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Hip pain

Find out more about the symptoms and causes of hip pain, as well as the benefits of personalised hip pain treatment at The Saxon Clinic in Milton Keynes

Hip pain is a common complaint that can affect individuals of all ages. If you’ve experienced long-term hip pain, you know it can significantly impact your physical and emotional wellbeing. The best way to treat your hip pain lies in the correct diagnosis of the cause of the pain.

The hip joint is the body’s largest ‘ball-and-socket’ joint. The top of your thigh-bone (femur) sits inside a hollow socket in your pelvis called the acetabulum. Your hip’s ball and socket joint allows a wide range of movement and gives stability to support the body’s weight.

A thick, soft tissue structure further supports your hip. It is made up of your gluteal muscles and the tendons that hold them in place.  

Although the hip joint is typically very strong and durable, it can be susceptible to injury, overuse and degenerative ageing. This article explores the symptoms, causes and treatments of hip pain, as well as the benefits of personalised hip pain treatment at The Saxon Clinic in Milton Keynes. 

Hip pain can come in many forms. Hip pain can feel like shooting pain, a dull ache, pain that radiates down the leg, pain in one or both hips, or pain that intensifies at night.

There are three main areas of the greater pelvis where you might experience hip pain:

  • The front includes pain in the groin, which might radiate down the front of the thighs all the way to the knee
  • The side (lateral hip), including the outer hip area
  • The back of your hips and buttocks

Localising your hip pain is a crucial first step in determining the cause.

Your doctor will start by asking about the location of your pain. They will then explore various factors, including:

  • Your age
  • If any activities caused your pain (an injury or fall)
  • How long you’ve had the pain
  • If it has gotten worse over time

A physical assessment of your leg and hip movement can help assess the degree of pain, stiffness and mobility that you are experiencng.

Most of the time, your family history, symptoms and physical examination should be enough to provide your diagnosis.

Sometimes further tests are needed for an accurate diagnosis:

  • X-rays give a view of the hip bone’s shape, contour and angle
  • CT scans (computerised tomography) provide a detailed 3-D image of your hips
  • MRI scans give a clear picture of the surrounding soft tissue around the hips
  • Ultrasounds can diagnose greater trochanteric pain
  • Blood tests can reveal if you have an infection or rheumatoid arthritis

Below, we’ll discuss some of the most common causes of hip pain, broken down by location.

If you feel pain in the front of your hips or your groin area, it could be because of arthritis, a hip fracture, a labral tear or hip impingement.

Osteoarthritis

For older adults, osteoarthritis (OA) is the most common cause of hip pain. Pain from hip osteoarthritis is located in the front part of the hip or the groin. It may feel deep, constant and aching. Pain and stiffness might cause difficulty performing everyday activities such as putting on your shoes or getting into and out of the car.

In osteoarthritis, your hip joint’s protective covering of cartilage is thinned and worn down, causing pain, stiffness and decreased mobility. It is not known what causes osteoarthritis, but it is considered a ‘wear and tear’ condition that can happen gradually as you age.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is an inflammatory joint disease that can cause pain, swelling and stiffness in the joints. It can affect any adult over 16, although it is more common in adults aged 40-60, and women are more commonly affected. 

Rheumatoid arthritis is an autoimmune disease, which means the body’s immune system attacks healthy tissue — in this case, the healthy tissue of the hip joint. The pain associated with RA may feel like a throbbing or aching pain that is worse after periods of inactivity, such as after sleeping or not moving for some time.

Treatment for rheumatoid arthritis typically involves anti-inflammatory medications and medications that target the body’s immune system.

Fracture

Hip fractures are cracks or breaks in the top of the femur close to the hip joint. They can be caused by a fall or other injury to the hip. Individuals over 65 are more prone to falls and fractures, and women are at even greater risk.

Hip fractures are serious injuries that require immediate medical attention. The National Institute for Health and Care Excellence (NICE) recommends that surgery should be performed no later than the day after hospital admission. In roughly half of all cases, hip replacement surgery is necessary.

If you have fallen or suspect a fracture, you should always seek immediate medical attention.

Labral tear

The labrum is a thick ring of cartilage that surrounds the rim of the hip socket (acetabulum).

A labral tear is when this tissue is damaged or torn. This can happen as a result of a fall or trauma, but often there is no known cause.

Pain from a labral tear is often felt in the groin. You might also experience a clicking or locking in place sensation in the hip joint. 

Labral tears can sometimes be treated non-surgically with rest, anti-inflammatories and specialised physiotherapy rehabilitation. Another option is keyhole surgery, called arthroscopy.

Hip impingement

Also called femoroacetabular impingement (FAI), hip impingement syndrome is when the top of the femur (the ‘neck’ of the femur) impinges against the rim of the socket (acetabulum).

