Pain felt in the hip can be caused by many different anatomical structures all the way from the lower back and pelvis down to issues of alignment in the knee and foot. Hips are a common area where muscle imbalances occur, for example the front musculature of the hip is tight while the back muscles are weak. This type of imbalance can lead to many common pathologies like tendinopathies, bursitis’, muscle strains and even degenerative changes or osteoarthritis. In any case, it is important that you have your hip pain assessed by a medical professional be it a Physiotherapist, Chiropractor or Sports Medicine Physician. It is important to seek treatment for your hip pain as early as possible to ensure a quick recovery and prevent your body from developing stubborn compensations strategies that take longer to overcome.
What Makes the Hip Joint Unique?
The hip is a ball and socket joint, with a deep socket, making it a much more stable joint in comparison to the ball and socket joint of the shoulder. The hip joint does have some unique features.
- Labrum – this structure is like a rubbery rim that further deepens the hip socket and creates a vacuum seal in the joint.
- Its own internal blood supply – deep in the center of the joint is a special ligament and artery that bring oxygen rich blood to the head of the femur (the ball aspect of the bone).
- Variations in orientations of the joint/bony structures- The thigh bone (femur) has a unique angle that occurs at the top angling it towards the socket. This angle and orientation is individual and everyone is unique. This can explain how some people naturally toe out or in, or have deep hip range while others may not.
The hip joint has over 17+ muscles that cross it and that play a role in alignment and movement of the hip. The coordination, flexibility and strength of these muscles are integral to a healthy hip. The hip is closely connected to the movement of the pelvis and lower back. Tightness and dysfunction in these areas can impact the hip and vice versa.
What are the Causes of Hip Pain?
Hip Pain due to Muscle Strains and Tendinopathy
This is the most common reason people seek treatment for hip pain at Rebalance Sports Medicine. There are numerous muscles each with their own tendons (a tendon is the aspect of the muscle that attaches to the bone). When excessive demand is placed on one or more of these muscles they can become strained and an inflammatory response will ensue. A muscle strain may occur with a sudden demand that the muscle cannot withstand and fibers of the muscle get torn. On the other hand, excessive loads that are repeatedly placed through a tight muscle will lead to tugging of the tendon which leads to micro tears, inflammation and eventually a tendinopathy. Tendinopathies occur over time with repetitive movements and demands that are irritating. Please read our previous blog to learn more about treatment of proximal hamstring tendonopathy.
Hip Pain due to Bursitis
The bursa usually found in between the muscles and bones are meant to reduce friction as muscles slide back and forth over boney structures. When the muscles are too tight, they can squish the Bursae which lead to inflammation and ultimately a painful bursitis. The most common area of bursitis around the hip joint is at the greater trochanter called “Trochanteric bursitis” which can be found on the outside of the hip.
Hip Pain and Snapping Hip Syndrome
This sensation and sound of snapping typically occurs at the front or side of the hip and is caused by abnormal muscle tension or altered joint mechanics. One source of snapping can occur from tight tendons flipping over one another or flipping over bony prominences of the hip. Working on strength and flexibility around the hip will be important to resolving the issue.
Hip Pain due to Labral Tears
The labrum, a cartilaginous structure that deepens the hip socket, can tear or start to wear down. This type of injury may create the feeling of a deep click or clunk within the hip joint. This injury can also be associated with a locking sensation meaning the hip feels stuck and may need to be “worked out” for the range to return. Individuals with this injury will also complain of a pain deep in the hip and groin area. When the labrum is torn or worn down, it’s integrity will be compromised and as such no longer vacuum seals the hip bone. This makes it challenging to have a centred hip and may lead to earlier degenerative changes. In more severe cases an arthroscopic hip surgery may be indicated.
Hip Pain due to Anterior Hip Impingement
Anterior hip impingement refers to a condition where the connective tissues at the front of the hip joint get pinched with certain movements of the hip bone. You may be prone to impingement if your hip socket has a unique shape, based on genetic or developmental factors. You may also get impingement when you have imbalances of the muscles around the hip joint. If some muscles are tight, they can pull the hip bone out of the ideal centred position making pinching more likely at end ranges of movement. In some cases, an abnormal bony growth has formed on the front lip of the hip socket which can lead to pinching. Generally, anterior hip impingement leads to pain with deep hip flexion noticeable with a deep squat. Improving the muscle imbalances around the hip joint with a skilled physiotherapist can be very helpful at resolving impingement. Please read our previous blog to learn more about Femoral Acetabular Impingement (FAI).
