The causes of hip pain are multitudinous. In some cases, you know it was that awkward movement or long run that started the pain. But in other cases, hip pain can start gradually, and you’re not aware of the cause.

Many causes of hip pain can be treated with physical therapy

The cause of hip pain and symptoms can be hard to pinpoint because the anatomy of the hip is so complicated. There are a lot of potentially pain-causing structures packed into a very small region. And, considering that pain can also be referred here from other places, you start to realise why it’s a tough area to diagnose.

A thorough evaluation from a healthcare professional is key to getting a correct diagnosis and understanding your treatment options.

However, certain symptoms might give you a clue to the cause of your hip pain, and what steps you can take to relieve it.

Common Causes of Hip Pain

1. Osteoarthritis

    Osteoarthritis is a major cause of hip pain. Symptoms include pain in the groin that can radiate to the buttock or thigh.

    At first, the pain is worse with activity and eases with rest. Later, you may also have pain at rest, including at night that can make sleeping difficult. Your hip may also feel stiff, especially after periods of inactivity, although later the stiffness can become more constant.

    Some people may also find their hip starts to make clicking or grinding noises. This is because of damage to the cartilage that lines the bones of the joint. And as the disease progresses, the muscles that surround the hip weaken, which can lead to difficulty rising from a chair and balance issues.

    2. Hip bursitis

    Bursitis refers to inflammation of a bursa. These small, fluid-filled sacs sit between bony prominences, muscle tendons and ligaments to reduce friction. However, irritation of a bursa can lead to intense pain.

    There are two main bursae that can cause hip pain. One is located at the outer edge of the hip, where the hips are widest. Less commonly, the bursa at the front of the hip, in the groin area, can be affected.

    Bursitis is characterized by sharp pain, aggravated by repetitive movements, and can be worse after rest. You may also find it painful to lie on the affected side.

    The area may be warm, tender to touch, red and swollen. With time, the pain changes to become more of a dull ache, and it can radiate over the buttock and into the leg.

    Bursitis tends to affect older people, those with rheumatoid arthritis or scoliosis, and people who have irritated the area with activities such as stair climbing, cycling, running or standing for prolonged periods. A fall onto the hip can also trigger a bout of bursitis.

    3. Tendinosis

    Tendons are connective tissue cords that attach muscle to bone. Repetitive strain or overuse can cause damage to a tendon. Sometimes, the rate of damage overtakes the tendon’s capacity to heal, leading to a cycle of wear and degeneration.

    This condition, called ‘tendinosis’ or ‘tendonitis’, commonly occurs in the hip’s flexor tendons, which pull the knee up towards the chest. They can be irritated by activities such as running, dancing, gymnastics, cycling or playing football.

    Flexor tendinosis causes pain and tenderness in the groin area. Stretching these tendons becomes painful. This means people with flexor tendinosis tend to shorten their stride length when walking. They might stand with a pronounced arch in the back, which reduces pull on the tendons. There may also be pain when rising from lying down or when going up stairs.

    Because the flexor tendons lay over the bursa at the front of the hip, tendinosis can sometimes lead to an episode of bursitis.

    4. Strains and sprains

    Strained muscles and sprained ligaments commonly result from a trauma. You’ll probably know if you have a strain or sprain, as a fall, impact or excessive movement leads to immediate pain in the affected muscle or joint.

    The hip joint is deep, stable, and surrounded by large muscles, so sprains here are less likely. However, a significant trauma such as a traffic accident, or a sports injury where the leg is twisted or pulled away from the body, can lead to sprains of the hip ligaments.

    Muscle strains are more common, often affecting the adductor (groin) or flexor muscles. These muscles are especially active in sports that involve kicking or strong leg actions, such as football, martial arts or gymnastics.

    5. Labral tears

    The labrum is a rim of cartilage that surrounds the socket of the hip joint. It acts like a rubber gasket to seal the joint, and its functions include increasing stability, reducing stress and retaining joint fluid.

    However, a high-impact accident, such as a traffic collision or a sports injury, or repetitive pivoting or squatting movements, can tear the labrum. Additionally, some people are born with structural differences in the hip that cause wear on the labrum, eventually leading to a tear.

