Hip pain can come from any of your thigh, buttock or lower back muscles also your hip, sacroiliac and lower back joints. To establish where exactly the hip pain is, can be very helpful to identifying what structure is causing the pain.
Hip pain is one of the most common pain and injury that we treat. From young dancers to 80 year old patients with arthritis.
Pain may arise from structures that are within the hip joint or from structures surrounding your hip. The precise location of your hip pain can provide valuable clues about the underlying cause. The hip is a complex region to determine where the pain is coming from due to the close proximity to the lower back. It can make it difficult to distinguish if the pain is truly coming from your hip or lower back.
Any pain or problem in the hip joint will have a ripple effect on the knee, ankle and foot. So get it sorted before you cause even more problems. Hip pain can be caused by any of the muscles, tendons or joints, so let’s look at the different types of structures in your hip.
The major muscle group in the back of the hip are the Gluteal muscles that is made up out of 3 muscles (Gluteus Maximus, Gluteus Medius, Gluteus Minimus muscle) We have a deeper layer of muscles that mainly turn the hip outwards. In the front of the hip, the Quadriceps muscles in the front and the Hamstring muscles that originates just below the fold of our buttocks. On the inside is a group of four muscles called the adductor group, and a strong band of connective tissue called the ITB (Iliotibial band) on the outside of the pain.
Muscle strains are often called ‘muscle pulls’ or ‘pulled muscles’ because of the way these injuries occur, with the muscle tissue forcibly stretched until it is torn. There are a large number of muscles around the hip, each one doing its part to keep our hip joint stable.
Inside the Hip joint
The inside of the hip joint has a cushion like membrane called the Labrum. The cushioning inside your hip could get torn and these are called – Labrum tears. Labrum injuries like Labral tears are most often Surgically repaired, but in most cases first picked up by a Physiotherapist.
There are large bursas (fluid-filled sacs) that surround areas of the hip and allow the muscles and tendons to glide more easily over bony prominences. Hip Bursitis is a condition when this protective Fluid-filled sac, becomes inflamed and irritated. Direct pressure over the Femur shaft will bring on the pain. These patients usually complain of not being able to sleep on their side due to the hip pain.
Joints can refer pain downwards from the hip, or upwards towards the lower back. The femoral head and the acetabulum are lined with articular cartilage that allows the bones to move within the joint with less friction. Also, the socket area of the acetabulum is covered with tough cartilage called the labrum. Just like any other joint cartilage, these areas can wear away or tear and become the source of pain.
Hip joint pain mainly presents with C-sign, this means that when you describe your pain as being on your hip by putting your hand over your hip with your thumb pointing backwards(Your thumb and index finger creates a “C” around your hip).
On the other hand groin pain when moving your hip is a warning sign of a problem inside the joint itself. Joint pain is usually more difficult to pinpoint therefore a skilled set of hands would need to determine where the pain is coming from.
Hip joint conditions are damage or injury to the hip ball-and socket connection. Diseases that attack and destroy the hip joint are arthritis type conditions which includes: Osteoarthritis, Rheumatoid Arthritis, Juvenile arthritis.
Tendons are cables that anchors the bone to muscle tot the bone. Every muscle has a tendon on either side of the muscle, the one at at the top called the proximal tendon and one at the bottom, called the distal tendon. Any one or multiple tendons can become irritated causing a inflamed tendon. One of the most common hip tendons that gives a problem a Gluteal tendonitis.
The hamstring tendons that attach onto our sitting bone can become irritated and give you a hamstring tendinitis, or even the Rectus femoris muscle’s attach onto the front of the hip can cause you to feel a flexor tendinitis type of pain.
Pain can be referred from other structures outside the hip joint, meaning that while the hip hurts, the problem may potentially originate elsewhere. Inflammation of the sciatic nerve as it arises from the spinal cord in the back can cause hip pain, especially if the L1 or L2 nerve roots are involved.
Other types of nerve inflammation may manifest as hip pain, including pain arising in the lateral femoral cutaneous nerve of the thigh. Pain from an inguinal or femoral hernia may also cause pain that is felt deep inside the hip and groin.
The hip joint is kept stable by a group of very strong ligaments that must be able to allow movements into certain directions, but prevent the femur head from poping out of its socket. Thick bands of tissue surrounds your hip joint, forming a capsule. A constant negative pressure must be maintained inside the capsule. The ligaments and Capsule weave together to keep your hips joints stable.
Ever seen a Ballet dancer do the splits? They take years to lengthen and condition their hips to allow such a large range of movement. If you would jump into a split you may rip some of your hip ligaments and start experiencing clicking deep inside your hip. This ‘click’ is an abnormal translation of the ball & socket joint due to the hip ligaments not being able to stabilize your hip joint. Be very careful.
Nerve supply to the hip comes from two big branches called the femoral nerve in the front and the sciatic nerve at the back. Irritation, compression or impingement of these nerves can cause a dull ache with sharp sting, electrical pains running down your leg.
Sciatica is also a condition that can cause thigh pain at the back of the leg all the way to your toes. Hip pain radiating from your lower back down your leg, may be a very serious problem.
Hip pain is extremely common therefore we have helped many patient relieve their pain, but we frequently see patients suffering for months before they decide to do something about the pain. Most hip pain don’t start after a fall or injury, but usually develops over time, but it can occur as a result of sports injuries, work injuries or simply walking.
