Hip Pain

The hip is the classic ball and socket joint. Typical pains are felt at the front, deep inside the joint and are often to do with the cartilage surface including arthritic changes (hip

arthritis) or the fibrous tissues around the joint like the labrum and bony impingement issues. These are felt as deep pinching type pains. Pains nearer the surface are commonly to do with the numerous tendons.

The side of the hip can be very sore to lay on and are to do with tendon problems as well as bursa issues around the hip bone itself. (Trochanteric Bursitis)

At the back are the big gluteal muscles and tendons which are stubborn sporting injuries as well as deeper nerve and muscle type problems sometimes related to the back and pelvis as well as the deeper muscles and the nerves that pass through this area.

Case courtesy of Dr Thuan Tzen, Koh, Radiopaedia.org. From the case rID: 42600

It is suggested that hip pain is a ‘hangover from evolution’.

Dr Paul Monk, of the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, took 300 ancient specimens from the Natural History Museum in London and Oxford, and the Smithsonian Institution in Washington to create a library of 3D models, and spot changes to the shapes of single bones over millions of years. The findings show that the so-called neck of the thigh bone grew broader to support the extra weight as we evolved. However, studies show that the thicker the neck of the thigh bone, the more likely it is that arthritis will develop.

Scientists say this is one potential reason why humans are susceptible to so much hip pain. But they say it is not all bad news – the right physiotherapy and working on maintaining a good posture can help mitigate some of the downsides of our design. Link here to Paul Monk.

  • Lateral

    The hip bone (femoral head or Greater Trochanter) has a lot of strong tendons attaching to it from the gluteal as well as the Iliotibial band passing over the top of it. The tendons can become strained and inflammed and give a deeper lateral hip ache. They are deep so it can be hard to get your fingers onto it.

    The Iliotibial band has a bursa (fluid-filled sack) between it and the hip bone to absorb the friction caused as it slides back and forth as we walk. If the band gets tight with prolonged sitting or biomechanical changes the bursa gets inflamed and it is very tender to press and lay upon. It gives a deep ache when sat as well as sore to get moving. This is called Trochanteric Bursitis and most-commonly occurs in sedentary people between the ages of 40 to 60 years. This is often confused with gluteal tendon pain and accurate diagnosis is important. This paper describes the findings of an MRI study.

    Treatment for this is manual therapy, resolving the tightness that is causing the increased friction and strength around the glutes. Shockwave can be very useful too as shown in this research paper on shockwave for Trochanteric Bursitis.

    Occasionally you can get a muscle strain around here, sometimes off the rim of the pelvis, but not often.

  • Front

    Most arthritic change is felt deep in the front of the hip. This is an ache and sharpness on movement which limits weight bearing and range of motion such as rotation and flexion especially.

    However, there are a number of sporting type injuries in the younger athlete which arise as pain deep in the joint when running or lunging. This is particularly felt when hugging the knee to the chest or taking it across the body. These are things like hip impingement often called Femoral Acetabular Impingement and can involve bony changes such as CAM deformity of the neck of the femur.

    More superficial pain, when walking or running, is usually due to tendon issues in the numerous muscles such as sartorius, rectus femoris (RF) and tensor fascia lata (TFL), as well as the deep bursa like Psoas. These are common in sportsmen and women and can be hard to settle if not treated properly.

    The front of the pelvis is obviously here and a more deep and central pain or pain at rest can be to do with bony changes such as stress fractures or osteitis pubis. Hernias affect the nerves in the front of the hip and can give a number of different symptoms which often defy standard diagnostics.

  • Back

    The gluteal tendon is sore to sit on as well as to run. This is a deep pain in the lower buttock.

    The hamstring tendon sits adjacent to this and is often confused or misdiagnosed as sciatica or muscle strain. It is a long term issue that takes ages to clear so get it seen!

    The sciatic nerve passes through the back of the joint and can, in itself, cause pain, sometimes referred from the back, as well as be pinched by muscles such as piriformis. This is something called piriformis syndrome and can give odd symptoms like restless legs at night. Piriformis can be tight constantly and this is caused by problems with the pelvis and the Sacro-iliac joint. It is commonly missed in runners as the cause of many issues lower down the leg.