The hip is the largest ball and socket joint in the body. The thighbone (femur) sits securely into a cup-shaped socket (acetabulum) in the pelvis. It helps the leg move sideways, forwards, backwards and rotational. Surrounding ligaments, tendons and muscles hold the hip joint together. There are fluid filled sacs (bursae) that cushion and protect the hip joint, allowing the tendons and muscles to move smoothly. A hip injury can make it difficult to walk, use the stairs, squat or sleep on the affected side. A snapping or clicking sensation or noise around the hip joint may cause you to worry. However, if you are not in any pain, in most cases the slicking or snapping is nothing to worry about.
Hip injuries are a common cause of hip pain. You may not remember an injury occurring, especially if your symptoms began gradually or during everyday activities. Problems within the hip joint itself tend to cause pain on the inside of your hip or your groin. Hip pain on the outside of your hip or upper thigh is typically a result of problems with muscles, ligaments, tendons and other soft tissues that surround your hip joint.
Hip pain can sometimes be caused by conditions and diseases in other areas of your body, such as your lower back. This is known as referred pain.
Causes of Hip Injuries
Whenever you use the hip, such as walking or going for a run, a cushion of cartilage helps prevent friction as the joint moves in its socket.
There are many reasons you could be experiencing hip pain, including:
Muscle or tendon strain
Hip injuries can cause strain of the hip and groin area, including hamstring strains and groin pulls, are common among athletes. Muscles surrounding the hip joint are particularly prone to this sort of injury due to the level of force that the muscles can generate. Repetitive activities can add strain on the muscles, tendons and ligaments that support the hips. When they become inflamed due of overuse, they become painful and prevent the hip from functioning normally.
Hip bursitis
Bursae are sacs of liquid located between the tissues such as bone, tendons and muscles. They work to ease the friction from the tissues rubbing together. When the bursa become inflamed in the outside of the hip joint, they can cause pain, particularly with movement. Inflammation of the bursae is typically related to repetitive activities that irritate or overwork the hip joint. Treatment for hip bursitis is generally effective; however, the condition is prone to coming back and can sometimes become a constant problem.
Contusion
A contusion is a deep bruise in the ridge of the bone on the outside of your upper hip. This is usually the result of a direct blow or fall. When an athlete suffers from a contusion on the outside of the hip, the injury is referred to as a hip pointer.
Tendonitis
Tendons are thick bands of tissue that work by attaching bones to muscles. Tendonitis of the hip, also known as flexor tendonitis is a condition that describes inflammation or irritation of the tendons, usually the result of repetitive stress from overuse. Hip tendonitis is more common in people who participate in sport such as running, cycling and swimming, or other high intensity sport.
Hip stress fractures
Stress fractures of the hip generally occur in the femur bone. They are more common in long distance, endurance runners and occur more frequently in women than men. These hip injuries can be seen in people with deficient nutrition as it can cause the bones to become weak and brittle.
Hip labral tear
Surrounding the hip socket is a ring of thick tissue (cartilage) known as the labrum of the hip. As well as cushioning your joint, the labrum work like a rubber seal to help hold the ball at the top of your femur firmly within the hip socket. When a labral tear occurs in the hip, a piece of tissue can catch in the joint, causing a catching and painful sensation. People who carry out repetitive twisting movements have an increased risk of developing this problem.
Femoroacetablar impingement (FAI)
FAI is a condition where a bone spur grows along one or both of the bones that form the hip joint, creating an irregular shape. As the bones do not fit perfectly together, they rub against each other during movement, causing friction that can damage the joint and soft tissues, along with loss of mobility.
Osteitis pubis
Osteitis pubis is a condition caused by repetitive pulling of the muscles over the front of the hip joint, on the pelvis. This result is inflammation and pain where the right and left pubic bones meet at the bottom of the pelvis. This condition is common in people who run, including football and rugby players.
Sports hernias
Sports hernias are usually caused by repetitive movement, particularly those that require twisting and turning at high speed such as when playing hockey or skiing. The problem is believed to be caused by an imbalance of the strong muscles in the thigh and the relatively weaker muscles in the abdomen.
Snapping hip syndrome (SHS)
Snapping hip syndrome occurs when muscle tendons become inflamed, typically due to overuse. SHS can cause a snapping sensation or noise as you over your hip joint and the muscle tendons rub over the hip socket bone.
There are three forms of snapping hip syndrome: internal, external and intra-articular. Internal SHS occurs when the tendon slide over the bone structures at the front of the hip joint. External SHS occurs when the tendons or muscles slide over the bone at the top of your femur (thighbone). Intra-articular SHS is caused by a hip joint issue or injury. Different internal SHS, intra-articular SHS is not caused by a tendon or muscle. In dancers and athletes, serious cases of SHS can result in pain and ultimately affect their performance.
