Flexible Fitness: Why does my hip hurt?
Hip pain is common among people of all ages, and more prevalent in the active population. The hip joint connects the top of the thigh bone to the socket of the pelvis. You may feel hip problems in the groin, thigh, buttock or even the inside of your knee.
There are many potential causes of hip pain. Some problems occur inside the hip joint and can include arthritis, labral (cartilage) tears and impingement. Other causes occur outside the hip joint such as muscle strains, tendon strains and bursitis. Proper treatment of hip pain depends on accurate diagnosis of the underlying cause.
There are several types of arthritis that can affect the hip joint. The most common is osteoarthritis (OA). This is a progressive degeneration or wear and tear of the cartilage inside the joint. Treatment for early arthritis often includes medications such as non-steroidal anti-inflammatory and pain medications. Physical therapy to increase the mobility of the joint, and exercises to improve strength of the muscles surrounding the hip has been shown to be beneficial in patients with early to moderate hip OA.
Cartilage tears can occur from a traumatic event or more commonly with repetitive pivoting and twisting as in some sports or day-to-day activities. This can occur when the top of the thigh bone makes abnormal contact against the socket of the pelvis. This can cause irritation in the joint, and possibly damage the cartilage.
A muscle strain or tearing of muscle fibers can occur when you put more demand on a muscle than it can withstand. This can result from a single episode of excessive force on a muscle, or when repetitive forces exceed the ability of the muscle.
There are several things that can increase your risk of muscle strain, including sudden increases in activity level, changes in patterns of training or excessive loading during intensive training. Imbalances of strength from one leg to the other or between opposing muscle groups in the same leg can also increase the risk of muscle strain.
Trochanteric bursitis is a common problem causing pain on the outside of the hip and possibly down the outside of the thigh to the knee. The trochanteric bursa is a small fluid-like sac meant to decrease friction between the bone and the tendons that pass over it. Discomfort may be experienced with prolonged standing, walking, stair climbing and running. Management of an acute flair can include rest, ice and physical therapy.
Regardless of your symptoms, a thorough history and physical exam by a physician or physical therapist will help to determine the underlying cause of hip pain and treatment planning. The basic goals of physical therapy are to determine the source of the problem, and address joint restrictions, muscle weakness, muscle tightness and faulty movement patterns to distribute stresses equally throughout the body during activities using the hip. Physical therapists will look above and below the hip for these same issues and prescribe specific exercises to address strength or flexibility deficits and movement patterns to help maximize activity and minimize risk for re-injury.
Rhonda Salvo, PT, is an advanced physical therapist at Spaulding Outpatient Center Framingham (Mass.). She is a graduate of Northeastern University with 23 years of clinical experience with special interests in both orthopedic and neurological populations. Nancy Sibley, PT, DPT, is an expert physical therapist at Spaulding Outpatient Center Framingham. She has more than 25 years’ experience in orthopedic physical therapy and is a certified strength and conditioning specialist. She recently received a doctorate of physical therapy from Massachusetts General Institute of Health Professions in May 2013.