This can result in the labrum becoming painfully pinched, called hip impingement. This typically causes a sharp pain upon some flexing and twisting movements, such as swinging your legs into the car. This can cause damage to the cartilage.

Hip impingement syndrome can be treated with anti-inflammatory pain medication, exercises and physiotherapy. 

Pain on the outer edge of the hips could be bursitis or injury to the muscles, ligaments, or tendons.

Sprains and strains

Hip inflammation and injury are common in many athletes. Hip strains or sprains can occur when the hip muscle (strain) or hip ligament (sprain) is stretched, torn or pushed beyond its limits. Hip sprains and strains can cause pain, swelling, tenderness or spasms that become worse when walking, climbing stairs or when stretching your hip muscles.

Hip flexor strains are common in individuals who use the lower part of their bodies in activities such as cycling, running, swimming, football and golf. Hip flexors are the group of muscles located on the front of the hip that help you flex your hips and bend your knees.

You can treat mild strains and sprains at home with rest, ice and anti-inflammatory medications.

Greater trochanteric pain syndrome

Greater trochanteric pain syndrome — sometimes known as trochanteric bursitis — is when you experience pain on the outside of the hip that can spread down the leg. It can be painful to sleep on the side of the affected hip.

If you have greater trochanteric pain syndrome, you might have bursitis or gluteal tendonitis.

Bursae are fluid-filled sacs that act as a protective cushion when you move your joints. When the bursa becomes inflamed, it can cause pain in the hip. This inflammation, called bursitis, is usually caused by overuse, trauma or repetitive activities that irritate the hip, but it can just as commonly happen for no apparent reason.

Gluteal tendonitis is when your gluteal tendons become inflamed. Tendons are strong tissues that connect your muscle to the bone. Like strains or sprains, tendons can become irritated by overuse and repetitive movements.

Read more about greater trochanteric pain syndrome and how to treat. 

Pain felt in the back of the pelvis or posterior of the buttocks could be a symptom of lower back problems.

When you experience pain in your hips that is a symptom of a condition from another part of your body, it is called ‘referred pain’. Referred hip pain could be a sign of back pain, sciatica, hernia or gynaecological problems.

Many patients worry that hip pain felt in the back of their hips and along their buttocks could be a symptom of sciatica. Sciatica is when the sciatic nerve in the lower back is compressed or trapped, sending radiating pain down the lower back, deep in the buttocks and down the leg.

Although you might experience referred pain in your hips, sciatica is not a symptom of any problem with your hip joint.

In addition to the more common causes of hip pain above, there are various less common causes of hip pain.

These include:

  • Avascular necrosis (AVN) – a rare condition in which blood supply to the top of the femur stops, causing the bone tissue and surrounding tissue to die.
  • Meralgia paralysis – causes numbness in the front of the thigh from a small trapped nerve in the groin.
  • Cancer lesions or tumours – typically accompanied by other symptoms in addition to hip pain.
  • Septic arthritis – a rare and serious condition in which the joints become infected. If you have sudden pain or swelling in one joint and feel feverish, you should call 111 for immediate advice.

You can treat hip pain that is mild or minor at home with painkillers, ice or heat and rest. But if your pain does not clear up in a few days, you might want to see a doctor.

You should see a medical professional if your hip pain:

  • Prevents you from doing your normal activities
  • Causes difficulty sleeping
  • Worsens or keeps coming back
  • Does not improve after two weeks of home care
  • Continues for more than 30 minutes after waking

You should seek urgent care if you have had a fall, suspect a fracture or if you have hip pain and feel feverish. 

Treatment for hip pain will depend on the cause and severity of your pain.

Mild to moderate symptoms can often be relieved at home with over-the-counter painkillers such as paracetamol and ibuprofen. Injuries to your soft tissues (muscles, ligaments or tendons) often improve with rest, ice and painkillers. 

If your pain does not improve after a few days, your doctor may recommend additional treatments. These can include:

  • Stronger painkillers – your doctor might prescribe stronger NSAIDs (non-steroidal anti-inflammatory drugs) to help your pain.
  • Physiotherapy – a physical therapist can recommend movements and exercises based on your specific condition that can help reduce pain and stiffness, increase mobility and strengthen your hip joint and muscles.
  • Steroid injections – an injection of corticosteroids into your hip can help relieve pain and inflammation.
  • Weight loss – being overweight can increase osteoarthritis pain. Just a small amount of weight loss can lighten the load on your hips, reducing symptoms of hip pain due to osteoarthritis.
  • Surgery – total hip replacement, also called hip arthroplasty, and hip resurfacing can improve the quality of life for those who suffer from long-term chronic hip pain.
  • Keyhole surgery (hip arthroscopy) – this minimally invasive surgery is performed by an orthopaedic surgeon who will access your hip joint via several small incisions around the joint. It is used to diagnose and treat several causes of hip pain, including labral tears and hip impingement syndrome.

