Why does my hip hurt?

Living with hip pain

If you're wondering 'why does my hip hurt?', you probably need an expert opinion to help tackle the cause of your hip pain. We've spoken with a range of talented consultant orthopaedic surgeons from Circle Health Group to explore 5 of the most common causes of hip pain, helping you to find out whether it's time to seek specialist help.

Hip pain is common, especially as you age and your joints become worn down over time, though many people suffer from hip pain after an accident or injury, which can happen at any age. Living with hip pain can be tremendously challenging, regardless of the cause. It can make simple, everyday tasks demanding, including driving, shopping, and even more basic household chores.

Some hip pain can come and go and be managed with regular painkillers and rest, while other types can be more long-lasting and difficult to deal with, making socialising, sleeping and staying active a constant struggle.

In our Joint Pain Matters survey, we found that 66% of people with joint pain struggle to sleep, 69% feel it negatively impacts their mental health, and 40% of people living with painful joints said that it affected not just them but the people around them too.

There are a variety of joint pain conditions that could be the reason behind the pain in your hip. There are also many effective treatment options available to help you manage and treat these, allowing you to return to a healthy and active life as usual. So, rather than putting up with pain, read our guide to hip pain causes and see if we can help you get back on your feet.

How does my hip work?

Your hip joint is a ball and socket joint that is essential to your ability to walk and move freely. It is formed by the upper part of your thigh bone (your femur), which sits inside the socket-like part of your pelvis, which is known as the acetabulum.

When your hip is working properly, it allows you a wide range of movements. It is also the joint that you use the most, absorbing the stresses and strains of daily life. Your hip is very durable, but like any other joint in your body, it can become damaged.

Damage to your hip joint is almost always what's at the root of pain in your hip. And if you are experiencing hip pain, you will often have related symptoms, too. The most common are inflammation or swelling in and around the joint, which might be accompanied by redness, tenderness or soreness. Your hip might be stiff, too, and many people find that they don't have the same range of movement as before, meaning they simply can't use their hip like usual.

Typically, all these symptoms are interrelated, and discovering and treating the cause of your hip pain will treat your other hip problems also.

1. Osteoarthritis

Osteoarthritis is the most common type of arthritis in the UK and one of the most common causes of hip pain and stiffness. It happens when the smooth cartilage across the surface of your hip joint wears down over time.

Cartilage is a connective tissue that protects your joints and bones. It's strong and flexible and acts as a shock absorber in your hip joint, as well as preventing your bones from rubbing together. As it wears down, the other elements in your joints lose protection and cushioning. They rub together and, over time, they wear down. All this contributes directly to hip pain and stiffness.

Consultant Trauma and Orthopaedic Surgeon Mr Bhupinder Mann explains:

"Often a result of 'wear and tear' and simply getting older, hip osteoarthritis occurs when the layer of cartilage degenerates. Although it's usually an age-related condition, it can arise at any age, particularly if there is a family history of hip problems or there has been previous injury to the hip."

There are other forms of arthritis, including rheumatoid arthritis and septic arthritis, but osteoarthritis is a more common cause of hip pain.

Consultant Orthopaedic Surgeon Mr Simon Garret says: "Having hip pain can be scary, particularly if it's affecting your ability to walk and go about your everyday life with ease. But by far the most common cause of hip pain I see is arthritis, which is the essentially wearing away of the normal, smooth cartilage inside your joint."

2. Rheumatoid arthritis (RA)

This is an inflammatory joint condition caused by an autoimmune process, which happens when your body attacks its healthy cells by mistake. Mr Mann explains that this often causes pain, swelling, and inflammation in your joints, which can dramatically affect your ability to move. Joints affected by RA are commonly surrounded by inflamed tissue, which often results in chronic pain. People with rheumatoid arthritis often experience it in both their hip and their knees.

Mr Pierre Nasr, consultant orthopedic surgeon at Three Shires Hospital, explains that the cause of rheumatoid arthritis is unclear:

"At the moment, it's unclear what causes rheumatoid arthritis. We understand what causes inflammation, which happens when your body attacks itself, but we do not understand what triggers the process as a whole. Studies suggest there may be genetic and environmental triggers involved, which could affect people with genes that predispose them to developing RA. The strongest associations with genetic environmental triggers include gender (female) and having a family history."

• Mr Pierre Nasr answers more of your questions about rheumatoid arthritis.

3. Hip bursitis

The bursae are fluid-filled sacs that act as cushions between your bones and tissues, preventing the build-up of friction as the separate parts of your joint move against one another. If a bursa becomes inflamed, it produces more fluid, causing it to swell. This can cause hip bursitis with pain and stiffness in your hip, as well as a clicking noise when you move your hip.

4. Hip injuries

Hip injuries can damage your hip bone (as they can damage any joint), causing pain and swelling. Sometimes this can resolve on its own with painkillers and rest, and in other instances you might need medication or even surgery to repair the damage to your hip.

Although osteoarthritis is the most common cause of hip pain as we get older, in younger people it is less common, so if you are under 40 and experiencing hip pain, it may be due to an injury.

