HIP PAIN

The hip joint is the largest ball-and-socket joint in the body. It connects the pelvis to the thigh bone (femur). The socket is called the acetabulum and the ball is the head of the femur bone. The hip joint is robust, designed and built to withstand a great amount of wear and tear, but, despite its durability, the joint is not indestructible, and hip joint pain is common.

Most people think of osteoarthritis as the cause of hip pain, but hip pain can be caused by a wide range of problems.

Hip pain affects men and women, young or old. It can start suddenly or slowly and can be mild or debilitating. It can be felt it in a small area around the hip or over a wider surrounding area. It can last days or years and can sometimes be hard to treat.

Hip pain is often short term or acute, and lasts a few days. It usually improves on its own with self-care. It is called subacute hip pain if it lasts between 4 and 12 weeks.

Chronic hip pain on the other hand, lasts for 3 months or longer, even after the initial injury or underlying cause of pain has been treated. Chronic hip pain can occur in some people that get acute hip pain. This means that in a small percentage of people the pain can continue for much longer than expected and in some of those cases the chronic hip pain can be debilitating and difficult to treat.


HIP PAIN SYMPTOMS

Hip pain can occur suddenly or slowly. Hip pain can also occur immediately after an injury or the onset of symptoms can be delayed.

Symptoms may include a dull or sharp pain and/or a stiff hip joint. Pain can also be felt nearby in the buttock, lower back, thigh, groin or even knee. Sometimes there may be a locking clicking or catching sensation in the hip. Arthritis can also cause a grating sensation when the hip moves. If there is an infection, the area could be red swollen and warm.

There might even be tingling, numbness, pins and needles and associated weakness.

Hip pain can be made worse when walking up or down stairs, sitting or standing for some time or even when playing sports.

Sometimes people can be very unwell if there is a more serious cause like an infection or fracture of the hip.


HIP PAIN CAUSES

The precise location of hip pain can provide valuable clues about the underlying cause. Problems within the hip joint itself tend to cause pain on the inside of the hip or groin. Pain on the outside of the hip, upper thigh or outer buttock is usually caused by problems with muscles, ligaments, tendons and other soft tissues that surround the hip joint.

The parts of the hip joint all work seamlessly together like components of a complex piece of machinery but if one part is faulty, the whole system can be affected and malfunction.

When hip experts make an assessment, a few things need to be considered, because hip pain could be caused by a number of problems in or even around the hip joint. A few hip pain causes are:


