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Hip Pain - What You Should Know

Pinning Down the Problem

By

Updated May 26, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Hip Pain - What You Should Know
Image © A.D.A.M.

We tend to take our bodies for granted. Rarely do we think about the design of our anatomy and harmonious function of our body parts. That is, until something goes wrong. Let’s examine one of the large joints in our body.

Hip Anatomy

The hip is a joint which is found where the thigh bone and the pelvic bone come together in a ball-and-socket formation. Our joints are what allow movement. The thigh bone is called the femur. The top part of the femur is a roundish ball (known as the femoral head) that fits inside a socket in the pelvic bone, called the acetabulum. A ligament, strategically placed in the acetabulum, helps to hold the hip in place along with several other ligaments. Ligaments connect bone to bone.

The femoral head is covered with a cushioning layer of cartilage. This allows the femur and acetabulum to interface smoothly. Most of the time, that is. When cartilage wears away, through aging or disease, such as arthritis, the bones do not interface so smoothly. Severe cartilage loss results in a painful physical abnormality, commonly referred to as bone-on-bone.

Causes of Hip Pain

First of all, "hip pain" is a fairly broad term -- a somewhat vague symptom like "stomach ache" -- which presents you and your physician with a fairly large elimination tree. To make it more manageable, let’s sort hip pain into two large categories: acute and chronic. Acute hip pain typically stems from an injury or some sort of physical trauma, such as a fall. Chronic hip pain more typically emanates from an ongoing situation (e.g., inflammation), overuse, or strain. Hip joint pain is commonly felt in the groin, which overlies the joint, but it may express itself away from the joint, in the thigh or buttock, for example. Further complicating things, hip pain can even be caused by a back problem, or by problems with structures that surround the hip.

Acute pain:

Hip fracture is the most common cause of acute hip pain and the one you don’t want. As we age, bones become thinner, one’s balance less certain, and falls become more common. Some physicians prescribe weightlifting (modest weights) for baby boomers and the aging population to help them keep their balance, and prevent falls. Many hip fractures that are caused by falls require surgery to repair the hip and a difficult recuperation.

Sometimes it doesn’t even take a fall to fracture the hip. For those suffering with osteoporosis (diminished bone density from loss of calcium and other minerals), even ordinary activity can generate a hip fracture. Again, the best action plan in this case is prevention -- thwart bone loss before it starts. Exercise and sometimes a supplement can help slow bone loss.

We can't emphasize this fact enough: hip fractures are serious. Patients often are forced to deal with complications of being bed-bound (e.g., pneumonia and blood clots), which further delay their recovery. Less than half of those afflicted return fully to “normal” life.

Chronic pain:

Regular, unrelieved hip pain often comes from an inflammatory condition. Here are some of the best known causes of chronic hip pain:

  • Arthritis - Inflammation of the joint, which can be felt away from the hip, in the thigh, or the groin.
  • Bursitis - Inflammation of the bursa (a fluid-filled sac located between tendon and skin or tendon and bone) can be the cause of the pain that is felt upon rising from a chair, walking, going up stairs, or even driving.
  • Joint infection - Bacterial or viral.
  • Osteonecrosis of the hip - Necrosis means death. The hip bone can die from lack of blood supply. The famous athlete Bo Jackson suffered from this condition as a result of a football injury (1990) and had to have a hip replacement as a result. The good news: he fully recovered and was able to resume his career in professional baseball.
  • Sciatica - Inflammation of the sciatic nerve that runs down the leg.
  • Simple strain or sprain - May be caused by simple overuse, or a sudden movement the "wrong" way (e.g., an awkward side-to-side movement), as in tennis. Strains and sprains are small tears in muscles and ligaments, respectively; with rest, they may heal without further intervention.
  • Tendinitis - Inflammation of the tendons due to highly repetitive activity.

Treatment of Hip Pain

Based on your age and activity, you may have some idea of what is causing your pain. For a reasonable amount of time, you can try self-care measures to speed healing and help achieve some level of comfort.

  • Immediately cease activities that aggravate the pain: sports, running, walking. Give your hip a chance to heal on its own, perhaps as little as one day to as much as one week. Listen to your body. Then resume activities slowly.
  • Apply heat
  • Try very gentle stretching
  • Take an over-the-counter pain medication, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin) or naproxen (Aleve).
  • To facilitate sleep, try placing a pillow between your legs, and sleeping on the side that doesn’t have pain.

If you suspect bursitis:

  • Apply ice three to four times per day, for 15 minute periods, for the first two to three days. To avoid ice burns, or even frostbite, place a towel over your hip, then apply ice.
  • Avoid standing for long periods.
  • Wear flat shoes; avoid high heels.
  • Maintain a healthy weight.

If you are not improving with the self-care measures within a few days, or a week at most, contact your doctor. You may need prescription medications to control the pain, an injection to reduce inflammation, or various other treatment options.

If your pain is severe, especially as a result of a known injury or fall, seek emergency medical care immediately.

Also read: Physical Therapy for Hip Pain

Sources:

Anatomy of the Hip. Southern California Orthopedic Institute. Accessed 11/6/12.
http://www.scoi.com/hip.php

Hip Pain. MedlinePlus 6/4/2011.
http://www.nlm.nih.gov/medlineplus/ency/article/003179.htm

Hip Pain - Beyond the Basics. Up-to-Date. Bruce C. Anderson, M.D. October 2012.
http://www.uptodate.com/contents/hip-pain-beyond-the-basics

Anterior Hip Pain. American Family Physician. John W. O'Kane, M.D. October 15, 1999.
http://www.aafp.org/afp/1999/1015/p1687.html

Hip Conditions. Hospital for Special Surgery. Accessed 11/6/12.
http://www.hss.edu/hip-pain-center-hip-conditions.asp

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