Hip Pain due to Degenerative Changes or Osteoarthritis
Osteoarthritis (OA) of the hip can occur with age, typically around 60 years of age or possibly earlier if someone has experienced a traumatic injury to the hip. Osteoarthritis is a term that describes a sequela of events that occur as a result of the wearing of a joint. This process results in thinning (or complete wearing down) of the joint cartilage which leads to bone on bone pressure. This process can stimulate thickening of the bone and bony outgrowths (osteophytes) which is a reaction to the bone on bone pressure. A key symptom with osteoarthritis is gradual loss of hip motion and increasing pain with weight bearing activities. To prevent and also manage the pain it is important that you keep your hips strong and flexible. It also is helpful to maintain a healthy body mass and active lifestyle. A total hip replacement (a surgical procedure where a prosthetic joint is inserted) is a treatment approach that can be helpful when all conservative measures have been exhausted. Physiotherapy is the first line of defense and can be very successful in managing osteoarthritis.
Hip Pain due to Hip Dysplasia
Newborn and very young children are often tested and monitored for hip dysplasia. In hip dysplasia, the socket of the hip joint is underdeveloped which means it does not form deep enough to hold the ball portion of the hip bone snug in all directions. Babies, children and individuals with hip dysplasia are more prone to dislocation and can cause issues with the blood supply to the hip. Often surgical interventions are considered. This may continue to be a chronic issue. Hip pain can occur throughout your life and it is important to keep your hips strong avoid demanding exercises that create pain.
Hip Pain due to a Fracture
A hip fracture is an injury, crack or break in the bones of the hip. This type of injury is often a result of some sort of trauma, such as a fall or a car accident where the knees contact the dashboard. It is more likely to occur in elderly populations or other groups of people who have frail, weak bones. This painful condition will require a period of immobilization so that the bone can heal successful. In some cases, surgical intervention or a hip replacement will be required. Physiotherapy management will be an important part of the rehabilitation process once individuals are medically cleared for exercise. Your physiotherapist will help restore your movement and help you build your strength and stamina back up so that you can get back to pre-injury status.
Hip Pain Caused by a Lumbar Radiculopathy
Sometimes pain that is felt around the hip and groin region can actually be originating from the low back as a result of compression of a nerve root. If this is the case, you may also experience pain and/or stiffness in your back and you may notice that certain postures change the pain. If treatment is targeted at the wrong source, it will not be successful. This is why it is important that you are assessed by your trusted Physiotherapist or Chiropractor to rule out the low back as a source of pain.
Hip Pain Caused by Pelvic Floor Musculature Referral
The muscles that make up your pelvic floor can refer directly into the hip region and can be a source of pain when they are tight or have trigger points within them. These muscles are not only in close proximity to the hip, but they share common nerve innervations and some of them even cross or connect to the hip bones. If you experience incontinence, painful intercourse, difficulty with urination, difficulty with bowel movements and/or constipation, these may be signs that indicate your pelvic floor may be involved. An assessment with a Pelvic Health Physiotherapist is recommended to evaluate this region as the source of your hip pain.
How can Physiotherapy, Chiropractic, Massage Therapy and a Sports Medicine Doctor Help your Hip Pain?
A team of healthcare professionals can personalize your treatments to address your specific injury and help you return to your personal lifestyle goals. Each member of the team has its role. Treatments with a Physiotherapist and/or Chiropractor will help to control your pain with therapeutic modalities, acupuncture or dry needling. Your physiotherapist or chiropractor will also help improve range of motion of the joint with hands on manual therapies and will guide you through an individualized exercise program to build up your strength and normalize any muscle imbalances. Soft tissue release is also an important aspect of your treatment and you may require adjunct massage therapy treatment to address this. Education in regards to lifestyle modifications or orthotics maybe recommended. We also have the support of Sports Medicine Physicians for additional diagnostic testing and alternative medical interventions if your treatment does not progress as expected. If you are experiencing hip pain that does not resolve on it’s own within 1-2 weeks or is getting worse from its initial onset, we highly recommend having your hip assessed by a trusted health care professional.
