The hip joint can withstand repeated motion and a fair amount of wear and tear. This ball-and-socket joint — the body’s largest — fits together in a way that allows for fluid movement. Despite its durability, the hip joint isn’t indestructible. With age and use, the cartilage can wear down or become damaged. Muscles and tendons in the hip can get overused. Bones in the hip can break during a fall or other injury. Any of these conditions can lead to hip pain.
Arthritis. Osteoarthritis and rheumatoid arthritis are among the most common causes of hip pain, especially in older adults. Arthritis leads to inflammation of the hip joint and the breakdown of the cartilage that cushions your hip bones. The pain gradually gets worse. People with arthritis also feel stiffness and have reduced range of motion in the hip.
Hip fractures. With age, the bones can become weak and brittle. Weakened bones are more likely to break during a fall.
Bursitis. Bursae are sacs of liquid found between tissues such as bone, muscles, and tendons. They ease the friction from these tissues rubbing together. When bursae get inflamed, they can cause pain. Inflammation of bursae is usually due to repetitive activities that overwork or irritate the hip joint. Symptoms may include:
• Pain on the outside of your hip and upper thigh.
• Pain that starts as sharp pain, causing you to yelp when the area is touched, and later develops into an ache.
• Pain when you get up after sitting for a long time, and which may worsen when you take a long walk, climb a lot of stairs, or squat for awhile.
• Pain that’s worse at night when you lie down or sleep on the affected hip.
People with bursitis don’t have pain while standing.
Tendinitis. Tendons are the thick bands of tissue that attach bones to muscles. Tendinitis is inflammation or irritation of the tendons. It’s usually caused by repetitive stress from overuse.
Muscle or tendon strain. Repeated activities can put strain on the muscles, tendons, and ligaments that support the hips. When they become inflamed due to overuse, they can cause pain and prevent the hip from working normally.
Hip labral tear. This is a rip in the ring of cartilage (called the labrum) that follows the outside rim of the socket of your hip joint. Along with cushioning your hip joint, your labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket. Athletes and people who perform repetitive twisting movements are at higher risk of developing this problem.
Cancers. Tumours that start in the bone or that spread to the bone can cause pain in the hips, as well as in other bones of the body.
Avascular necrosis (also called osteonecrosis). This condition happens when blood flow to the hip bone slows and the bone tissue dies. Although it can affect other bones, avascular necrosis most often happens in the hip. It can be caused by a hip fracture or dislocation, or from the long-term use of high-dose steroids (such as prednisone), among other causes.
Hip pain at night can also be caused by your sleeping position, your mattress or pillows, or pregnancy. It’s also possible to have another problem, such as lower back pain, that causes your hip to hurt. That’s called referred pain. If you regularly wake up at night from hip pain, the way you’re sleeping or your mattress could be to blame. A mattress that’s too soft or too hard could trigger pressure points, which may lead to a sore hip. Try sleeping on your back or, if you’re a side sleeper, sleep on the side that doesn’t hurt and put a pillow between your knees to keep your hips aligned.
Symptoms of Hip Pain
Depending on the condition that’s causing your hip pain, you might feel the discomfort in your:
• Inside of the hip joint.
• Outside of the hip joint.
Sometimes pain from other areas of the body, such as the back or groin (from a hernia), can radiate to the hip.
You might notice that your pain gets worse with activity, especially if it’s caused by arthritis. Along with the pain, you might have reduced range of motion. Some people develop a limp from persistent hip pain.
If hip pain wakes you up, you can try these things to get back to sleep:
• Change your sleeping position. Keep experimenting to find the most pain-reducing position.
• Place wedge-shaped pillows under your hip to provide cushioning. If you don’t have a wedge-shaped pillow, try folding a pillow or blanket to create a wedge shape.
• Sleep with a pillow between your knees to reduce stress across your hips.
• Put one or more pillows under your knees. This can ease pain from sciatic-piriformis syndrome.
If the above measures don’t help, a simple way to relieve hip pain is by holding ice to the area for about 15 minutes a few times a day. Try to rest the affected joint as much as possible until you feel better. You may also try heating the area. A warm bath or shower can help ready your muscle for stretching exercises that can lessen pain.
If your hip pain is caused by a muscle or tendon strain, osteoarthritis, or tendinitis, you can usually relieve it with an over-the-counter pain medication or a nonsteroidal anti-inflammatory drug.
Rheumatoid arthritis treatments also include prescription anti-inflammatory medications such as corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) which target the immune system.
If you have arthritis, exercising the hip joint with low-impact exercises, stretching, and resistance training can reduce pain and improve joint mobility. For example, swimming is a good non-impact exercise for arthritis. Physical therapy can also help increase your range of motion.
When osteoarthritis becomes so severe that the pain is intense or the hip joint becomes deformed, a total hip replacement (arthroplasty) may be a consideration. People who fracture their hip sometimes need surgery to fix the fracture or replace the hip.
You should consult an expert Orthopaedic surgeon like Dr Arunava Lala if :
• The hip pain came on suddenly.
• A fall or other injury triggered the hip pain.
• Your joint looks deformed or are bleeding.
• You heard a popping noise in the joint when you injured it.
• The pain is intense.
• You can’t put any weight on your hip.
• You can’t move your leg or hip.
Your orthopaedic may check for tenderness and swelling around your hip. He will also assess the range of motion of your hip for signs of arthritis and tendonitis. Reduced motion is a sign of arthritis. He may also take blood or fluid samples, or order X-rays to rule out various conditions.
Your Orthopaedist may talk with you about these treatments:
• Physiotherapy, getting regular massages, or both.
• Removing fluid from the bursa.
• Arthroscopic surgery to remove the bursa.
• Steroid or cortisone injections into your bursa or hip joint.
• Hyaluronic acid injections to lubricate your hip joint.
• Arthritis medicines, including disease-modifying antirheumatic drugs (DMARDs) and biologics.
• Arthroscopy, which is surgery to remove loose pieces of cartilage or bone spurs around the hip.
• Hip resurfacing to remove and replace damaged bone in the hip socket.
• Arthroplasty, also known as total hip replacement surgery.