  • Hip strain and sprains of surrounding muscles, ligaments, and tendons. Sometimes hip muscle pain can be related to myofascial pain syndrome which causes muscle spasms and exquisite tenderness. Muscles that could be sprained or strained might be the psoas muscle and piriformis muscle over the buttock region, sartorius and hip adductors in the front, tensor facia latea and gracilious on the side and the semi-membranous and semi-tendonous over the back of the thigh.
  • Myofascial pain is pain that occurs because of specific problems with the surrounding muscles, ligaments and tendons of the hip. The muscles, as mentioned above, may develop discrete little tight knots (taut bands) that are called myo-fascial trigger points. Trigger points are hyperirritable spots in the covering (fascia) surrounding muscle and can be very painful and quite debilitating. When a trigger point is touched or examined, it can cause extreme hip pain in and around the area.
  • Bursitis occurs when small, fluid-filled sacs that cushion the bones, tendons and muscles near the hip joint become inflamed. When the hip trochanteric bursa becomes inflamed and painful it is sometimes called greater trochanteric pain syndrome.
  • Hip labral tear involves the ring of cartilage (labrum) around the outside rim of the socket of your hip joint. The labrum cushions the hip joint and acts like a rubber seal that helps hold the ball in the socket.
  • Arthritis. There are many different types of arthritis but osteoarthritis is the most common. Although osteoarthritis can damage any joint in the body it most commonly affects the hip joint and also the hands, knees and spine. Other forms of arthritis that could affect the hip include rheumatoid and psoriatic arthritis. A dangerous form of arthritis is septic arthritis, which is an infection in the hip.
  • Referred pain is where pain in one part of the body can be felt in another part of the body that is nearby. This occurs when different parts of the body share the same nerves to send signals to the hip and brain. A common cause of hip pain can be referred pain from the lower back or spine. Spine problems like facet joint arthritis or disc prolapses can both contribute to spinal nerves being compressed where they leave the spinal column (pinched nerves). This compression condition is called lumbar foraminal stenosis and can cause radiating pain anywhere down into the buttock, hip, leg or foot. Lumbar spondylosis (osteoarthritis) is spine arthritis, which is an age-related condition that affects the facet joints, discs and ligaments of the lower back. Pain in these areas can commonly refer into the hip region. Hip pain can also be referred from the sacroiliac joints and even the abdomen.
  • Nerve pain: sometimes neurological problems can cause hip pain. Neurological causes might include meralgia paraesthetica, shingles (zoster), post herpetic neuralgia, or even some spine conditions as mentioned above or sciatica.
  • When pain persists following acute pain, this can sometimes cause changes within the nerves and set up some forms of nerve pain, also called neuropathic pain. Being sometimes hard to diagnose, nerve pain management is usually best handled by pain specialists.
  • Sensitisation: sometimes a problem in the nervous system called sensitisation can occur. This is when the pain, usually a nerve pain seems to be spreading up into the body and or down into the arm, or even into the other side of the body. People with sensitisation can even have sensitive skin in the hip region and even light touch using a brush can be exquisitely painful.
  • Post-surgical pain: after an operation or surgery, e.g., pain after hip replacement. Pain can sometimes persist after the tissue has had sufficient time to heal. This can occur in up to 25% of all surgeries and sometimes persistent hip pain can be severe, intolerable and debilitating. Post-surgical pain can be caused by almost any type of operation, and can be caused by many things, including nerve injury or scarring, ongoing hip inflammation or infection, muscle weakness and stiffness. This is a complex pain condition and should be assessed and managed by pain specialist physicians in conjunction with the operating surgeons. Nearby nerves that can be damaged during hip trauma or surgery may include the sciatic nerve, femoral nerve, anterior and or lateral femoral cutaneous nerves, superior and inferior gluteal nerves.

Contact us to find out what's causing your pain.


WHO GETS HIP PAIN?

Anyone can get hip pain and it can occur at any age.     

Some people are more likely to develop hip pain. Here are a few risk factors that might make the development of hip pain more likely:

  • Older age
  • Lack of exercise and low fitness level
  • Being overweight
  • Certain jobs or activities that require walking up and down stairs or heavy lifting, particularly when it involves repetitive movements of the hip joint.

HOW DO I GET A HIP PAIN DIAGNOSIS?

Hip pain is complex and should be assessed by a medical professional or pain specialist who will take the time to understand the pain story and perform a physical examination before setting forward a diagnosis and treatment plan.

In some circumstances imaging tests may be required. Types of imaging tests might be X-rays, CT scan, MRI scan, bone scan or ultrasound.

Once a diagnosis is made, the medical professional or pain specialist will determine the best hip pain treatment. 

Book an appointment to have a Pain Specialist make a hip pain diagnosis.


WHAT HIP PAIN TREATMENT IS AVAILABLE? 

Treatment of the hip pain depends on if the problem is acute (meaning it only occurred recently i.e. days and weeks) or if the problem is chronic (meaning it has been present for more than 2-3 months).

ACUTE HIP PAIN TREATMENT

Most acute hip pain is mild and settles with simple treatments.

  • Simple treatments like hot or cold packs, physical activity, exercise and physical therapy.
  • Pain medications like anti-inflammatories and anti-spasm medications to provide pain relief.

If pain is long lasting (chronic pain), debilitating and has not been responding to treatments an assessment should be made by a pain management specialist, who can assess and treat most types of chronic pain.


CHRONIC HIP PAIN TREATMENT

Through years of experience, we’ve figured out that good and long-lasting chronic hip pain relief doesn’t work unless all bases are covered.

The best hip pain management combines pain-reducing treatments combined with other selected therapies like physical and psychological rehabilitation treatment.


