Conquering Hip Pain

If you've ever experienced hip pain, you're not alone.

It's a common issue that can stem from various causes, such as hip bursitis, osteoarthritis, piriformis syndrome, lower back problems, and labrum tears.

As a seasoned Physical Therapist, I want to empower you to understand these conditions, their risk factors, symptoms, and how to differentiate between them.

You will also learn what activities and exercises to avoid to prevent the worsening of these conditions.

Lastly, I'll provide some practical advice on home treatments you can do to get relief.

Part 1: Hip Pain Explained: Causes and Symptoms

Hip Joint Structure and Major Muscles

The hip joint is one of the most important and complex joints in your body. Think of it as a powerful connector that links your upper body to your lower body, helping you to move smoothly and maintain balance.

The hip joint is a ball-and-socket joint. This means it has a part shaped like a ball (the head of the femur or thigh bone) that fits neatly into a matching socket (the acetabulum) in the pelvic bone.

This design allows the hip joint to move in various directions: forwards and backwards, side-to-side, and rotation inwards and outwards. It is a highly flexible joint but also very stable, thanks to the robust network of muscles, ligaments, and tendons that surround it.

Major muscles that support and move the hip include:

1. Gluteal Muscles (Glutes): These are the muscles in your buttocks. The gluteus maximus, the biggest muscle in the human body, helps extend and rotate the hip. The smaller gluteus medius and minimus are important for hip stabilization and moving the leg away from the body (hip abduction).

2. Hip Flexors (Iliopsoas): These muscles are on the front of your hip and help to lift your knee towards your chest (hip flexion). They also play a role in maintaining posture.

3. Adductor Muscles: Located on the inner thigh, these muscles pull your legs together (hip adduction).

4. Quadriceps: These muscles, located on the front of your thigh, extend the knee and work with the hip flexors to lift your knee towards your chest .

5. Hamstrings: Located on the back of your thigh, these muscles work to bend your knee and move your thigh backward (hip extension).

All these muscles and the hip joint work together seamlessly when you're walking, running, standing up, sitting down, bending over, or even just standing.

A healthy hip joint is vital for maintaining mobility and an active lifestyle.

Common Causes of Hip Pain

Hip Bursitis and Tendinitis

This condition is inflammation of the bursa, a small fluid-filled sac that cushions your hip joint, or the tendons, bands of fibrous tissue that connect muscle to bone.

Hip bursitis/tendinitis often results from repetitive stress injuries or trauma and presents with pain during activities and at rest.

Osteoarthritis

Osteoarthritis is a degenerative joint disease that involves the wearing down of the protective cartilage that cushions the ends of your bones, leading to bone rubbing against bone.

Osteoarthritis risk factors include age, obesity, prior joint injury, and genetic predisposition.

The condition typically presents with joint stiffness and dull aching pain that worsens with activity.

Piriformis Syndrome

This neuromuscular condition happens when the piriformis muscle compresses the sciatic nerve, causing pain, numbness, or tingling in the buttock and down the back of the leg.

The piriformis is a small muscle located deep in the buttock region. It runs from the lower spine to the upper thigh bone, just below the hip joint.

The main function of the piriformis muscle is to help with rotating the hip joint outward, away from the body. It also helps keep the hip joint stable during movements like walking and running.

When piriformis becomes tight or inflamed, it can compress the sciatic nerve, which runs beneath it. This can cause pain, tingling, or numbness in the buttock and down the back of the leg.

Piriformis syndrome can be caused by prolonged sitting, unsuitable exercise, or injury. The pain is often intense and located in the buttock, with possible radiating leg pain.

Lower Back Problem/Sciatica

Sometimes, a lower back problem can refer pain to the hip.

Sciatica, which is irritation of the sciatic nerve that runs from the lumbar spine (lower back) to the legs, can often mimic hip pain.

