Causes of Hip Pain

The hips are the body’s largest ball-and-socket joint that are made to handle a fair amount of wear and tear as well as repetitive motion. However, pain in the hips is very common and can be caused by a variety of factors.

Arthritis

    • Arthritis is one of the most common causes of hip pain, particularly in older adults. The following forms of arthritis can lead to inflammation in the hip joint and breakdown of the cartilage that helps to cushion the hip bones. Any of these forms of arthritis can also cause stiffness and limited mobility of the hips. 
    • Juvenile Rheumatoid Arthritis (also known as Idiopathic Arthritis)
    • Rheumatoid Arthritis 
    • Septic Arthritis
    • Osteoarthritis
    • Psoriatic Arthritis (arthritis in patients with psoriasis)

Injuries

    • Trochanteric Bursitis is the inflammation of the small, fluid-filled sac on the outside of the hip joint known as the bursa. This is a common injury-related cause of hip pain. 
    • Hip fracture
    • Inguinal hernia
    • Sprain
    • Tendinitis (tendon inflammation)
    • Dislocation
    • Labral tear of the hip

Pinched Nerves

    • Meralgia paresthetica 
    • Sciatica
    • Sacroiliitis

Cancer

    • Metastatic cancer that has spread to the bones
    • Leukemia
    • Bone cancer 

Additional Causes

    • Avascular necrosis (death of bone tissue)
    • Osteoporosis
    • Synovitis
    • Osteomyelitis (bone infection)

Symptoms

The location of a patient’s hip pain is extremely valuable in identifying the cause of pain and the best options for treatment. Pain on the inside of the hip or the groin is typically indicative of problems with the hip joint itself. Pain on the outside of the hip, upper thigh, and buttocks are signs of problems with the muscles, tendons, ligaments, and soft tissue that surround the hip joint. The gluteus medius, gluteus maximus, iliotibial band, piriformis, psoas major, and adductors are all major muscles surrounding the hips. The hips are also closely related to the sacroiliac joints in the lower back. It’s not uncommon for patients to treat both the lower back and hips to help alleviate hip pain. Hip pain can be a direct result of injury or inflammation of any of these muscles that support the hips, or it can be referred pain as a result of lower back problems. 

Treating Hip Pain

For minor hip pain or the first line of at-home treatment, patients should prioritize rest. Avoid bending at the hip as well as direct pressure on the hip. In addition, patients can take over-the-counter pain medication such as Tylenol or Advil as well as alternate applying heat and ice to the painful area. 

If hip pain leads a patient to a pain management physician, they will likely go through the patient’s medical history and conduct a thorough exam to identify the cause of the pain. There are several non-surgical options available to help treat hip pain. Therapeutic ultrasound is a noninvasive procedure that uses sound waves to increase blood flow and relax muscle spasms, both of which aid in pain relief. A modified version of this treatment known as phonophoresis is when a medication, usually hydrocortisone, is added to the gel used for the ultrasound. One survey of physicians identified over 50% of survey respondents would use therapeutic ultrasound or phonophoresis to reduce inflammation in cases like bursitis or tendinitis. 

Cortisone shots are another effective way of treating inflammation. Cortisone shots are injected directly into the joint/site of pain. A type of x-ray called fluoroscopy is used to guide the needle to the proper location in the body and a corticosteroid medication is then released via the injection site. These medications have been proven to relieve pain and inflammation over time. Cortisone shots can only be administered in the same location three to four times per year, however, they are commonly used to provide relief for patients with bursitis, osteoarthritis, rheumatoid arthritis, psoriatic arthritis, and tendinitis.