As the largest, and one of the strongest joints in the body, your hips can put up with a lot of repetitive motion and wear. Cartilage cushions the ball-and-socket to allow for smooth rotation as you walk, run and move.To keep your hip moving smoothly, a complex network of bones, cartilage, muscles, ligaments, and tendons must all work in harmony.
But as with all joints, the hip cannot withstand endless overuse,and the muscles, tendons and cartilage can wear down over time, or sustain damage from injury or disease. If you have hip pain, the first step is to understand what is causing it. There are numerous possibilities, depending on your medical and activity history. Seeing an orthopedic specialist is the best way to diagnose a hip injury, but understanding the most common causes of hip pain can be helpful.
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Tendinitis
Tendinitis is inflammation or irritation of a tendonand canaffect tendons connected tothe muscles that control hip motion. The hip flexor, as the name implies, allows your hip to flex and rotate. It’s made up of two muscles known as the iliopsoas, which attach by a tendon to the upper thigh. The iliopsoasis called upon to help you walk and run, andalso to help other weaker muscles that aren’t pulling their weight leaving it susceptible to overuse and tightness. Translation – if you have weak gluteal or core muscles, your iliopsoas are probably doing more than their share and can becomeswollen and tender when put under repeated stress. This can certainly cause lingering hip pain.
Another common cause of hip joint tendinitis, particularly in runners, involves the thick span of tissue that goes from the outer rim of the pelvis to the outside of the knee known as the iliotibial or “IT” band. Also susceptible to overuse injury, it causes pain that can radiate along the entire length of the IT band from the knee all the way up to the outer side of the thigh to the hip. In fact, many people with IT band overuse present only with complaints pain to the outside of the knee.
Bursitis
Bursitis has many causes and can be intensely painful. Bursae are the fluid-filled sacs that cushion skin or muscle against the bone, allowing muscles and tendons to move smoothly. The most common hip related bursitis is on the outside of the hip socket near the “point” of the hip. Often triggered by repetitive motion and – you guessed it – overuse, this type of bursitis can also be brought on by things as simple as lying on the affected side for too long.
Labrum Tear
Hip labral tears are actually not painful for many patients. When symptoms do occur, they generally take the form of deep groin pain, gluteal pain, clicking, catching, locking, or giving out. Limited range of motion or stiffness can also be indicators of a hip labral tear, which is why physicians test range-of-motion as part of an examination. Physical activities like golf, ballet, tennis and softball that repetitive twisting, pivoting and hip rotation cause strain on the joint that can lead to deterioration and ultimately a hip labral tear. Tears can also be caused by a collision (typically in contact sports) or structural abnormality.
Sciatica
When a herniated disc in the spine presses on the sciatic nerve, or if a tight muscle in the pelvis pinches around the nerve, it tends to cause pain that runs along the nerve from the lower back, down the hip and into one or both legs and feet. The pain is typically sharp or burning, and is often triggered by movement – even by a cough or sneeze -that can last for weeks. With sciatica, it’s uncommon for people to have hip pain alone. Lower back pain is sometimes present, and patients often report a tingling, burning or feeling of numbness running down their leg.
Treatment
For most types of hip pain, there are multiple treatment options,available that typically begin with conservative, non-invasive options like a short course of NSAIDs (e.g. Advil or naproxen), periods of rest, yoga and stretching, physical therapy to increase hip strength, stability and range of motion.
If conservative options do not resolve hip pain, injections, surgery or hip replacement may be considered. Options can include:
Injections can both help to diagnose and treat some hip injuries. Orthopedic specialists can use an injection to numb the hip joint to determine if the joint is the source of hip pain, and then make treatment recommendations accordingly. Cortisone injections are also used to reduce inflammation and provide pain relief which may be done using ultrasound or fluoroscopy.
Hip Arthroscopy is a minimally invasive procedure that allows doctors to see the hip joint without making a large incision. It can be used to diagnose and treat a wide range of hip problems.
Hip Joint Replacement or Total Hip Replacement also known as Total Hip Arthroplasty (THA)to replace all or part of the hip joint with an artificial device to restore joint movement (prosthesis) when the cause of pain is significant arthritis of the joint.
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The anterior hip approach allows your surgeon to access the hip from the front of the body and avoid cutting any major tendons or muscle groups, significantly reducing pain and recovery time. Many people back to an active lifestyle as soon as six weeks after the procedure, with far fewer post-procedure restrictions.
Revision total hip replacement is performed when the original primary total hip replacement has worn out or loosened in the bone. Revisions are also carried out if the primary hip replacement fails due to recurrent dislocation, infection, fracture or very rarely, ongoing pain and significant leg length discrepancy.
The hip is one of the largest weight-bearing and most interconnected joints in the body so it’s understandable why hip pain is so challenging. Don’t let hip pain keep you from being active. Get a professional diagnosis and treatment plan so that you can maintain or improve your mobility and remain active. Schedule an appointment today with one of our orthopedic hip specialists to find the right solution for your hip pain.
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