113.

Illustrations

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