How common is hip pain?
Pain arising from bones, ligaments, joints, tendons and muscles (musculoskeletal pain) is a major public health issue, In the four years 2004-2006 it cost Australians $4 billion (19
) and affected 30% of the population (about one in three people) (1
Hip pain, regardless of the cause, makes up a substantial portion of this group and the cost. It is a problem found in all age groups and in people of both athletic and sedentary lifestyles.
Hip pain does occur more commonly in older age groups and in women. Close to 40% of women over the age of 70 (20
) and up to 23% of women over the age of 40 have reported hip pain (21
). Hip pain is also a problem for men.
Hip pain in children can be serious: a child with hip pain should be seen by a doctor immediately.
How does hip pain impact on people?
People with hip pain have more trouble leading active lives than those without hip pain, tend not to participate in physical leisure activities and are likely to find normal activity harder and less pleasurable (22
). This will often adversely affect a person’s ability to control their blood pressure, maintain a healthy weight (1
) and maintain a sense of good well-being.
What causes hip pain?
Hip pain can result from problems in or around the hip joint and can arise from referred pain from the lower back or pelvic joints (for example the sacro-illiac joint or the pubic symphysis) (23-26
Conditions that involve the hip joint include
- Hip arthritis
- Hip labral tears
- Ligamentum teres tears
- Damage to the surface of the hip joint (chrondral surface deficits)
- Loose bodies within the hip
Conditions that involve the tissues around the hip joint include
- Bursitis and tendon problems
- Greater trochanteric pain syndrome
- Tendons that are commonly involved include but are not limited to; Gluteus medius and minimus, Quadratus Femoris, and the tendons of Psoas and Piriformis.
- Strain of the anterior pelvic structures, e.g. osteitis pubis
- Post-natal “weakness” or “instability”
- Problems with appropriate muscle activation
- Iilo tibial Band syndrome/tightness
- Problems with the bones about the hips e.g. stress fractures (27).
Conditions that refer to the hip area, that is, it feels like “hip pain” but is actually from somewhere else (23-26)
- Low back pain
- Sacroiliac joint pain
- Pubic symphysis issues
- The back and hip are integrally linked, it is possible to have several of these problems occurring simultaneously (2, 28)
What helps with hip pain?
Getting the right diagnosis
Why is diagnosis difficult at times?
- In addition to the hip joint, reported pain can be a symptom of a number of different problems - for example problems in the back and/or pelvis
- Xrays, Ultra sound and MRI scans don’t always help. It can be difficult to distinguish the actual cause of the problem when there are changes due to normal (mostly pain free) aging, leading to misdiagnosis
- There are a lot of joints, muscles, tendons, ligaments and bursa located in this area - therefore many components that need to be evaluated
Effective treatment relies on three things:
- Identifying the most likely affected tissue (e.g. bone, ligament, tendon, muscle, cartilage)
- Addressing and correcting (if possible) the most likely cause or causes of the problem
- Identifying and modifying (if applicable) any lifestyle activities/behaviours that may be making the situation worse
- Physiotherapists are trained to undertake a thorough assessment - including a comprehensive history and examination of the person’s ability to move and the function of their hip and back - to evaluate the contributing factors.
- Physiotherapists are trained to review of any imaging (x-ray, ultrasound, MRI), and the reports so as to put these into the context of the person’s history and thus interpret and integrate all the findings
- This will lead to a tailored rehabilitation program that may include: appropriate exercise therapy, hands on treatment, and guidance and education regarding any necessary lifestyle modifications (29-31)
- Modifying activities where necessary e.g. including some non-weight bearing exercises into a fitness program, and possibly reducing any high impact exercise
- Using a walking stick or walking poles
- Changing sitting, sleeping and exercise arrangements
- If appropriate, losing just 5kg of weight may help significantly with the pain (32)
Total hip replacement is the preferred treatment for severe hip osteoarthritis (33). Fortunately not everyone needs this level of intervention. Occasionally people who suffer from hip pain are given the wrong diagnosis or the whole picture is not clear, in these cases, proper diagnosis and/or simple lifestyle changes can often make a big difference.
Surgery is also an option for severe and non-responsive bursitis and gluteal tendon tears. However this should be a last resort option once a tailored physiotherapy program has been shown to be ineffective (34).
Hip arthroscopy is sometimes recommended for labral tears and for femoral acetabular impingement. As with bursitis and gluteal tendon tears, this generally should be a last resort once a tailored physiotherapy program has been shown to be ineffective.
Injection therapy for tendons (tendinopathy) and bursitis:
While some injection drugs provide good short term relief there is limited evidence that they provide long term relief. In some people injections stop being effective altogether and may even result in a worse outcome for the person Cortisone injections treat the symptoms, they do not address the underlying biomechanical, training, activity related problems that have led to the tendinopathy or bursitis in the first place. The most effective long term treatment for tendinopathy is tailored exercise therapy (35-37
How quickly does hip pain resolve?
Hip pain as a result of tendon, bursa or labral tear problems can take a number of weeks and even months improve. This is because there are lots of components to address and because tendons and the labrum don’t have a good blood supply. There are some effective treatments that can help in the short term, but long term results take…a long time. It is likely the person has had the problem for some time – so the muscles and tendons needs time to regain strength and flexibility. Even with the correct treatment a tendon/bursa problem may take 3 to 12 months to get better.
A problem related to the joint may resolve quickly or slowly.
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