Lower back problems and sciatica are usually associated with poor posture, heavy lifting, and prolonged sitting. In my articles “Sciatica and Herniated Disks: What You Need to Know Part 1 and Part 2” you can find causes, symptoms, and treatment options for herniated disks and sciatica.

Sacroiliac (SI) Joint Inflammation

The sacroiliac (SI) joints are located where the base of the spine (the sacrum) meets the pelvis (the ilium). They play a critical role in transferring the load from your upper body to your lower body and vice versa. These joints can become inflamed and painful, a condition known as sacroiliitis.

When the SI joint is inflamed or dysfunctional, the resulting pain can often be mistaken for hip pain. This is due to the proximity of the SI joint to the hip joint and the complex interplay of muscles, nerves, tendons, and ligaments in this region.

Moreover, SI joint dysfunction can lead to gait changes, like limping, that might cause additional strain on the hip joint and muscles around it, exacerbating the pain and discomfort.

Labrum Tear

The labrum is a type of cartilage that surrounds the socket of your hip joint.

Labrum tears can occur due to injury, structural abnormalities, or repetitive motions, often causing a deep, aching pain in the groin area, and, sometimes, a locking or clicking sensation in the hip joint.

Hip Avascular Necrosis (AVN)

Avascular necrosis is also known as osteonecrosis, which literally means "bone death".

In the context of the hip, avascular necrosis occurs when the blood supply to the femoral head (the ball part of the ball-and-socket hip joint) gets disrupted.

When the blood supply to the femoral head is disrupted, it starts to "starve." This lack of blood causes the bone to weaken and eventually collapse.

And just like a machine with a broken part, a hip joint with a collapsed femoral head can't function properly. This results in pain and limited movement.

The disruption of blood supply can happen due to several reasons, such as fracture or dislocation of the hip joint, excessive alcohol consumption, prolonged high-dose steroid use, and certain medical conditions like sickle cell disease.

Insertional Hamstring Tendinitis

The hamstring is a group of muscles at the back of your thigh. They play a significant role in many movements, like bending our knees or extending our hips.

One end of these muscles attaches to the bottom part of our pelvis, at a spot known as the "ischial tuberosity".

The ischial tuberosities are often referred to as "sitting bones" or "seat bones" because they bear most of the body weight when we sit.

These are the two large bony protrusions at the bottom of the pelvis that you can feel when you sit down, especially on a hard surface. They serve as the attachment points for several muscles, including the hamstrings, and play a critical role in walking and running.

In the case of insertional hamstring tendinitis, the point where the hamstring muscles attach to the pelvis becomes irritated or inflamed due to overuse or strain.

This overuse could be due to repetitive or excessive high-intensity activities like sprinting, jumping, or sudden starts and stops.

This irritation causes pain and tenderness in the buttock area and can sometimes lead to swelling. The pain may increase when you perform activities that involve hamstring muscles, like climbing stairs or accelerating while running.

Muscle Imbalance and Hip Pain: Understanding the Connection

Muscle imbalances around the hip can significantly contribute to hip pain. An imbalance occurs when some muscles are overly tight, while others are weak, disrupting the harmony of muscle forces around the joint.

The key players in maintaining hip stability and mobility include; the gluteus maximus (the largest muscle in the buttocks), the piriformis (a small muscle located deep in the buttock), the hip flexors (a group of muscles at the front of the hip), and the adductor and abductor muscles (muscles on the inside and outside of the thighs, respectively).

Gluteus Maximus

When the gluteus maximus is weak or underused, it can't effectively perform its role in extending and externally rotating the hip. This can put increased pressure on the smaller muscles, like the piriformis, leading to overuse and pain.

Piriformis

If the piriformis muscle becomes overly tight or spasms, it can press against the sciatic nerve, causing piriformis syndrome. This condition can mimic hip pain.

Hip Flexors

When hip flexors (such as the iliopsoas muscle) are tight, they can pull the pelvis forward into an anterior tilt. This change in alignment can put extra strain on the hip joint and the lower back, potentially causing pain.

