Hip pain is a fairly common ailment and falls among the five most reported musculoskeletal issues in the US. Around 15% of people over the age of 60 are estimated to have some kind of pain around their hip. Different conditions give rise to different kinds of injury and pain in one or more regions of the hip. Some hip pain issues can even prove to be debilitating and can bring tremendous emotional and financial burden to patients and their families. Although many hip pain issues can be treated with normal medication and a few sessions of onsite or online physical therapy for hip pain, the treatment of some serious conditions may even require surgery.
Understanding The Hip
The hip joint, also known as the acetabulofemoral joint, lies in the middle part of the body below the lower back and above the legs. Its main function is to support the weight of the upper body and provide balance to the entire body. The hip region in its entirety hosts a very complex structure made up of several bones, muscles, tendons, and nerves.
Basically, two bone structures form a hip joint, which includes the thighbone (femur) and the pelvis. As a whole, they create the largest ball-and-socket joint within the human body. The rounded upper end of the femur is the ball, while the concave area in the lower side of the pelvis (also called the acetabulum) is the socket. The ball fits into the socket to form the joint, allowing the legs to achieve motion in a stable manner. The ball further attaches to the remaining area of the thigh bone via the femoral neck. Lying next to the femoral neck is a bump called the greater trochanter, which sits on the outer region of the hip, with the surrounding muscles are attached. A pad of cartilage exists between the acetabulum that helps in preventing friction between the concave area and the ball.
In a healthy hip joint, the muscles, ligaments, tendons, nerves and bones all work in harmony to allow the joint to move easily and provides stability to the body.
Categorization of Hip Pain
Depending upon the cause of the pain, a hip pain issue can belong to any of the following three categories, which are as follows:
1. Articular pain
Articular pain is caused by problems affecting the joint. Conditions including osteoarthritis, inflammation (arthritis), osteonecrosis of the femoral head (deterioration of thigh bone tissue), and hip impingement commonly causes articular pain.
2. Periarticular pain
Periarticular pain is caused by problems that affect the structures surrounding the hip like muscles, tendons, ligaments, and bursae. These pains are often felt around the outer part of the hip.
3. Radicular pain
Radicular pain is attributed to causes that originate outside of the hip. This kind of pain radiates to the hips from other injured body parts like the lumbar spine, knee or sacroiliac joint.
Common Hip Pain Conditions
Let’s look at some of the most commonly reported hip pain conditions:
1. Athletic pubalgia: Commonly known as sports-hernia, this type of injury is caused by the tearing or damaging of muscles or tissues around the lower abdomen area. The pain from this condition usually is felt around the groin area. It a common injury among amateur sportsmen, or people who are only occasionally involved in strenuous sports or outdoor activities. Most cases of sports-hernias can be treated by rest and physical therapy, but in some cases even surgery may be considered essential by the physician.
2. Hip fracture: Hip fracture is a common condition observed across people from all backgrounds and ages. Usually, an accidental fall against the hip region can cause the bones in the pelvis to crack and bring inflammation around the surrounding tissues, which tends to cause severe pain. Depending upon the severity of the fracture, the pain levels can vary. Generally, people from older age groups tend to develop more fractures, primarily because of the bones weakening with age. Treatment for serious fractures can take months and may require several weeks of medication, in addition to onsite and online physical therapy for hip pain.
3. Bursitis: Bursitis is caused by the inflammation of the fluid sacs that protect the tendons and muscles from rubbing directly against the bones. It is observed to be more prevalent in people aged above 60. Pain from bursitis is usually felt around the outside of the hip, thigh, and/or buttocks. The normal treatment procedure for bursitis includes a mixture of painkillers, anti-inflammatory drugs, and passive physical therapy methods like ice compresses. In cases of severe pain, the doctor may also give a cortisone injection to reduce the inflammation.
Tendinitis is caused by straining or overuse of the tendons that cause muscular imbalances in the hip. Typical symptoms of tendinitis include moderate to severe levels pain accompanied by tenderness around the groin or the hip flexor area. The treatment for tendinitis include resting, painkillers, anti-inflammatory drugs and physical therapy drugs.
5. Labral tears:
Tearing of the labrum is caused by anatomic abnormalities that cause the hip to be too shallow or have an impingement. It can also appear in those with some past history of a hip injury. It’s a fairly common issue among athletes and dancers. The pain from labral tears is usually felt around the hip or groin. In many patients. the normal movement of the legs can also be affected. Usually, this condition requires surgery to repair the labrum and shave down the misshaped bone. It can also require some post-surgery physical therapy.
6. Pelvic floor issues:
Pain issues around the pelvic floor are caused by other problems like endometriosis or even gastroenteritis and prostate cancer. Unusual persisting pain around the pelvis may be referred to a gynecologist or a gastroenterologist.
7. Hip impingement:
Hip impingement is observed in some young people engaged in high-intensity athletic activities. It causes the hip bones to fuse in an abnormal shape and limit movement. It not only causes pain but also increases the risk of premature osteoarthritis. Less severe issues may be treated with physical therapy, but more severe issues may need surgery to move the hipbones to a normal position.
Osteoarthritis is caused by the inflammation and breakdown of cartilage which causes the joints to turn stiff and swollen. It is commonly observed in aging people, people affected by obesity, or patients with a past history of traumatic injury. The pain is the result of bones in the hip rubbing against each other ultimately deforming the joint. Less serious conditions can be treated to an extent with common medications and physiotherapy. However, some severe cases may even require hip replacement surgery.
Risk Factors for Hip Pain
Based on the observations of hip injury incidences, the following population are considered to be at the highest risk of developing hip pain:
- Elder age groups
- People with obesity
- People living a sedentary lifestyle
- People with a previous hip injury
- Special genetic and in-born conditions like hip instability
- Irregularly active sportsmen and adventurers
Physical Therapy for Hip Pain
In general, it is observed that physical therapy benefits people suffering from hip pain by helping control symptoms and improving or restoring mobility. In many conditions, it not only aids in recovery but also curtails excessive dependence on painkillers. However, physical therapy shouldn’t be considered the solution to all hip pain problems and careful consultation with the physician is necessary to determine whether physical therapy would be helpful or not. Most of the time, if physical therapy fails to aid pain-relief and recovery, it can be taken as go-ahead indication for surgery.
Like in other conditions, a physical therapist tends to make a custom treatment plan for hip pain recovery based on the advice of the doctor and the capacity of the patient. For example, in post-surgery cases, the physical therapist may recommend a few sessions of on-site passive physical therapy, aided by multiple sessions of online physical therapy for hip pain. But for less severe cases, simple stretches and exercises may prove to be adequate.