There are several things that may be causing your hip pain, and finding out which one it is will involve a thorough examination from a specialist. Some of the factors that may determine the cause of your hip pain include your age, where the pain is located, how long the pain has lasted, how the pain feels, and how severe it is.
For example, in young adults, hip pain most often occurs due to strain, sprains, contusions, or bursitis. In older adults, osteoarthritis and fractures tend to be the most common cause.
The treatment you receive for your hip pain will depend on what is causing it.
Some common causes of hip pain include:
- Hip impingement
- Piriformis syndrome
- Labral tears
- Rheumatoid arthritis
We will take a closer look at some of these causes of hip pain below.
You may have a fracture if:
- You feel a sudden and sharp pain when placing weight on your leg or when rotating your hip externally
- You are unable to put your full weight on your foot
- You have experienced trauma that impacted your hip
People over the age of 50 are at an increased risk of hip fractures. Usually, hip pain from a fracture is felt in the front side of your hip and groin. In addition to hip pain, you may also have lower back pain and/or knee pain.
Your leg may also look shorter due to the foot being turned outwards at an odd angle. Your physician will need to perform a clinical examination and take some scans before diagnosing a fracture.
Stress fractures, which are very fine fractures due to repetitive overuse, usually occur in athletes or people with lower bone density due to other conditions such as osteoporosis. The symptoms of a stress fracture consist of a feeling of muscle strain or tendonitis in your hip.
If a fracture is found, treatment is usually surgical. Your consultant may use the surgery to strengthen and stabilise your hip bone, or you may need a hip replacement.
This is the most common cause in adults over 50 years old. Osteoarthritis causes constant, deep pain and stiffness that gets worse if you stand for longer and put weight on your affected leg. You may develop a limp as a result and have reduced mobility in your hip. Pain may get worse if you try to rotate your hip.
Treatment for osteoarthritis of your hip usually include changes in lifestyle, specific exercises that relieve hip pain, or using a walking aid. Paracetamol or NSAIDs (non-steroidal anti-inflammatory drugs) may also help with mild and moderate to severe pain, respectively.
If the pain is severe, your consultant may prescribe the use of opioid medication in the short term. Finally, hip replacement is the last treatment option, which offers good, long-lasting results.
Rheumatoid arthritis (RA)
Rheumatoid arthritis (RA) is an inflammatory joint disease. When RA affects the hip joint, you may experience pain and stiffness in the morning or after prolonged periods of rest. The pain tends to get better with movement.
Treatments for RA include NSAIDs, steroids, and other disease-modifying drugs specifically for RA. The treatment may also be applied locally, in the form of hip injections.
The labra are cartilages that surround the rim of your hip socket, within your hip joint. If you have hip pain from labral tears, you may feel a dull or a ‘knife sharp’ pain in your groin, have a painful clunk or clicking in the hip joint, a snapping hip, or a painful ‘giving way’ sensation.
Pain from labral tears is usually felt at the front of the hip, near the groin. However, labral tears may also cause hip pain on one side and pain that radiates down the leg to the front of the thigh or buttock.
Treatments for labral tears include rest, NSAIDs such as aspirin or ibuprofen, physical therapy, or cortisone injections.
Surgical treatments for labral tears will depend on what caused the tear. They include arthroscopy or hip replacements for more severe cases.
Femoroacetabular impingement, or hip impingement
Hip impingement more commonly affects young and physically active people. The pain is usually gradual and tends to get worse with sitting, getting up from a seat, getting in and out of a car, walking up a hill, or leaning forward.
In femoroacetabular impingement, bones rub against each other due to a structural problem, causing pain.
Treatments for impingement include rest, avoiding the physical activities that make the pain worse, taking NSAIDs or cortisone injections. Surgery such as arthroscopy or osteotomy may also be recommended, as well as hip replacement for more severe cases.
The bursa is a sac filled with fluid near the hip joint. Each hip has two bursae.
Inflammation of these bursae can lead to hip pain in two different types of bursitis:
- Iliopectineal bursitis — can cause hip pain in the groin area, where the groin feels tender to touch
- Bursitis trochanterica — a very common condition that typically causes hip pain on one side along with tenderness to touch in the outer side of the hip
Bursitis is often caused by repetitive movement or an injury.
Osteonecrosis of the hip (or avascular necrosis of the femoral head)
Avascular necrosis of the femoral head, often called osteonecrosis of the hip, is a condition in which the bony tissue dies due to a lack of blood supply to the head of the femur (the thighbone).
Osteonecrosis tends to affect young adults under 50 years of age. It also affects men more than women. Other underlying conditions can trigger osteonecrosis, although in many cases no underlying cause can be found.
Osteonecrosis tends to cause hip pain that is gradual and that gets worse when walking. It can show no signs on an X-ray for weeks or even months. The hip pain is usually felt in the groin area, but it can radiate down the leg to the thigh.
Osteonecrosis can progress; hip pain at rest is a sign that it may be at an advanced stage. Moving the hip may be easy to do in the early stages of the condition, but this will be limited in more advanced stages.
The most effective treatment options for osteonecrosis involve surgery.
Strains and tendonitis
A strain is acute damage to the muscle or tendon, while tendonitis is when a tendon swells (becomes inflamed) after a tendon injury. Tendonitis is usually caused by chronic overuse of a joint.
Hip pain from a strain is felt in the medial thigh or the front of the groin area. Squeezing something between the knees may cause pain. The strain can be hip flexor strain, groin strain, or hamstring strain.
Hip flexors are a group of muscles located toward the front of the hip. They help you lift your knee up towards your body.
Hip flexor pain is felt in the front area where the thigh meets your hip. A strain in the hip flexors may cause pain in the front of the hip, difficulty walking, getting out of a seat, climbing, and so on. The front of the thigh may have some swelling.
Hip pain from strains and tendonitis tends to improve with rest, applying ice, and avoiding activities that cause pain. Your consultant may recommend physiotherapy, which includes mild exercises and stretching. NSAIDs may also help relieve the pain immediately after the strain.
Surgery is reserved for severe tears in the tendons and severe muscle strain.
Piriformis syndrome is a condition that occurs when the sciatic nerve is irritated by the piriformis muscle. Piriformis syndrome can cause a sciatica-like dull pain in the hip and buttock that gets worse when sitting or walking. The hip pain can irradiate down the back of the leg.
Piriformis may result from a trauma to the buttock or from prolonged sitting.
Treatment includes stretching exercises that your consultant may prescribe, NSAIDs, rest, and correcting the activity that caused the syndrome and pain.
Other causes of hip pain
Hip pain may also be caused by:
- Neurological disorders such as Meralgia paraesthetica
- Tumours (either benign or malignant) and cancer lesions
- Septic arthritis — this is a medical emergency characterised by serious pain on movement, complete inability to bear any weight on the leg, feeling severely ill, and having a fever.
Your consultant will perform a thorough examination to exclude the above causes.
Hip pain and referred pain
It is important to note that pain that is felt in the hip can sometimes signal a problem with another organ or part of the body altogether. This ‘referred’ pain that is felt in the hip may reflect an issue in the lower back or even in the knees.
Moreover, there are major blood vessels and nerves that go across the hip on their way from inside your abdomen and to the periphery of your legs. Because of this, urological, gynaecological, and gastrointestinal problems can also cause ‘hip pain’.