    A labral tear causes groin pain and a sense of catching or locking with hip movements. You may also find your hip feels stiff. However, some people with a labral tear have no hip pain or symptoms.

    Labral tears can alter the mechanics of the hip and increase the risk of developing osteoarthritis later on.

    6. Stress fractures

    Stress fractures happen in bones that are unable to cope with the load placed on them. This may be because someone is very active, such as long-distance runners. Or it may be because the bone is weak, for example, in people with osteoporosis. Osteoporosis is common in the elderly and in people with a history of nutritional or hormonal disorders.

    The symptoms of a hip stress fracture can be vague. The pain is difficult to pinpoint, but you’ll notice it when moving the leg in any direction. Putting weight on the leg causes pain, but there can also be a wave of pain as you take weight off the leg.

    Hip pain caused by a stress fracture tends to develop gradually, but it’s persistent and will worsen over time. The pain can spread to the knee. It can become severe and cause difficulty with walking and standing.

    If you suspect a hip fracture, seek medical attention. It can interrupt the blood supply to the top of the thigh bone, causing long-term damage.

    7. Hip impingement

    This occurs where the shape of the hip socket or the top of the thigh bone causes pinching with certain movements.

    Since this bony shape is present at birth, hip impingement is usually picked up in young people, especially those that are active.

    There are two types of impingement: the most common (femoroacetabular impingement) occurs at the front of the joint, causing groin pain. This is most noticeable with hip flexion, such as bringing the knee up towards the chest or squatting. The second (ischiofemoral impingement) happens at the back of the hip. It causes pain in the buttock with hip extension, such as when taking a long stride.

    Although the structural cause of hip impingement can’t be altered without surgery, research has shown that physical therapy improves both pain and function.

    8. Referred hip pain

    Sometimes the cause of hip pain is somewhere else entirely. A problem in the low back can irritate nerves that feed the hip, causing pain, tingling or numbness. Other joint problems, such as sacroiliac disorders or osteoarthritis of the spine, can also refer pain to the buttocks and groin. In addition, conditions that affect the pelvic or abdominal organs, such as the urinary, reproductive or digestive systems, can result in pain around the hip area. In these cases, you may notice that the pain is not affected by movement.

    Tips to relieve hip pain

    Hip pain is complicated. If you have hip symptoms, try some of these techniques to alleviate the problem. However, if the pain is serious, persistent, or you’re struggling with normal activities, make sure you get a proper diagnosis and find out your options for treatment.

    1. Ice and warmth

      Apply an ice- or heat-pack over the site of the pain for around 20 minutes every two to three hours. You can also alternate warmth and ice, using each three or four times for 2-3 minutes per session. These will help reduce swelling and inflammation, encourage blood flow and ease muscle tension. However, the treatment is quite superficial and the hip is deep, so effectiveness will depend on the structure causing the pain.

      2. Stretches

      Ease stiffness and tension with gentle range-of-motion exercises. Try lying on your back, holding the knee on the painful side. Move the knee in circles, going as wide as possible without aggravating the pain.

      3. Exercise

      An exercise that combines stretching, strengthening and balancing can work wonders to manage ongoing hip pain, such as osteoarthritis. Try yoga therapy or Tai Chi. Or take up swimming to mobilise your hip while supported in warm water.

      4. Stress management

      Stress impacts your experience of pain, raises inflammation and affects that most healing of activities, sleep. Take steps to combat stress using exercise, good nutrition, self-care and relaxation techniques.

      Osteopathy for hip symptoms

      It’s worth trying some self-help techniques to ease your hip pain. But persisting or worsening symptoms may need professional intervention.

      Your osteopath will not only examine your hip to find the root cause of the pain, but they will evaluate you biomechanically to determine whether other issues, such as posture or imbalances, are stressing the hip.

      Once they’ve made a full evaluation and diagnosis, your osteopath will apply methods such as massage, mobilisation, joint manipulation, and muscle techniques to reduce your pain and inflammation. Every treatment is specialised to fit your diagnosis and personal requirements.

      They can also advise how to avoid your symptoms from recurring. They might suggest stretching and strengthening exercises, alterations to habitual postures, activity modifications, helpful tips for sleeping comfortably, even changes to footwear!

      So don’t let hip pain hold you back. Get in touch with our team in Central and let us help you get on with your life!

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