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HIP PAIN: CAUSES, SYMPTOMS AND REMEDIES

Hip pain can have many causes, some of which can be treated by an osteopath, others only by a doctor.

Osteopathy can be useful in many situations and, in most cases, even preventatively.

Symptoms can be different depending on the cause of the problem and it can take more or less time to resolve the pain.

ANATOMY OF THE HIP

The hip, also known as the hip joint, is an anatomical region that joins the pelvis, pelvic area and thigh.

The hip is mainly made up of the dome (or acetabulum) and the head of the femur, which, being spherical in shape, fits inside it.

Often, hip pain originates in the joint itself, while other times it can originate in the many structures that surround the hip.

WHAT ARE THE CAUSES OF HIP PAIN?

Pain can be caused by the joint itself or by other structures surrounding the hip.

We can divide the causes of hip pain into two categories:

Traumatic origin
More generalised non-traumatic origin
While in the former we have a clear idea of the cause, i.e. trauma, in the latter there are many possibilities that lead to hip pain.

From the point of view of Osteopathy, we can act mainly on the latter, since many of them are due to hypofunction of the joint.

In many cases, incorrect posture overloads the hip, creating pain or even premature degeneration of the joint.

There are work and sports situations that can affect the movement of the hip, for example, a tiler, who has to bend frequently, creates a situation of repeated compression in the hip, leading to premature wear of the joint.

Sporting activities, such as skating, can also alter the function of the hip and cause pain.

Osteopaths can improve the body’s ability to compensate by releasing structures that become hypomobile and whose function is affected by overload.

Hip pain can be caused by many factors, so it is very important to assess and discover the cause of the pain.

TRAUMATIC CAUSES OF HIP PAIN
HIP FRACTURES
CONTUSIONS

HIP FRACTURES

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Falls are the main cause of hip fractures in the elderly.

The fracture occurs due to the combination of two effects of old age, osteoporosis and loss of balance.

These two factors are the main cause of falls. Sometimes a bone can break on its own, causing a fall.

Bones can weaken due to other factors, such as bone cancer, a benign tumour or a cyst.

When we talk about a hip fracture, we are usually referring to the neck of the femur; more rarely we have a fracture of the acetabulum, which can usually occur in an accident.

The site of the fracture is important when deciding on the type of surgery to be performed to repair the injury.

Symptoms

Pain in the hip, inability to move due to the injury, difficulty putting weight on the affected limb, swelling.

Remedies

Go to the emergency room and follow the doctor’s instructions.

CONTUSIONS

Bruises and sprains can be the result of trauma which, although it doesn’t break the bone, can be very painful.

A sprain usually causes an injury or inflammation of the muscle and tendon (tendonitis).

Due to the amount of force required to walk, run or jump, the hip joint has to be able to support many times the weight of the body.

The muscles, bursae and ligaments are designed to protect the joint from these forces. When these structures are inflamed, the hip can malfunction, causing pain.

Symptoms

Lateral pain to the touch, limitation of movement, swelling, often increases with movement and decreases with rest.

Remedies

Ice, flushing, painkillers (on prescription), if it doesn’t go away in a few days, carry out investigations.

NON-TRAUMATIC CAUSES OF HIP PAIN

Hip pain can be caused by many factors. Even a simple systemic inflammation of the body can affect the hip in some way, or poor posture at work or during a sporting activity.

HIP ARTHROSIS – COXARTHROSIS

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Arthrosis is a chronic, degenerative and potentially disabling disease caused by damage to the cartilage.

If the damage to the cartilage is extensive, the functionality of the joint is compromised. Osteoarthritis can affect any joint, the most common being the shoulder, knee and lower back, but when it occurs in the hip (coxarthrosis) it can seriously impair hip movement.

Symptoms

A feeling of stiffness, sometimes accompanied by an inability to flex the thigh.

The pain is progressive, does not come on in one episode and can be felt internally, in the groin area or anteriorly.

It usually affects people between the ages of 40 and 60, usually women, who are overweight.

Remedies

As it is a degenerative disease, the best remedy is prevention, maintaining an active and balanced lifestyle.

Consult an osteopath to improve posture and load, as well as to release the areas of greatest tension.

You will then be given specific mobility and strengthening exercises that you can do on a daily basis to keep your hip free. It is recommended that you use an exercise bike or walk with the help of walking poles, avoiding climbs and descents.

The use of medication is prescribed by the doctor, sometimes hyaluronic acid infiltrations are carried out.