If you are suffering from hip pain, rather get it checked. Please do not delay in consulting your physiotherapist if you experience hip pain. Rather do something about it and get it looked at, than wait with your fingers crossed and hope it goes away.
An accurate diagnosis is vital to manage your pain and treat it appropriately, because what works for one problem rarely works for another. There are so many remedies out there, at least just get it under the eyes of an expert that work with these types of problems every day. Many conditions can take many months or even years to heal when the diagnosis is incorrect or treatment is neglected.
Hip Pain in the …
Causes of Hip pain
Its a difficult assessment and not many medical practitioners are able to pinpoint the main source of your pain, instead they only aim to relieve the symptoms of your hip pain, but rarely get to the root cause. This makes your hip more vulnerable to injury and wear down the joint. Hip pain must not to be taken lightly, there is a reason why hip replacement surgery is one of the most common surgeries performed around the world.
Your hip contains some of the largest muscles in your body, not to mention you use them every day. We rely on your hip muscles to stand up, walk and run. The structures in the hip is vulnerable to injury especially overuse injuries i.e. repetitive movements like a walking, climbing stairs and running.
Thigh pain may be caused by:
- Overuse – Tendon inflammation, labrum injuries and arthritis
- Trauma – Contusions, fractures and labrum injuries as well as muscle or ligament strains and sprains.
- Overuse – A sudden high repetition of muscle contractions like increasing your running distance too fast. Tendons become irritated causing tendinitis or bursa becomes inflamed resulting in a hip bursitis.
- Overload – The muscle is subjected to sudden forceful contraction like increasing the leg press machine too fast, or doing too many squats or lunges. You can just imagine if you jump from 20kg to 40kg in one week. The muscles won’t be able to keep up.
- Overstretch – Muscles are very weak in its stretched position. When the hip structures are forcibly stretched beyond its normal boundaries, it will tear. Running uphills or stairs will force the muscles to contract from its stretched position.
- Weakness – Muscle fatigue can play a role if you are not strong enough.
- Poor technique – During training (Wrong movement pattern), that can load the hip incorrectly and stress certain structures significantly more.
- Poor Management – Neglected injury that has not completely healed.
- Excessive stretching – of the muscle against a force, for example during weight lifting like a dead-lift, when the load is applied on both sides of the tendon, while it needs to contract and lengthen at the same time.
- Instability – The femur buckles under load, and its not able to stay centered in the hip socket.
- Autoimmune – Rheumatoid arthritis
- Referral from other joints – Hip or the Lower back
- Referral from nerves – Irritation, compression of the femoral or sciatic nerves.
What needs to be tested to determine the source of the hip pain
- The movements from your ankle, knee and hip (how they interact with each other)
- Lumbar and Sacral vertebrae
- Pelvis (forwards and backwards tilt)
- Muscles surrounding the hip joint
- Core muscle control and pelvic floor muscles
- All the thigh muscles that attach onto the Femur (Quadriceps, Hamstrings, Adductors)
- The Sciatic and Femoral nerves
- The articular surface of the Ball and socket joint of your hips
Hip Pain Treatment
- Acupuncture & Dry Needling
- Heat packs (Thermal therapy)
- Kinesiology Tape
- Rigid Strapping or taping
- Neurodynamics (Nerve tissue mobilizations)
- Dynamic Strapping
- Strengthening exercises
- Guided loading protocol
- Stretches (Static, dynamic and ballistic)
- Moon boot
- Compression Bandage or Sleeve
- Supportive strapping and taping
- Biomechanical Analysis
- Gait Analysis
The Older Hip
If you are in the older population group, you will be more vulnerable to age-related hip issues such as hip arthritis, trochanteric bursitis and GTPS (Greater Trochanteric Pain Syndrome). Functional limitations could include simply walking, sit to stand, single leg standing, stairs or even sleeping in severe cases.
Hip pain can also be associated with reduced balance. A thorough balance assessment may be required to predict a falls risk. Falls prevention exercises may be prescribed by your physiotherapist to address any individual deficits. They may even advise you to utilise a walking assistance device such as a walking stick, crutches or a walking frame.
The Sporting Hip
Younger sports-related hip issues may come on after prolonged running, jumping or landing activities. Specific sporting hip conditions should be discussed and thoroughly assessed by your hip physiotherapist. Biomechanical deficits and subtle hip weakness that may only show on a slow-motion video are just two of the potential causes of sporting hip injuries.
Groin pain is one of the most common symptoms associated with hip joint pathologies such as hip osteoarthritis and hip labral injury. There are also many other causes of groin pain that need to be excluded by a health professional. More info: Groin Pain.
Only after a thorough hip assessment will your hip pain be effectively rehabilitated to relieve your current hip pain and joint dysfunction, plus prevent the return of any future hip pain.
Other Causes of Hip pain
- Joint – Hip joint pain, Labrum tear, Osteoarthritis of the Hip joint
- Muscles – Gluteus muscle strain, Quadriceps muscle tear, Groin muscle tear, Hamstring muscle tear
- Tendons – Quadriceps tendinitis, Gluteal tendinitis, Hamstring tendinitis
- Bursa – Hip Bursitis
- Ligaments – Inguinal ligament sprain
- Nerve- Pinched Sciatic nerve over the hip
- Bone – Femur Fractures, Avultion fractures or Stress fracture of Femur Head
- Iliotibial band