Hip Pain Causes

Hip pain is one of the most common skeletal complaints of patients visiting doctors. It can be caused due to injuries or health conditions. Aging can also be a cause for hip pain. This discomfort around the hip area can be short-term or may become a chronic issue. 

Anatomy of the hip joint

The hip joint is a type of ball and socket joint, which is a type of joint where a ball-shaped socket of one bone fits in a cup-shaped socket of another bone. This allows for free movement of the rounded bone. As you age, the lubricant in the joint reduces, which can cause pain and discomfort. 

The hip joint provides support to the body. They connect the lower extremities to the upper extremities and help in weight bearing. This joint allows movement in three axes:¹ 

• Transverse axis: It allows for flexion and extension movements
• Longitudinal axis: It allows the vertical movement along the thigh by internal and external rotation
• Sagittal axis: It allows forward and backward movement called abduction and adduction 

Causes of hip pain

Hip pain can be due to ageing, injury or a medical condition. According to research, around 10% of the population suffers from hip pain.² 

Hip pain can be classified into two categories: orthopaedic or non-orthopaedic. 

Orthopaedic causes

Orthopaedic causes are further divided in intra-articular and extra-articular causes:²^,³ 

Extra-articular causes refer to reasons other than the hip joint; these include problems with: 

• Nerves. An example issue is sciatica: It refers to compression of the sciatic nerve located between the lower back and feet. Affected people might feel tingling or stabbing pain in their back or down their leg to their feet 
• Muscles
• Tendons
• Ligaments
• Joint capsule
• Knee
• Gluteus muscle tear
• Greater trochanteric pain syndrome: this is also known as lateral hip pain or trochanteric bursitis. This is characterised by pain on the outer side of the hip and thigh 
• Lumbar spine
• Meralgia paresthetica: This condition is characterised by burning pain, tingling and numbness in the outer thigh area due to nerve compression. Several factors, such as wearing tight clothes, pregnancy, trauma, diabetes or obesity, can cause this condition
• Piriformis syndrome: The piriformis muscle runs from the lower spine to the top of the thigh. When piriformis muscle compresses the sciatic nerve and causes inflammation, this condition is called piriformis syndrome  

Intra articular causes refer to reasons occurring due to the joint: 

• Osteoarthritis: This condition leads to joint pain and stiffness as the tissues or cartilage degenerates. People experience pain while moving the joint, swelling or tenderness 
• Rheumatoid arthritis: This is an autoimmune condition which causes the immune system to attack its own cells, resulting in swollen, stiff or painful joints 
• Septic arthritis: This is an infection when germs enter the joint after an injury or accident. It can be serious if left untreated 
• Labral tear: The labrum is the ring on the socket area of the hip joint. An injury to the labrum is called a labral tear 
• Fracture: Fracture in the legs or hip might cause hip pain
• Development dysplasia of the hip: This is also called congenital dislocation of the hip. In this condition, the ball and socket joint of the hip are not properly formed in babies. It can affect either one or both hips 
• Avascular necrosis: This refers to the death of bone tissue due to lack of blood supply. It can happen in case of a broken or dislocated hip

Non-orthopaedic causes

Non-orthopaedic causes refer to issues not related to bones:

• Inguinal hernia: It happens when a part of the intestine or abdominal cavity protrudes into the abdomen (mostly inguinal canal). This condition may be painful
• Skin conditions
• Gonadal tumours
• Fibromyalgia: This is a condition which causes increased sensitivity to pain and muscle stiffness all over the body. It is thought to be due to abnormal levels of chemicals in the brain that deliver pain messages around the body 
• Gynaecological causes

Risk factors

There can be several causes for hip pain. But, some factors are said to be risk factors for hip pain.

• Old age: As a person ages, the body suffers from wear and tear. This increases the chances of hip pain 
• Injury: If you have suffered from any injury or fracture in your hip region, then you have an increased chance of suffering from hip pain. In cases where an injury has not healed properly, chances of hip pain are very high 
• Overweight: In overweight people, hips have to bear the extra weight of the body. This increases the chances of hip pain 
• Stress: People who put too much strain on their hips due to personal or professional reasons have increased chances of injury as well as hip pain.

Diagnosis of hip pain

If you are suffering from hip pain regularly, then it is better to consult your GP. They will gather some information about your injuries or symptoms and prescribe some tests. The following diagnostic procedures can be done.²

• Blood tests: Full blood count (FBC) and erythrocyte sedimentation rate (ESR) can be done to check for causes of hip pain 
• X-ray: X-ray is a radiological procedure performed to diagnose any fracture or dislocation
• Ultrasound: Ultrasound can be performed to check for joint effusions or bursitis
• Magnetic resonance imaging (MRI): This procedure can help in detecting any soft tissue abnormalities 

Treatment of hip pain 

Treatment of hip pain depends on severity of symptoms and physical conditions.² 

• RICE method: Hip pain can be treated at home by RICE method.
  • Resting, taking a break from physical activity and resting to prevent worsening of symptoms 
  • Ice pack or cold compress for 10-15 minutes every hour on the day after injury. From the next day, it can be applied every three to four hours
  • Compression bandage around the hip area
  • Elevating the hips and supporting them with the help of pillows or blankets. 
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to suppress the pain, especially if the pain is arising due to osteoarthritis. Steroid injections can be given in the hip joint with the help of ultrasound to reduce the pain. Meralgia paresthetica can be treated by removing compression source, antidepressants, and NSAIDs
• Therapy: Physiotherapists can be very helpful in treating hip pain. They can show a variety of physical therapies and stretches that strengthen the body. Obese patients are encouraged to lose some weight 
• Surgery: If other treatment options don't provide any relief from pain, then surgery can be considered. Total hip arthroplasty (THA) is hip replacement surgery where the hip is replaced with an artificial implant

Prevention

General safety measures can be adopted to prevent any injury or trauma that can cause hip pain. 

• Wear comfortable and supportive footwear
• If you feel pain, take a break from physical activity and rest 
• Engage in yoga or other exercises to maintain strength
• Be careful while performing any activity, especially on roads

Summary

The hip joint is a ball and socket joint that carries the weight of the body, and it causes pain for many people. 

Hip pain is a common complaint among older people. Around 10% of the population suffers from hip pain. Causes of hip pain may be orthopaedic or non-orthopaedic. Orthopaedic causes can be due to reasons arising directly from joint issues. They include osteoarthritis, rheumatoid arthritis, septic arthritis, labral tear, sciatica, nerve issues, bone issues, fractures, development of dysplasia of the hip, avascular necrosis, problems in tendons or muscles.

Non-orthopaedic causes include reasons that are not directly related to bones. They include inguinal hernia, skin conditions, tumours, fibromyalgia or gynaecological issues. 

Risk factors include old age, injury, being overweight or stress to the hip joint. 

Hip pain can be diagnosed by examination, blood tests, X-ray, ultrasound or magnetic resonance imaging. Treatment options vary depending on the severity of symptoms and the cause of pain. Medications such as NSAIDs are used for pain relief in some cases. The RICE method is preferred in cases of new injury. Physical therapy and surgery are considered depending on the symptoms.