Your hip is a relatively complicated structure. It’s a ball-and-socket joint, which means it has multiple planes of movement and requires a variety of bones, ligaments, tendons, and other soft tissues to function the way you need them to. It’s also a weight-bearing joint, so it endures a considerable amount of force whenever you walk, jump, or perform other everyday activities.
In short, there’s plenty that can go wrong with the joint and trigger hip pain. The pain can arise from problems within the joint or from outside it, and the symptoms can vary depending on the cause.
Persistent hip pain can limit quality of life. At first, only certain activities might cause hip pain, and it might be possible to avoid doing those things for a while.
“But sometimes, things like walking to your mailbox, getting groceries, getting into a car, and getting your shoes on hurt,” says Matthew Deren, MD, a Cleveland Clinic orthopedic surgeon. “When those things are causing pain that limits quality of life, then we have to look at how we’ve been treating it and might consider joint replacement.”
What is Hip Pain?
People don’t all mean the same thing when they discuss hip pain. Sometimes, the pain can feel like it’s on the outside of the hip. Other times, it seems to be toward the back. For others, it occurs around the front, in the groin.
The location of hip pain varies and can help indicate the cause, when considered along with other tests your clinician might perform.
“A lot of times people think of their hip as the outside of their hip, where their hand rests on their pocket, but your hip joint itself is actually in your groin,” Dr. Deren says.
Common Causes of Hip Pain
Arthritis is frequently a cause of hip pain. Both osteoarthritis and inflammatory arthritis (for example, rheumatoid arthritis) can cause pain in the hip.
“People with arthritis usually have groin pain and decreased range of motion of the hip. They can’t straighten their hip out quite as much, so if they’re lying flat, that hip won’t go all the way flat,” Dr. Deren says. But he stresses that the change can be pretty subtle, and people might not notice it on their own. “A limp is pretty common and then the lack of rotation of the hip can cause difficulty putting on shoes or trimming your toenails.”
Hip fractures often cause constant hip pain with or without weight bearing. People with hip fractures might be unable to walk, and they require prompt medical attention. Hip fractures most often occur after a fall or other trauma but can also occur from repetitive stress on the joint.
Bursitis causes hip pain when small, fluid-filled sacs called bursae become inflamed. Usually, bursae act as cushions for the bones and other soft tissue in the joints, but when swollen they can cause pain and restrict movement. For instance, pain on the outside of the hip and thigh may be due to trochanteric bursitis, inflammation of the large bursa on the trochanter, the bony prominence on the outside of the hip.
Hip pain also may result from tears of the labrum, the ring of tissue that lines the hip socket and helps the bones move smoothly against each other. Hip labral tears can happen in young athletes and also in older people, and may occur due to a traumatic injury, arthritis, or a misaligned hip joint. While smaller tears may not cause symptoms, large ones may trigger hip pain, as well as joint instability and stiffness.
Some people experience osteonecrosis, the death of bone tissue due to lack of blood supply, at the top of the femur. This condition can cause the bone to collapse and trigger hip pain.
And, in some instances, pain in the hip doesn’t originate there, but rather outside it or from higher up, in the spine. “Sometimes, it’s not the hip joint causing the hip pain at all,” Dr. Deren says. “It could be the muscles around the hip or lumbar back pain that’s radiating down to the hip area. Sciatic nerve pain is common, and those symptoms can be similar to hip pain.”
Symptoms and When to Seek Medical Help
Hip pain can develop slowly over time or suddenly after an injury. Pain resulting from a fall or other injury demands immediate care.
For slowly developing hip pain, Dr. Deren suggests, “If it’s bothering you enough that you’re thinking about it, then it’s probably worth getting it checked out.”
Diagnosing Hip Pain
A review of your medical history and a physical examination can often determine the cause of hip pain. Your doctor can use a standard x-ray to detect arthritis and other conditions. If the x-ray doesn’t clearly identify the cause of hip pain, magnetic resonance imaging (MRI) can help with diagnosis for some people—for example, a labral tear will appear on an MRI but not on an x-ray.
Your healthcare provider also may try diagnostic injections to help determine the source of hip pain and provide some temporary relief. “If an injection of local anesthetic and steroid into the hip joint itself results in resolution of the symptoms, then it’s a good sign that the problem is actually in the hip joint, even though the arthritis may not be severe,” Dr. Deren adds.
Treatment Options for Hip Pain
Home care and self-management strategies, such as resting and applying ice to the joint, are options for occasional hip pain that does not interfere with daily life, as are oral over-the-counter medications such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve).
Ask your healthcare provider about a referral to a physical therapist, who can help you preserve and restore strength and mobility in your affected hip.
Injecting the hip joint with a combination of corticosteroid medications and anesthetics can help relieve hip pain and be used diagnostically to confirm the cause. For some people, injections can also help delay hip replacement surgery.
Surgery may be the only treatment option in some cases of hip pain. For example, hip fractures often require surgical repair, which entails the use of metal screws, pins, plates, or rod-like implants to help the bone heal.
For people with severe hip arthritis, a hip replacement can relieve pain and improve physical function. Review the risks and benefits of this surgery with your physician, and discuss any steps you need to take to help optimize your outcomes.
“For a lot of people with bad hips, they will feel immediate relief right after hip replacement surgery, which is pretty amazing,” Dr. Deren says. Some people will need physical therapy to rebuild strength around their hip after years of not using it normally. Others will recover fully from hip replacement surgery without requiring much physical therapy.
Preventing Hip Pain
Dr. Deren advises that “staying at a healthy weight is really important in keeping people from not wearing out their cartilage.”
Consider these tips that can help reduce or prevent hip pain and its causes:
- Optimize your weight through diet, physical activity, and, if necessary, weight-loss medications. Excess weight places added stress on your hips and other weight-bearing joints.
- Stay active. Physical activity, especially lower-impact activities like walking or swimming, can help you maintain hip mobility and strength.
- Guard against injuries, especially falls. Wear appropriate footwear, remove any clutter or other tripping hazards from inside and around your house (especially your hallways, stairs and the pathways from your living area and bedroom to the bathroom), and keep those areas well lit. Also, make sure you have sturdy handrails on any staircases.
- Improve your bone health to lower your risk of hip fractures. Get at least 1,000 to 1,200 milligrams of calcium daily (good dietary sources include low-fat/fat-free dairy products, fortified cereals, and dark, leafy green vegetables). Get at least 800 to 1,000 international units of vitamin D a day from fortified milk or orange juice, fatty fish (salmon, mackerel, tuna), sun exposure (10 to 15 minutes without sunscreen) or vitamin D3 supplements. And, get at least 30 minutes of bone-building weight-bearing exercise (e.g., walking, jogging) on most, if not all, days of the week.
