Hip pain in adults causes, symptoms, and treatments

The hip is a ball-and-socket joint that is inherently stable because of its bony geometry and strong ligaments, allowing it to resist significant increases in mechanical stress.

Pain or discomfort felt in or around the hip region can be due to several reasons. List of hip pain causes can be the following but not limited to:

• Problems in bone or cartilage: 
  • Hip fractures: seen more commonly in geriatric population. 
  • Infection of the bone or joints.
  • Osteonecrosis of the hip (due to loss of blood supply) 
  • Rheumatoid or Osteoarthritis of hip 
  • Ankylosing spondylitis 
  • Labral tear of the hip
  • Femoral acetabular impingement
  • Hip dislocation
• Pain around the hip may also be caused by problems such as: 
  • Hip ligament sprains 
  • Iliopectineal or trochanteric bursitis 
  • Hamstring strain
  • Iliotibial band syndrome
  • Hip flexor strain
  • Groin/adductor strain 
  • Snapping hip syndrome

(https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/hip-pain) 

Problems in the lower back i.e. lumbo-sacral region can refer pain in the hip. Other causes, which can refer pain in the hip region may include tumor in the pelvic region, sciatica, fibromyalgia and health conditions of the abdominal-pelvic region. For accurate diagnosis, it is best to work with your doctor or a healthcare professional. 

How can hip pain be avoided? 

• Wear the right protective equipment prior to a sport or strenuous physical activity.
• Try to find modified ways to accomplish tasks.
• Stretch and warm up adequately before tasks and cool down after the activity. 
• Give body adequate rest and recovery time after strenuous activity or an intense sport. 
• Make sure that the home and work space are clutter free to avoids trips and falls.
• Use assisted mobility equipment if balance is poor.
• Pace your exercises and substitute impact activities to lesser or no impact for e.g. swim instead of running. 
• Use good fitting shoes with cushion during physical activities.
• Correcting dysfunctional lower body biomechanics for e.g. using arch support for flat feet. (https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/hip-pain) 

What are the treatments for hip pain?

Hip pain can be managed at home using following methods:

• Resting and avoiding painful or aggravating activities.
• Icing or cold compress for 15-20 minutes two to three times daily. 
• Compression bandage or sleeve can help control swelling around the hip.
• Elevating the hip above heart level using pillows or cushion helps reduce peripheral swelling. (https://my.clevelandclinic.org/health/symptoms/21118-hip-pain) 
• Taking over-the-counter pain medication like ibuprofen or acetaminophen.
• Sleeping on non-painful side with pillow between the legs.
• Losing weight if obese or overweight.
• Avoid standing for long duration and if unavoidable, using cushioned footwear and being aware of equal weight distribution on both feet. (https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/hip-pain) 

When to seek medical help?

It is always advisable to get appropriate diagnosis from a healthcare provider prior to avoid complications. However, in case of following signs and symptoms one should seek immediate medical attention:

• A joint that appears deformed or out of place or a leg that appears shortened.
• Inability to move your hip or leg.
• Inability to bear weight on affected extremity.
• Intense pain.
• Sudden swelling.
• Fever, chills, redness or signs of infection.

Which hip conditions can be treated by physical therapist? 

Few of the following conditions are likely to benefit with physical therapy intervention:

Hip osteoarthritis: Osteoarthritis, the most common type of arthritis, is caused primarily by age-related wear-and-tear that involves the deterioration of the smooth outer covering of bone, known as cartilage.