How Long Does it Take to Recover from Hip Pain?
There is no simple answer to this question. There are several factors that need to be considered when evaluating a realistic timeframe for recovery. First and foremost, the origin and cause of the pain needs to be determined. Then, other factors such as duration of symptoms, severity of symptoms and your commitment to get the proper treatment will also influence recovery timelines. In broad terms, recovery can take a few weeks up to a few months. In some cases, such as large labral tear (requiring arthroscopic surgery) or advanced OA (requiring a total hip replacement) recovery timelines may be extended based simply on wait times for the surgical procedure itself. Your physical therapist or chiropractor will have a better idea of timelines once they conduct a thorough assessment and have a chance to follow your response to treatment after a couple of visits. Some things take time to respond, especially strengthening exercises. Muscle changes can take up to 6 weeks with daily and consistent work. Remember to be patient and consistent with your exercise program. Keep in mind that your trusted physiotherapist or chiropractor sees these types of conditions regularly and will be the best person to advise you on the best course of treatment. They will inform you if your symptoms are not progressing as expected and if you should book a consultation with a Sports Medicine doctor for further investigations or treatment options.
What are the Best Exercises to Help with your Hip Pain?
A well-rounded program should address lower back and hip range of motion as well as a graduated strengthening and flexibility program. These exercises should be individualized to your particular needs and goals.
Some of the most common exercises are described below to help you get started. These exercises should be performed in a pain free range and modified or stopped if pain increases during or after. For motor co-ordination it is imperative that you perform the exercises, paying close attention to good form, in a slow and controlled fashion. Aim for 3 sets of 10-15reps.
Dead Bug or Bird Dog
Lying on your back bend your knees and place your feet flat on the ground. In a controlled manner let you knees fall in either direction from one side to the other.
Figure 4 Stretch
Lying on your back with your knees bent and your feet flat. Take the foot of the affected hip and place that ankle over the knee of the opposite leg. Open your affected hip so that your leg position looks like the number 4. Grab behind the knee of the unaffected leg and pull it up towards your chest. You will feel a stretching sensation deep in the buttocks of the affected hip. Hold 30sec and Repeat 2-3x.
Standing while holding onto a stable object for balance. Grab the ankle of leg being stretched and pull it towards your buttocks. Keep your hip above your knee in space. You should feel the stretch down the front of your thigh. Hold 30sec and repeat 3x/per leg.
How to Treat Hip Pain at Home?
- If you have acute onset of pain in your hip, you may first want to try ice over the area. If the pain built up gradually over time and/or has been lingering for some time then heat might be the better choice. You may also choose to apply both intermittently depending on how they make your symptoms feels. Ice or heat should be applied for 10-minutes at a time with a break right after. You can repeat the process 3-4x.
- You should also try to figure out the positions and activities that aggravate your hip pain. Pay close attention to the positions that make you feel worse such as lying on the hip or walking/standing for prolonged periods. Try to modify these positions or avoid them temporarily until you can gradually reintroduce them as you get stronger with your exercise regime.
- In an early painful stage, try maintain range of motion (ROM) with gentle movements.A pool environment is a great way to get your hip moving without compressing the joint. Pool walking forward side and backwards, hip circles or squats are all great pool exercises for a sore hip.If you do not have a pool you can perform ROM by lying on your back or stomach and moving your hip forward, sideways, backwards.
- If the pain continues and does not respond to the aforementioned strategies then over the counter pain or anti-inflammatory medication might be indicated. Before starting any new medications, we recommend talking to your pharmacist or physician to ensure you are choosing the right medication for your condition.
If your hip pain does not improve with these strategies and/or you are unable to return to your pre-injury status, consider booking in to see one of our experienced Physiotherapists or Chiropractors who will be able to help you get a head start on your recovery. Contact Rebalance Sports Medicine today.