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Hip pain symptoms

We uncover the range of symptoms that hip pain can cause and how it can impact your health

Hip problems and conditions can lead to symptoms such as swelling, stiffness and pain in your hips.

Hip problems could also cause pain in other areas of your body such as your buttocks, groin, knee or the muscles around your lower leg or thigh.

Men with hip conditions might also experience pain in their testicles.

Hip pain may be felt in several locations, depending on the exact nature of the condition. The hip joint surfaces are located deep within the groin region owing to the angled anatomy of the upper thigh-bone (femur). You may experience sudden sharp pain in hip comes and goes, pain from hip to knee, burning hip pain or back and hip pain.

Any joint based condition such as hip osteoarthritis, hip impingement or cartilage tears (labral tears) are often primarily felt in this region. However, these conditions may also be felt as a deep buttock pain. Hip joint conditions can also cause outside hip pain, as well as hip and thigh pain. In some cases hip joint conditions may be felt as knee pain rather than hip pain itself, or hip and leg pain.

Conditions affecting the soft tissue towards the outside of the hip (known as the trochanteric region), including trochanteric bursitis (hip bursitis pain) as well as a gluteal tendon problem, will normally be felt only in this region.

In certain circumstances, some may feel these conditions refer pain down the outside of the thigh and the front and outer knee area (hip pain radiating down front of leg). This may lead to left leg pain from hip to foot, or hip and knee pain together.

Other tendon problems with the upper hamstrings will be felt locally over the sitting bones, and hip flexor tendon problems locally at the front of the pelvis and groin area, causing hip and groin pain.

When you sit down, the lower spine and hip joints flex significantly. You may have hip pain when standing up from sitting position, rather than when sitting itself. Often this pain can be walked off after a few moments.

Due to the extra hip flexion needed, pain will often be worse with sitting on lower seats and particularly when sitting directly on the floor, as this also requires an element of hip rotation. Driving may also be particularly troublesome as this requires repetitive active hip flexion movements.

For those with particularly stiff hip joints, which may arise as the result of hip osteoarthritis or hip impingement syndrome, this has the ability to compress the front of the hip joint. Individuals suffering from gluteal tendon pain or trochanteric bursitis will also often aggravate their symptoms, as a prolonged flexed hip position causes stretching of the gluteal tendons and iliotibial band (which as a result also compress the hip bursa).

Several solutions are normally recommended, including raising the seat height to ensure that the hips lie slightly higher than the knees. Reclining the backrest slightly may also help reduce the hip flexion angle. Using a small stool with wheels, instead of needing to sit directly on the floor, may help for those working with young children.

Hip pain after exercise may manifest for a number of different reasons, but is often related to strength and flexibility problems with the hip joint or muscles around the pelvis and lower limb. You may feel hip pain radiating down leg to foot, pain only on one side such as left side hip pain, right side pain above hip or pain in lower left abdomen near hip bone.

Sports involving powerful accelerations, significant lateral and rotational movements and kicking often result in different problems. Inner thigh muscle (adductor muscle) and tendon strains are common due to repetitive overload.

Sometimes, inflammation to the pelvic bone rather than the tendon itself may result (a condition known as osteitis pubis). Treatment may focus on appropriate rest from the aggravating activity for a period of time and a gradual period of strengthening for the adductor and rotational muscles of the hip.

If an individual has some degenerative hip arthritis or an anatomy which may predispose to hip impingement syndrome, they may also get hip joint pain from sports involving significant lateral and rotational movements.

Road cycling may also aggravate these problems, as the hip is not able to accommodate the range of motion needed for these activities. Modifying the technique or taking up other sports will often be recommended under these circumstances.

If an individual has participated in a particularly unaccustomed exercise, or if they have returned to a particular exercise or sport following a long rest from the activity, they may suffer with severe delayed onset muscle soreness (DOMS).

DOMS refers to muscular and tendon pain which is felt due to micro damage to these structures as they heal following resistance exercise and power-based sports. This pain peaks at 48 hours post exercise and as part of the healing process the muscles and tendons heal in a stronger structure and are thereby protected from future DOMS as part of the training effect.

Some causes of hip pain may have associated symptoms such as clicking and popping. This can understandably cause worry for patients, but in the majority of circumstances, associated symptoms like these are nothing to worry about. It is thought the most likely cause of most joint clicks and pops is in fact due to a process known as cavitation.

Cavitation is caused by tiny air bubbles escaping from the joint fluid. This can occur when a joint has been static for a prolonged period of time and is then moved, thereby, compressing the fluid under high pressure forcing the air bubbles out.

In some cases of hip osteoarthritis, hip impingement syndromes and hip cartilage (labral) tears there may be circumstances where clicking and popping to the hip joint is due to a loose fragment being trapped within the joint (bone or cartilage), or if the cartilage tear is unstable.

Although the hip joint is an extremely stable joint, some people may develop an instability to the joint. For instance, those with genetic hypermobility syndrome who also engage in sports such as martial arts and dance that require extreme hip range of motion.

This may be associated with a hip cartilage (labral) tear and, subsequently, cause clicking and popping to the hip. Other associated symptoms may include giving way and an inability to weight bear on the affected hip.

If these symptoms occur on a regular basis or for a prolonged period you should seek medical advice through a consultation with a physiotherapist or orthopaedic hip specialist. Under these circumstances further tests and scans will normally be considered.

Specialists offering Hip pain symptoms

Mr Jeya Palan

Orthopaedic Consultant Surgeon

BSc (Hons), MB BS, PhD, FRCS (Tr & Orth)

The Huddersfield Hospital

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Mr David Wood

Consultant Orthopaedic Surgeon

MB ChB, MRCS, FRCS (Tr and Orth)

Thornbury Hospital

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