Avascular necrosis (also called osteonecrosis)
Avascular necrosis is a bone disease that can cause pain and limit physical activity. The condition occurs when the blood flow to the hip bone slows and the bone tissue dies and collapses. Avascular necrosis is most common in the hip, although it can affect other bones in the body. Osteonecrosis may be the result of a hip fracture, dislocation or from a long-term use of high dose steroids. Anyone can develop this disease, although it is most common in people between 30 – 50 years old.
Hip dislocation or subluxation
Complete dislocation of the hip joint is an uncommon hip injury, often occurring as the result of a car crash. However, hip subluxation is a term used when the joint does not function properly. It occurs when the ball of the ball and socket joint is pushed slightly out of the joint. Hip dislocation and subluxation can result in short term and long term issues with the hip joint. People who sustain a dislocation will usually require general anaesthetic and sometimes surgery.
Hip arthritis
Osteoarthritis and rheumatoid arthritis are the most common forms of arthritis found in the hip, causing pain. Arthritis of the hips is common in athletes that participate in sports at an older age. Arthritis can lead to inflammation of the hip and the deterioration of cartilage that cushions the hip bones. Pain, stiffness and reduced range of motion in the hip are all common symptoms of hip arthritis.
Symptoms
Symptoms linked with hip pain depend on the cause. Seek medical advice if you are experiencing hip pain caused by an injury and show any of the following symptoms:
- Deformed hip joint
- Trouble sleeping on the hip
- Reduced mobility of your leg or hip, causing a limp
- Inability to bear weight on the affected leg
- Tenderness of the hip
- Intense joint or groin pain
- Sudden swelling over the hip
- Signs of infection such as fever, chills or redness
If your symptoms are minor, you may not need to see your doctor. Try self-care at home to see if that eases any of the pain or discomfort.
Rest
Try not to lay on the affected side and avoid sitting for long periods. Avoid constant bending at the hip and applying direct pressure on the hip.
Medication
Over-the-counter medication such as ibuprofen may help ease your hip pain.
Hot and cold treatment
Use a bag of frozen vegetables or ice cubes wrapped in a towel to apply cold treatment to your hip. A warm shower or bath can help loosen your muscles and prepare them for stretching and exercises.
If self-care treatments fail to help, make an appointment with your doctor.
Diagnosis
Doctors can generally diagnose hip pain with a medical history and physical assessment. Different conditions develop for different reasons, and understanding how symptoms started and have continued to develop can help guide the doctor to form a diagnosis.
A physical examination can help to detect the source of the discomfort. Manoeuvres such as internally and externally rotating the hip can be used to discover pain-inducing positions and movements.
In many cases, hip injuries can be hard to diagnose as the joint itself is rooted deep within the pelvis. Hip joint problems can occasionally be confused with symptoms of problems with the lumbar spine or bursa. Determining the source of the symptoms is helpful in guiding the diagnosis.
To provide an accurate diagnosis, your doctor may order further diagnostic tests. X-rays can be used to evaluate the bones of the hip joint. Other imaging tests include MRI scans and ultrasounds can be used to help further define the root of the pain and evaluate different aspects of the hip.
It is important that the proper diagnosis be achieved, as treatments can differ depending on the specific underlying diagnosis. Once the diagnosis has been attained, treatment plans can be started.
Treatment
The treatment of hip injuries depends on the cause of the pain. For pain related to exercise, rest is normally enough to allow the hip to heal and pain is usually gone within a few days. If you have arthritis, your doctor may prescribe medications to help ease symptoms such as pain and stiffness. Other treatment options can include:
- Anti-inflammatory medications such as ibuprofen will provide pain relief
- Cold treatment will help numb the area and soothe pain
- Hot treatment, including using a heat pad or having a warm shower will help soothe pain and stiffness
- Cortisone (steroid) injections can help reduce local inflammation
- Antibiotics are prescribed if there is an infection
- Surgical treatment including, pinning, repairing and replacement may be suggested if there is a fracture or severe arthritis
- Physiotherapy helps maintain joint mobility
Outlook
After identifying the cause of your hip pain, you can successfully manage it with a treatment plan. In the cases of minor injuries and exercise related accidents, you may not require treatment. However, in more serious situations, such as with arthritis or fractures, the symptoms will get worse if you do not receive treatment quickly.
Need Help?
If you are suffering from a hip injury, you can be seen by a Consultant Orthopaedic Hip Surgeon at One Ashford Hospital, usually within 48 hours. One Ashford Hospital is well placed to see patients with knee injuries from Ashford, Maidstone, Canterbury, Folkestone, Dover and all surrounding villages. To book an appointment, call the hospital direct on 01233 364 022 or email here.
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