Hip replacement surgery is considered by the doctor when there is severe pain and an inability to walk or bend.

TROCHANTERIC BURSITIS – INFLAMMATION OF THE HIP BURSA

Trochanteric bursitis is inflammation of the bursa located on the side of the hip that serves as a cushion to protect the greater trochanter from wear and tear caused by contact with the muscles and tendons.

Inflammation of this bursa can occur due to a variety of causes, from trauma to wear and tear, especially in people who practice activities such as running.

Symptoms

Lateral hip pain, present when walking or at night when sleeping on the side. The pain can cause lameness and difficulty climbing stairs. There may be oedema or swelling in the area.

Remedies

As this is an inflammation, it is advisable to consult a doctor for anti-inflammatory treatment, in addition to which local cryotherapy should be used. If the inflammation persists, it is advisable to consider physiotherapy treatments such as Tecar therapy .

ILIOTIBIAL BAND TENDINITIS

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Tendonitis is an inflammation of the tendon, in this case the iliotibial band, which originates in the iliac crest, passes laterally to the hip and inserts into the tibia and fibula head.

This band of tissue can become inflamed, causing pain in the hip, knee or both.

It is often known as runner’s knee, as it predominantly affects the knee of runners.

Symptoms

Lateral pain, which increases with activity and decreases with rest, sometimes associated with a ‘jerking’ movement of the tendon above the head of the femur..

Remedies

Ice, rest and anti-inflammatories (always with a doctor’s prescription) are the usual practice. It can be improved by specific stretching of the iliotibial band.

Osteopathic treatment can help, since the main cause of this inflammation is postural overload.

PIRIFORMIS SYNDROME

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Well-known, and often abused, piriformis syndrome is a condition that causes hip pain due to the sciatic nerve being compressed by the piriformis muscle.

It can be confused with sciatica, as the symptoms are similar, with the sciatic nerve being irritated.

Symptoms

Intense, deep pain in the buttocks, there may be muscle weakness, numbness in the lower back and along the thigh posteriorly, passing behind the knee, down the calf and into the foot (similar to sciatica).

The pain increases when climbing stairs or walking uphill, there is an associated reduction in mobility, with rest, especially in the supine position, the pain improves.

Remedies

Osteopathic treatment is strictly recommended in these cases, as there is a structural alteration of the nerves in the whole area.

The treatment aims to improve the function of the hip by restoring blood circulation and unblocking the superficial and deep muscles.

Ice and cold packs improve circulation by relaxing the muscles, and mobility and stretching exercises are recommended, as well as local self-massage.

SCIATALGIA

Ciatica

The difference between piriformis syndrome and sciatica is that in the latter there is involvement of the sciatic nerve caused by lumbar/sacral compression, whereas in the former the sciatic nerve is crushed and compressed by the muscle.

Symptoms

Constant pain originating in the lumbar region, passing posteriorly to the hip and travelling down the sciatic nerve to the foot. There is diffuse stiffness in the morning that improves with movement. Muscle weakness and numbness along the leg. Often causes lameness and hip pain.

Remedies

Rest is strongly recommended. In the case of an acute phase, it is necessary to contact the doctor who will prescribe the drug treatment to be followed.

Osteopathic treatment aims to improve and correct posture and improve back mobility.

Specific mobility exercises, stretching and muscle strengthening should become a daily routine to improve and keep the system in balance.

L1-L2 RADICULOPATHY

Radiculopatia

A compression of the L1-L2 root can cause referred hip pain, which can also be caused by the involvement of the femoral nerve that innervates the ileopsoas muscle, the main flexion muscle of the femur, which, if affected from a nerve point of view, can create movement dysfunction and anterior hip pain.

Symptoms

Pain localised anterior to the hip, increases with severe lumbar stiffness and improves with movement and rest.

Remedies

As with sciatica, the remedy is rest and manipulative treatment aimed at improving lumbar mobility.

HÉRNIA ABDOMINAL ou INGUINAL

hérnia abdominal

An abdominal hernia can cause pain in the anterior part of the hip.

It occurs when there is a weakness in the abdominal fascia, which with increased pressure creates a hernia. Depending on its location, it can be umbilical or inguinal, the most common.

Symptoms

Pain and discomfort in the groin, which can also radiate to the testicle, a burning sensation and a foreign body sensation in the area. The person has difficulty standing, has difficulty digesting and a digestive disorder.