Adductors and Abductors

If the adductor muscles on the inner thigh are stronger than the abductor muscles on the outer thigh, the imbalance can lead to abnormal hip mechanics, potentially causing conditions like hip bursitis or hip impingement.

Addressing these imbalances with targeted exercises can help restore harmony around the hip joint, improving function and reducing pain.

Unmasking the Hip Pain: Where and How Does It Hurt?

Hip Bursitis/Tendinitis

Pain from hip bursitis or tendinitis typically presents as a sharp, intense sensation located at the point of the hip and often extends to the outer thigh.

The pain usually worsens with activities like walking or climbing stairs and can be severe enough to disturb sleep.

It may become a dull ache during rest or when pressure is placed on the affected hip, like when lying on the painful side.

Osteoarthritis

The pain from hip osteoarthritis is often a deep, dull ache felt in the groin, buttock, or thigh, and may radiate down to the knee.

It usually starts gradually, initially appearing after physical activities and disappearing with rest. As the condition progresses, the pain can persist even at rest and disturb sleep.

The hip joint may also become stiff, particularly after extended periods of inactivity, like when waking up in the morning.

Piriformis Syndrome

Pain from piriformis syndrome is often described as a deep ache or tightness in the buttock, which can radiate down the back of the thigh, often mimicking sciatica.

It can be triggered by sitting for long periods, walking, running, or climbing stairs.

The pain may be accompanied by tingling or numbness that extends down the leg.

Lower Back Problem/Sciatica

Lower back problems can refer pain to the hip, causing discomfort in the buttock, hip, or outer thigh.

Sciatica, specifically, often presents as a sharp, shooting pain that starts in the lower back or buttock and travels down the back of the leg.

The pain is often accompanied by numbness, tingling, or weakness in the affected leg. Certain movements, like bending over, coughing, or sneezing, can exacerbate the pain.

SI Joint Inflammation (Sacroiliitis)

The pain from sacroiliitis is typically located in the lower back, buttocks, and thighs.

However, it can radiate down the back of the leg (similar to sciatic pain) or even toward the groin and hip area.

The pain may be worsened by movements like climbing stairs, running, or standing up from a seated position - activities that put stress on the SI joints.

Labrum Tear

A labrum tear usually causes deep, aching pain in the groin or the front of the hip.

The pain often worsens with physical activity, particularly movements that involve twisting or pivoting on the affected hip.

Some people also report a locking, clicking, or catching sensation in the hip joint, particularly when moving the hip. This is due to the torn labrum being caught between the bones of the hip joint.

Avascular Necrosis (AVN)

The pain from hip AVN can be felt in a few different locations:

• Groin: This is the most common site for pain due to hip AVN. The pain typically starts in the groin area because this is closest to the hip joint.

• Hip: Pain can also be felt in the hip joint itself, especially with weight-bearing activities like standing or walking.

• Thigh or Knee: In some cases, pain can radiate to the thigh or even down to the knee. This can sometimes lead to misdiagnosis because the pain is felt far from the hip joint, where the problem actually resides.

Insertional Hamstring Tendinitis

Here's where you would typically feel pain with insertional hamstring tendinitis:

• Buttock area: The primary area of pain is the lower buttock region, where the hamstring muscles attach to the ischial tuberosity.

• Posterior Thigh: The pain can also radiate or extend down the back of the thigh along the course of the hamstrings, especially during or after activity.

• Pain with Sitting: Due to the location of the injury, sitting for prolonged periods, especially on hard surfaces, can aggravate the pain.

Understanding where and how pain manifests in these different conditions can help in their early identification and prompt treatment.

!!! However, it's essential to consult a healthcare professional for a definitive diagnosis, as these symptoms can overlap, and the pain can sometimes be referred from other parts of the body !!!

In Part 2 you will find out what activities and exercises to avoid if you have hip pain.

You will also learn specific, easy-to-follow, home treatments to get relief fast.

Disclaimer

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