The right hip pain treatment for you will depend on what is causing your hip pain.

When home treatment, painkillers and physiotherapy are not enough to treat chronic, debilitating hip pain, you might consider hip replacement surgery. Although common, hip replacement is major surgery and should only be considered after other alternatives have been exhausted.

Professor Oliver Pearce, Consultant Orthopaedic Surgeon at Circle Health Group’s Saxon Clinic (MBBS, FRCS), explains: “Hip surgery for hip replacement will be the right choice when the arthritis pains are just not responding to simple treatments anymore. I always call it ‘when you’re fed up’.

He goes on to say, “‘Fed up’ means something different to different people, but when you’re literally fed up, the painkillers aren’t working, the stick isn’t working, reducing your activity of the things that used to make it hurt isn’t working, the night pain is driving you around the bend… When you’re fed up with the pain of hip arthritis, then hip replacement is on the cards.”

The Saxon Clinic in Milton Keynes has been treating hip pain for more than 30 years.

The clinic’s team of dedicated and experienced hip consultants, orthopaedic surgeons, nurses and physiotherapists offer a bespoke and personalised service, from your first consultation through to your recovery.

Diagnosis

If you’re suffering from hip pain, you don’t need to wait months to get answers. The Saxon Clinic offers rapid access to appointments.

If your initial diagnosis requires additional diagnostics, the clinic has an on-site imaging suite. This includes X-rays, CT scans, MRI scans, and ultrasounds so that you can be diagnosed quickly and easily. 

Treatments offered

The hip consultants and physiotherapists at the Saxon Clinic offer a personalised approach to hip pain treatment. Your consultant will suggest a tailored treatment programme to help relieve your hip pain.

Treatments offered by the hip consultants at the Saxon Clinic include:

The hospital’s facilities include two operating theatres, 12 private consulting rooms, en-suite bedrooms, on-site imaging and physiotherapy gymnasium for inpatient and outpatient treatment. 

For those patients who are ‘fed up’ with chronic hip pain, hip replacement surgery at The Saxon Clinic can be the best solution to improving their quality of life.

The philosophy at The Saxon Clinic is focused on the idea of enhanced recovery and early mobilisation for hip or knee surgery. A rapid recovery programme, also called an enhanced recovery programme (ERP), is a continually evolving system change from the patient’s first clinic visit to their clinic discharge.

Professor Pearce is the National Lead for the Rapid Recovery Programme (RRP) for Hip and Knee Replacement. 

According to Professor Pearce, enhanced recovery means that every step in the patient pathway is optimised for pre-emptive pain relief and early mobilisation. “It’s evidence-based medicine in action.

That means preemptive pain relief, it means using pain modulating agents (as opposed to just painkillers) and preemptively giving anti-sickness agents. Everything that you offer the patient gives the most pain relief, the least side effects and the greatest ability to start mobilising and continue mobilising early every step of the way.”

Early mobilisation after surgery is the key to a quick recovery, improved patient outcomes, less pain and fewer complications. “It's tricking your body into thinking it’s not had a major surgery because this system enables you to get up early,” explains Professor Pearce.

“If you are lying in bed after a major injury, the body sets off a cascade of biological responses that makes you want to hibernate and wait to get better, but that comes at a cost of increased medical problems after surgery. Whereas if you mobilise early, a lot of those things just don’t happen.”

Specialists offering Hip pain

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Mr Atif Malik

Trauma and Orthopaedic Surgeon

MB ChB, MRCS Ed, MRCS Eng, MSc. (Ortho. Eng), MFST (RCS Ed), Dip. Clin. Ed (RCS Glasg), Dip. Football Med (FIFA), FRCS Tr & Orth, FACS

The Saxon Clinic 2 more The Kings Oak Hospital The Cavell Hospital

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Miss Jane Webber

Consultant Trauma and Orthopaedic Surgeon

MB BS(Hons), FRAC(Orth)

The Saxon Clinic

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Mr Julian Flynn

Consultant Orthopaedic & Trauma Surgeon

MA (Oxford University), MBBS (University of London), FRCS of England (Trauma & Orthopaedics)

The Saxon Clinic

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Mr Ahsan Sheeraz

Consultant Trauma & Orthopaedic Surgeon

MBBS, MRCS, PGDip, FRCS

The Saxon Clinic 1 more The London Independent Hospital

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Professor Oliver Pearce

Consultant Orthopaedic Surgeon

MBBS, MRCS (England), FRCS (Trauma and Orthopaedics), Visiting Professor University of Bedford (ISPAR), Visiting Professor University of Bedfordshire (Health Sciences), Visiting Professor Cranfield University (Materials Science and Manufacturing)

The Saxon Clinic

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