Remedies

Go to a specialist doctor, who will try to push the hernia out internally with a manoeuvre; if it remains, conservative physiotherapy will be given to strengthen the pelvic floor. If the hernia tends to come out, surgical intervention may be considered.

VALGUS KNEE

Hip pain can also be caused by a valgus knee, which overloads the hip. This incorrect posture can create pain in the hip area.

Knee valgus can be caused by many factors, such as a long limb, a drop in the plantar vault or a malformation of the knee.

Symptoms

Generalised hip pain, worsens with walking and physical activity, improves with rest.

Remedies

Depending on the cause of the valgus, surgery can be performed on the tibial shaft if it is an anatomical problem, or postural if the valgus is created by a muscular imbalance.

VISCERAL PROBLEMS

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The hip is also closely related to the visceral system, so it should be borne in mind that hip pain can be caused by factors not directly related to the area of pain felt.

For example, fibrosis of the renal fascia, intestinal loops or the broad ligament of the uterus in women can create a series of tensions that go all the way to the acetabulum, thus causing an increase in connective tissue in this area, decreasing the hip’s ability to move freely and receive adequate nutrition.

Visceral pain is a dull ache that responds to distension and contraction of the viscera, which can lead to inflammation of the organ.

Sometimes the organ and the dermatome (region of the skin innervated by a sensory root) can have the same innervation root and thus, through a system of facilitation, influence each other, hence the theory of referred pain, i.e. musculoskeletal pain caused by a viscera.

Symptoms

A visceral problem can manifest as a general pain in the hip, limiting movement, without having a very specific symptom.

It can be felt as a sensation of stiffness in the iliac fossa.

Remedies

It’s difficult to establish a protocol for visceral problems; it would be a good idea to first consult your doctor, carry out an abdominal ultrasound and establish the real cause.

Osteopathic treatment in some visceral (non-pathological) situations, such as hypomobility of the colon or ileopsoas muscle, can solve the problem by eliminating the tension that causes hip pain.

Visceral Osteopathy in Lisbon

PREGNANCY

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As with visceral problems, pregnancy can also cause hip pain, again due to functional overload.

During pregnancy, internal structures undergo pressure changes that lead to strong compensation mechanisms.

Sometimes these mechanisms aren’t enough to keep the pain at bay. Usually the pain experienced is similar to sciatica, which occurs due to nerve compression as increased abdominal pressure affects the nerve and causes pain.

Symptoms

Constant pain that radiates from the lower back and along the path of the sciatic nerve, subsequently moving to the hip. There is a ‘pinching’ sensation in the hip.

Remedies

Rest, maintaining correct posture and doing specific hip and back mobility exercises, sleeping with a pillow between the legs, osteopathic treatments.

read more about Pregnancy Pain and  Osteopathy during pregnancy

CONSIDERATIONS FOR CHILDREN

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Children who complain of hip or leg pain require special attention and cannot be ignored. If the pain persists, perhaps with lameness or fever, consult your doctor and don’t neglect it.

Hip pain in children can be caused by:

  • Hip dysplasia, a congenital condition in which the head of the femur shifts and dislocates
  • Legg-Calvé-Perthe syndrome, or osteonecrosis of the femoral head
  • Rheumatoid arthritis or Still’s syndrome

If fever is also present, it may be septic arthritis or an infection of the femoral head, which can be of bacterial or viral origin.

Symptoms include fever, pain, lameness and sometimes even refusal to walk.

In these situations, always consult your doctor

Read the article on Pediatric Osteopathy and Flat head

WHEN SHOULD I GO TO THE DOCTOR IF I HAVE HIP PAIN?

Often, after an injury, people go to the doctor based on the intensity of the pain and their ability to stand, bear weight and walk.

If there’s a fracture, i.e. you can’t move your leg, you should call the emergency room and wait for instructions on what to do.

If the pain is constant and not so severe that you need to go to the emergency room, but despite rest, ice and medication the pain doesn’t improve, you should see your doctor. Especially if the pain causes you to limp or have difficulty moving.

If there is a loss of bladder or bowel function, this could mean the presence of cauda equina syndrome. In this case, it is important to contact the emergency department immediately.

Lameness is not common in children; if hip pain and lameness are associated with fever, an infection may be suspected and the doctor should be called.

WHAT TESTS SHOULD I DO TO FIND OUT THE CAUSE OF MY HIP PAIN?

Depending on the problem you’re having, different tests can be carried out.

