Pain in the hip region is quite common and can affect any age group.
The presence of conditions leading to such pain can negatively affect mobility, participation in sporting activities and a person’s overall quality of life.
The hip transmits loads between the upper body, trunk and lower limb. It allows mobility of the lower limb and provides a stable base for us when standing.
The hip joint is formed between the acetabulum (socket) of the pelvis and the head (ball) of the femur (thighbone). These areas of contact in the joint are covered with cartilage.
The labrum is a ring made of a stiffer type of cartilage and connective tissue which is attached to the rim of the acetabulum. The labrum deepens the acetabulum and distributes the stress between the two bones over a larger area.
The arrangement of the bones of the hip allows for movement along three different paths. Stability is provided by multiple strong ligaments as well as multiple muscles. These muscles, along with others, are responsible for movement of the hip.
In general, causes of hip-related pain can be classified as anterior (in the front) or lateral (on the side of the thigh). A few common ones include:
· Osteoarthritis (OA)
· Femoroacetabular impingement (FAI)
· Tendon injuries
· Greater trochanteric pain syndrome (GTPS)
OA is a progressive disorder of the joints which leads to deterioration of the cartilage and new bone formation at the surface and margins of the joints. There is no inflammation in this disorder. Risk factors for OA in the hip include age, genetics, joint disorders in childhood, metabolic disorders and prior trauma.
Symptoms of hip OA include pain in the groin, stiffness, difficulty walking and increased pain with some activities such as getting into/out of a vehicle or sitting on the toilet.
FAI is a condition resulting from the presence of bone in abnormal areas on either the femoral head or acetabulum or both. The abnormal areas of bone make contact with other areas during specific movements, leading to pain and restricted range of motion.
The labrum and cartilage can be damaged when this process occurs repetitively and can possibly lead to OA of the hip. Symptoms of this condition include groin pain, a locking or clicking sensation, stiffness and decreased range of motion.
Common tendons injured around the hip include the adductor group (which work to close the legs) and the iliopsoas (which lift up the lower limb). The adductors are usually injured in a “groin strain” in a sportsperson.
Symptoms of injury of one of these tendons include groin pain which is worse with activity, possible decreased range of motion and decreased muscle strength.
On the lateral aspect of the hip, there are tendons of the gluteal muscles as well as bursae (small sacs of fluid) which protect the tendons and muscles from friction caused by rubbing on the greater trochanter (bony prominence).
Any of these structures (or a combination of structures) can be affected and cause pain on the side of the upper thigh. This condition is known as greater trochanteric pain syndrome (GTPS). This pain can extend down the side of the thigh and worsen while lying on the affected side or after walking or running.
Weakness of the affected muscles may also be present on examination. Risk factors for this condition include:
· Prolonged pressure to the hip area
· Repetitive movements (walking/running)
· Commencing unaccustomed vigorous exercise
· Standing on one leg for long periods
The rehab doctor can play a significant role in the management of hip related pain. A thorough evaluation (history and physical examination) leads to an accurate diagnosis.
The diagnosis can be confirmed with tests such as x-rays, ultrasound or MRI. In the case of OA, x-ray can also assist with judging the severity of the condition.
Management of hip-related pain requires pain management using oral or injected medications, a properly planned and executed rehabilitation programme for the diagnosed condition.
In cases of severe OA or other indicated conditions, a referral to an orthopedic surgeon will be made so that restoration of function can occur.
If you have hip-related pain which is not resolved after two weeks, you should have a thorough evaluation as your first step towards regaining optimal physical function.
(Dr. Shane Drakes is Specialist in Physical Medicine & Rehabilitation and Sports Medicine. He can be contacted at [email protected])