While many hip injuries happen suddenly and have an obvious cause, others – known as overuse injuries – develop over time and the cause may be less clear. Common hip injuries include hip fractures, hip dislocation and hip labral tears.

Hip fractures

A hip fracture is when a crack appears at the top of your thigh bone (femur). Hip fractures are usually caused by an injury, for example during contact sports, or a traumatic accident, such as a road accident. Another common cause of hip fractures is having a fall.

A hip fracture should be treated as soon as possible, usually at an A&E department. If the break is particularly bad you might need surgery to help the bones heal.

Dislocated hip

Hip dislocation happens when the head of your thigh bone is forced out of its socket in your hip bone. This can cause severe pain and lack of mobility. If you dislocate your hip, you will usually have to have it put back into place under general anaesthetic (where you're asleep). In some cases a surgeon will need to make incisions (cuts) into your hip to help them reposition the bones correctly.

Hip labral tears

A labral tear is a common injury that can happen to your hip. This type of hip injury is often associated with sports such as golf, football or hockey. This is because these activities involve sudden movements and twisting or pivoting motions, which are the most common reason for injury to the hip labrum. (The labrum is a specific piece of cartilage in your hip.)

Labrum tears can often be treated using non-surgical methods such as rest, medications and physiotherapy. But in some instances you will need surgery.

5. Hip impingement

This happens when the ball of your hip joint pinches against the cup of your hip and they no longer fit together properly. This can be due to changes in your bones which are a result of repetitive movement during sports.

Pain that radiates down your leg

Hip impingement often causes a sharp, stabbing pain deep in the front of your joint that radiates down your leg.

Mr Sebastian Dawson-Bowling, consultant orthopaedic surgeon at The London Independent Hospital, says:

"Impingement between the top of the thigh bone and the outside of the hip is more common in younger people. Another group of people with symptoms of impingement experience pain that feels like it's coming from their hip joint but is coming from the joint above (their spine) or the joint below (their knee)."

6. Tendonitis

Lastly, tendonitis can develop when your tendons and muscles are overworked, such as during repetitive movement playing sport. Tendonitis describes the swelling of your tendon, which is a fibrous connective tissue that attaches your muscle to your bone. If you damage a tendon in your hip joint, you might develop tendonitis, which could be the cause of the pain and swelling in your hip.

Treating hip pain without surgery

While living with hip pain can dramatically affect your quality of life, the joint pain conditions listed above are often very manageable. There are actually a wide variety of both surgical and non-surgical treatment options available for hip pain, and your consultant will usually try and use the conservative methods first.

Some non-surgical options include:

Switching up your lifestyle

Certain lifestyle factors can increase the risk of hip pain because they can affect your overall health. These include being overweight, smoking, having a poor diet, and not getting enough exercise.

Making small changes to improve your health will likely be the first advice you are given to try and reduce your joint pain. For example, losing weight can ease the pressure on your joints. Low impact exercises can strengthen the muscles around your hips as well as improving your flexibility. Following a healthy and balanced diet can also help you maintain a healthy weight.

Physiotherapy

Physiotherapy for hip pain involves learning and following a series of specialist exercises designed to strengthen the muscles around your hip, improving your mobility and – in taking the pressure of your hip joint - reducing your pain.

Physiotherapy can be a highly effective treatment and many people see amazing results. You'll work one-to-one with your physiotherapist to learn the exercises and follow them for the duration of your programme.

Hip injection therapy

Also known as steroid injection therapy, this treatment involves injections of steroid medication (corticosteroid) into your painful hip joint. This can effectively reduce pain and inflammation in your hip, and the effects can last anywhere from a few weeks to a few months. This form of pain relief may be recommended if you can't take oral anti-inflammatories for any reason.

Oral anti-inflammatories (painkillers)

These can either be prescribed by your GP or your consultant. They reduce swelling in your hip, which can reduce your stiffness and pain.

Treating hip pain with surgery

If damage to your hip is more severe, you might need surgery to repair the damage. Surgery for hip pain includes:

Total hip replacement surgery

Total hip replacement surgery is surgery to replace your damaged and painful knee with an artificial knee, also known as a prosthesis. It is a highly effective and long-lasting way of eliminating pain and treating joint pain conditions.

Hip arthroscopy

Hip arthroscopy is a minimally invasive, keyhole procedure during which your surgeon will insert a long tube with a small camera and light attached to the end of it (an arthroscope) into your hip joint through incisions (cuts) in your skin. This tube is connected to a monitor that displays images of the inside of your knee, so your consultant can examine and repair the inside of your hip without having to ‘open up’ the joint.

Everything you need to know about surgery for hip pain.

Don't live with hip pain

If you are struggling to understand why your hip hurts and would like to get help in diagnosing and managing your hip problems, our network of dedicated consultants is here to help.

We can help diagnose your pain and begin building you a treatment plan to suit your needs and get you back doing the things you love.

Call us or book online to speak to one of our brilliant and talented orthopaedic consultants.