If you’ve been injured and it’s presumed that there may be a fracture, it’s best to go to the emergency room where an X-ray will be taken; on the other hand, if you have discomfort associated with back pain, you can go to an osteopath in Lisbon who will tell you whether you should see a doctor for further investigation.

Physical examination

The physical assessment of a patient with hip pain involves a series of specific tests for the hip, back and leg, as well as a complete assessment of the entire posture.

The hip will be assessed both under load in orthostatism (standing position) and during walking, as well as unloaded, evaluating all its structures, movements, strength and pain sensations.

Imaging

Classic radiographs of the pelvis may often not be enough to establish a diagnosis.

Based on your assessment, your doctor will tell you which imaging diagnosis to make in your specific case.

If you are looking for forms of arthrosis or structural deformity, a simple X-ray can confirm the diagnosis of osteoarthritis or degenerative joint disease

If, on the other hand, you are looking for degeneration of the cartilage or capsule, the radiologist will use a contrast method in which the degenerated or inflamed areas are specifically understood.

Blood test

If your doctor suspects that your hip pain is caused by a systemic disease, he or she may order blood tests.

These can assess a state of inflammation or infection, and are not hip-specific tests, but can, together with other assessments, help make the diagnosis.

WHAT TO DO IN CASE OF HIP PAIN

The treatment of hip pain depends on the diagnosis made.

As we get older, the body’s ability to compensate for and tolerate pain decreases.

If the pain has been caused by an injury, it may not be felt immediately, as the affected area may have remained stiff from the impact and only present pain after a few hours.

If you can stand and walk, even with a slight limp, it’s a good idea to rest and ice where you feel pain.

Movement of the hip after direct trauma doesn’t mean that there can’t be a fracture. In some situations, a compound fracture can occur which can cause pain without being incapacitating.

It should be remembered that anti-inflammatories and painkillers that are taken in situations like this, even without a prescription, always have a side effect, especially if they are taken in conjunction with other medicines that are usually taken. Especially in older people, it is advisable to consult your doctor about the medication you should take.

If the hip pain is associated with an activity, for example running, it is advisable to stop the activity and consult an osteopath to check that your posture is correct and does not overload the hip.

OSTEOPATHIC TREATMENT FOR HIP PAIN

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Osteopathic treatment of hip pain is strictly recommended, both as prevention and to improve the body’s functional balance.

If we have a postural attitude that overloads the hip, it is more likely to wear out prematurely and therefore suffer pain.

By eliminating joint and muscle dysfunctions, whether or not they are contiguous with the hip injury, osteopaths can help restore joint mobility and reduce pain.

Local therapy, whether manual or pharmacological, cannot eliminate the causes that lead to the body’s functional imbalance, as it only acts on the symptom.

It is therefore important to act on the whole system, rebalancing posture and load, in order to avoid worsening the situation, which can become chronic to the point of requiring surgery such as hip replacement.

Osteopath in Lisbon – Guzzetti Sebastian

HIP SURGERY

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Surgery is the final solution in a degenerative situation if the pain doesn’t go away with conservative therapies or when there is a fracture.

Hip replacement is perhaps the most common surgical procedure. The possibility of intervention is assessed mainly in patients who have advanced hip arthritis, which causes daily disability. The orthopaedic surgeon together with the patient will assess the type of operation to be performed.

Hip replacement is also performed in cases of degenerative lesions of the cartilage, capsule and previous forms of arthrosis.

What to do after hip surgery?

The aim of recovery after hip surgery is to restore the patient’s functionality. Hip surgery should always be considered subjectively, as even post-operative goals are strictly defined.

HOW TO PREVENT HIP PAIN

Our body is a machine that needs to be properly maintained throughout life.

If you maintain a healthy lifestyle, don’t put on weight and eat a varied diet that keeps your bones strong, and practice physical activity that allows you to maintain good hip mobility and prevent back pain, you’ll also slow down degenerative processes in the hip.

The most widespread indications for preventing osteoporosis and, consequently, bone fragility, especially in women, are the intake of calcium, vitamin D and bisphosphonates.

Posture plays a decisive role in the degeneration and prevention of hip pain, and incorrect posture can overload the joint, causing it to ‘wear out’ sooner.

An assessment by an osteopath can therefore improve posture and delay a possible degenerative effect caused by incorrect posture.

Article written by Sebastian Guzzetti
Osteopath and Pediatric osteopath in Lisbon, with over 10 years’ experience in Italy. Graduated in Human Motricity with a master’s degree in Sports Science.

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