TYPES OF TREATMENT

  • Medications to reduce the pain. These may be simple over the counter medications or can be medications prescribed by a pain specialist. Medications might include muscle relaxants or anti-neuropathic (nerve pain) medications. Sometimes analgesic compound creams are used to ease pain.
  • Pain interventions: injection therapies can be used to target, diagnose and manage chronic pain caused by muscle, joint and nerve pain. This includes interventional therapies like nerve blocks (lateral cutaneous nerve of the thigh, articular branches of the femoral and obturator nerve, medial branch nerve(s), lumbar nerve roots, cluneal nerves, gluteal nerves, sciatic nerve and even the lumbar plexus) radiofrequency ablation (RFA), pulsed radiofrequency (PRF) to the nerves previously blocked. Epidural and nerve root steroid injections. Sympathetic nerve blocks can also be performed.
  • Platelet-rich plasma (PRP Injections) can also be used in some locations around this area. Botox injections can be considered for certain types of hip nerve pain. It can be helpful in providing pain reduction that can last many months at a time.
  • Nerve stimulation or neuromodulation techniques: advanced pain reduction strategies may include spinal cord stimulation for severe hip pain. Some forms of spinal cord stimulation are high frequency stimulation (HF10), tonic stimulation, multi-waveform stimulation, Burst DR stimulation and even dorsal root ganglion (DRG) stimulation.
  • Surgery is generally recommended when tests show structural changes that need corrective surgery. When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. These are typically performed by an orthopaedic surgeon. Types of surgery might include, arthroscopy reconstruction, open reduction & internal fixation, osteotomy, synovectomy, relocation of a dislocated hip, arthrodesis, total hip replacement, joint revision.
  • Rehabilitation: most types of chronic pain treatment should be managed alongside some form of specialist rehabilitation. This is when the best results occur.

HOW DO I GET HIP PAIN RELIEF? 

Significant and persistent hip pain is best initially assessed by a medical doctor like a general practitioner (GP). They will make an assessment and make sure there are no warning signs for something serious.

If they suspect something more serious is causing the hip pain, they may do some scans or blood tests and make a referral to the appropriate specialist for treatment. If however no serious cause is diagnosed, the referral may be to a pain specialist for an assessment and therapy with the use of advanced pain reduction techniques.

If the hip pain is mild or improving, GPs may:

  • Reassure that there is no serious cause for concern and advise that the hip pain should improve with physical activity, e.g., hip pain exercises, and simple pain medications.

If the hip pain persists or returns GPs may:

  • Use stronger pain medications
  • Suggest management by an expert pain physiotherapist if the hip muscles are suspected to be a cause or contributor to the pain
  • Refer to a pain specialist physician to provide more comprehensive hip pain management using options like joint and nerve blocks, sympathetic blocks and radiofrequency ablation (RFA), pulsed radiofrequency or nerve  stimulation and neuromodulation using spinal cord stimulation.
  • Refer to an orthopaedic surgeon for an opinion.

WARNING SIGNS OF MORE SERIOUS HIP PROBLEMS

In some instances, pain can indicate more serious hip problems. These problems might include fracture or dislocation, infection, infection, osteomyelitis or avascular necrosis.

·      Fractures or dislocations of the hip can be caused by a direct hit, fall, and accident but sometimes can even occur without trauma.

·      Infection of the hip (septic arthritis) tends to occur if patients have a weakened immune system from any cause or medical condition or after an operation. Sometimes infections of the hip can occur if there is an infection elsewhere in the body. People with joint infections usually feel unwell and can have sweats and a fever. Another type of infection is osteomyelitis, which is when there is an infection in the bone itself.

·      If there is cancer in the bones of the hip or nearby, this can present with bone pain and fractures. The cancer can begin in the hip (primary cancer) or spread to the hip (metastases). Sometimes leukaemia can also cause hip pain.

·      Avascular necrosis (AVN) is the death of bone tissue due to a lack of blood flow. AVN can cause tiny cracks in the bone and the bone can even collapse. AVN occurs most commonly in the hip.

·      Inguinal hernias can even cause hip pain.

Seek urgent and specialist medical advice if you experience:

  • Sudden, unrelenting, disabling and severe hip joint pain
  • Recent injury or fall
  • Inability to walk or put pressure on the leg
  • Recent weight loss
  • Signs of infection are present like fever or feeling unwell, the area is red, hot or swollen
  • Numbness or tingling of the leg
  • Weakness in the hip or leg(s)
  • Problems with bladder or bowel function
  • Stiffness of the hip joint that is worsening
  • Pain does not settle by itself after a few days or weeks

Contact us to book an appointment with a pain specialist.