Hip osteoarthritis can occur when cartilage in the hip joint wears away, leaving less protection for the bones. When bones rub against one another, this can cause damage and result in pain around the hip joint. Ultimately the hip joint may fail causing significant limitation to mobility. (https://brighamandwomens.org/orthopaedic-surgery/osteoarthritis-of-the-hip) 

2. Hip flexor strain: The hip flexor muscles are in the front of the thigh. They are made up of the iliopsoas, sartorius, and rectus femoris muscles. They allow the hip to lift up, or flex. Muscle attaches to bone via a tendon. A hip flexor strain occurs when the muscle and tendon attached to the pelvic bone are injured. It may be a partial or a full tear of any, or all, of the hip flexor muscles. A strain is graded from 1 to 3:
   1. Grade 2 – is a moderate strain. There is tearing of fibres within the body of the tendon, where the bone and tendon meet, or where the muscle and tendon meet. The tendon is longer, and there is usually loss of strength.
   2. Grade 3 – strain is a full tear of the tendon. This is rare. (https://www.nationwidechildrens.org/conditions/sports-medicine-hip-flexor-strain#:~:text=A%20hip%20flexor%20strain%20occurs,1%20%E2%80%93%20is%20a%20mild%20strain) 

Sciatica: Sciatica refers to pain that travels along the path of the sciatic nerve. The sciatic nerve travels from the buttocks and down each leg.

Piriformis syndrome: Piriformis syndrome occurs when your piriformis muscle compresses

your sciatic nerve and results in inflammation. It can cause pain or numbness in your buttock and down the back of your leg. It can happen on one side of your body or both. (https://my.clevelandclinic.org/health/diseases/23495-piriformis-syndrome) 

Adductor/groin strain: Adductor strain or injury to the adductor muscle group is a common cause of medial leg and groin pain, especially among athletes. The adductor complex includes the three adductor muscles (longus, magnus, and brevis) of which the adductor longus is most commonly injured. All three muscles primarily provide adduction of the thigh. (https://www.ncbi.nlm.nih.gov/books/NBK493166/#:~:text=Adductor%20strain%20or%20injury%20to%20the%20adductor%20muscle%20group%20is,longus%20is%20most%20commonly%20injured.) 

Grade 1 – is a mild strain. There is a slight pull with tiny tearing. There is no loss of strength, and the muscle and tendon are the correct length.

Sciatica most often happens when a herniated disk or an overgrowth of bone puts pressure on the lumbar spine nerve roots. This happens "upstream" from the sciatic nerve. This causes inflammation, pain and often some numbness in the affected leg.

Although the pain associated with sciatica can be serious, those cases that are caused by a herniated disk can clear up with treatment in a few weeks to months. People who have severe sciatica and serious leg weakness or bowel or bladder changes might need surgery. (https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435) 

Hip dislocation: Hip dislocation occurs when the ball joint of your hip (femur) pops out of its socket (acetabulum). It’s a medical emergency. A dislocated hip is acutely painful and disabling. Immediate care reduces the chance of long-term complications. (https://my.clevelandclinic.org/health/diseases/22222-hip-dislocation)     

                  Anatomic components contributing to the hip's stability include the depth of the acetabulum, the labrum, joint capsule, muscular support, and surrounding ligaments. The major ligaments stabilizing the joint from directional forces include the iliofemoral ligament located anteriorly and the ischiofemoral ligament located posteriorly. Because the anterior ligaments are stronger, trauma to the hip commonly presents as a posterior dislocation when discovered (90% of cases). Dynamic muscular support includes the rectus femoris, gluteal muscles, and short external rotators. An understanding of the vasculature is important because trauma to the hip can displace the femoral head and interrupt the blood supply, leading to avascular necrosis (AVN). Branches from the external iliac artery form a ring around the neck of the femur, with the lateral femoral circumflex artery going anteriorly and the medial femoral circumflex artery going posteriorly. The major blood supply to the femoral head is the medial femoral circumflex artery. 

Research has shown significant improvements in gait and balance in patients who followed hip strengthening exercises program post hip arthroplasty. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10468294/) 

Including hip strengthening exercises in lower back pain and knee pain management also, has proven to show improved outcomes in pain and disability. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10536491/#:~:text=Among%20the%20966%20records%20identified,was%20assessed%20as%20%E2%80%9Cgood%E2%80%9D) 

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560005/)