Hip Pain – How do I know what’s wrong?

By Chiropractor Nick Loftus

The majority of hip pain that I see in the clinic usually has less to do with problems arising from the actual ball and socket joint itself and is most commonly associated with:

• muscular problems in the area (hamstring or groin strains, muscle imbalances, protective spasms etc)
• referred pain from a low back problem
• nerve pain if there is some sciatic irritation.

Another common cause of hip pain is trochanteric bursitis – inflammation of a fluid-filled sac over the bony outer part of the hip. This is often caused by increased physical activity coupled with tension and shortening in the muscles of the area.

Further causes of hip pain

Hip pain can be directly related to wear and tear of the cartilage weight-bearing surfaces (osteoarthritis) in the hip joint itself, but this is mostly seen in the older population and is usually readily visible on x-ray.

Very occasionally I will see people with pain related to altered hip structure as a result of congenital hip dislocation, Perthe’s disease (where temporary loss of circulation to the head of the femur causes avascular necrosis in the young) or impingement syndromes.

However in these cases the person involved will usually be well informed about their condition having typically been to see various specialists.

Symptoms of hip pain

Osteoarthritis: If osteoarthritis is present then the hip feels stiff most of the time but especially mornings and after sitting for longer periods. The range of movement tends to be reduced, gait is altered and pain can be felt around the groin area and down the front of the thigh, occasionally to the knee too. Going down stairs tends to be unpleasant.

Bursitis: With bursitis, pain is felt specifically over the area of the bursa at the top of the outer thigh either to direct pressure or after increased activity such as running. This is also sometimes associated with a “snapping hip” due to a tendon “flicking” across the bony prominence near or under the bursa.

Referred or muscular pain: With referred or muscular pains a patient usually complains of a dull ache in or around the buttocks likened to toothache or the feeling of having been kicked there. This tends to be fairly constant and the severity often related to how bad the low back itself is.

What you should do when suffering hip pain – Dos and Don’ts

First of all you need to be evaluated to find out what is causing your hip pain, as the advice given will vary greatly depending on what is wrong.

Self help for osteoarthritis will inevitably be quite different to that for say gluteus maximus shortening. Once you’ve had the necessary treatment then it’s usually a case of lifestyle management. Often, more exercise or possibly a change in exercise technique will be recommended if there’s nothing seriously wrong.

Ice packs help enormously with bursitis as does stretching, typically of the ilio-tibial band located down the side of the thigh. Pain-killers don’t usually seem to have much effect so avoid taking them indefinitely unless you’ve exhausted all other possible measures.

On the whole, regardless of cause, inactivity is the single biggest enemy. As always it’s hard to go wrong with a good walk each day or possibly a swim. Think also about your sleep posture and whether or not extra supportive pillows might help.

Treatment for hip pain

For hip pains relating to low back dysfunction (by far the majority) then Chiropractic manipulation and deep tissue may work work well over a few weeks, coupled with advice on stretches and strengthening exercises.

I often use dry needling (western acupuncture) too and this has been a useful adjunct especially for muscular pains or bursitis.

In the most severe cases of osteoarthritis then physical therapy is unlikely to give much relief and you would need to be referred to an orthopaedic surgeon for an evaluation for possible hip replacement. These seem to vary in success rate but I would say that the majority of patients I see are much happier once they’ve had the surgery. If the osteoarthritis is mild then mobilisation techniques can bring good relief.