Hip pain

The hip joint is a ball and socket joint, where the head of the thigh bone (femur) meets the pelvis (acetabulum). It forms a connection from the lower limb to the pelvic girdle, and is designed for stability and weight-bearing. As a result, there is a complexity of ligaments, tendons and muscles acting on the joint.  

Common causes of musculoskeletal related pains tend to originate from bones, ligaments, tendons and muscles. These symptoms tend to settle with time and good self-management. 

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Osteoarthritis

What it is?  

Osteoarthritis refers to joint pain with limitation of movement, which can affect daily activities. Contrary to most thoughts, osteoarthritis is not caused by ageing and does not necessarily get worse.  

In osteoarthritis we see changes to the cartilage of the joint as well as other secondary changes such as inflammation. Cartilage helps our joints move freely.   Changes to the cartilage can lead to pain, stiffness, and loss of movement.  This can in time lead to weakness around the muscles of the joint. 

Osteoarthritis is the most common type of arthritis, affecting 8.5 million people in the UK.  It most commonly affects people older than 45 and is more common if you are overweight, have a family history of it, or have previously injured the joint in question  

With osteoarthritis of the hip you’re likely to have pain mainly in the front of your groin, but sometimes around the side and front of your thigh, (sometimes down to and including your knee) and buttock.  Morning stiffness lasting less than 30 minutes is also very common. 

How to deal with it?  

If you think you have, or have been diagnosed with osteoarthritis of the hip there are several things you can do to help manage your symptoms and stop it from worsening  

Exercise 

Exercise has been shown to be beneficial in osteoarthritis. Try to increase your activity levels and consider taking up exercise. Walking, swimming and cycling are often well tolerated but choose something you enjoy. It is important when starting exercise to start easy and build up slowly. A small increase in your pain when you start is okay. 

Strengthening 

Osteoarthritis can lead to weakness. Strengthening the muscles around your hip will allow you to do things more easily such as standing up; getting in and out of bed; getting around, and any exercise you choose to do. Some pain when starting exercise is okay provided it is tolerable. Start with simple exercises and build up. Please see this link from versus arthritis for a description of useful exercises to help your hip:

https://www.versusarthritis.org/about-arthritis/conditions/hip-pain/#hip-pain_exercises-for-hip-pain 

Weight control

If you are overweight, try to lose some weight. Even a modest weight loss can make quite a difference to your symptoms 

Using a walking aid such as a stick or walking pole in the opposite hand to the affected hip can also help to take pressure off the painful joint.  

Simple painkillers

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus


Ice or heat therapy 

Heat may be helpful in the form of a hot water bottle, wheat pack or hot shower. This can help to relax the muscles around your hip and may allow exercises to be more effective.  

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to 3 times a day. 

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.  
  • Check the skin regularly during and after the ice pack application 
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Physiotherapy

If you find that you are not improving, an assessment and advice from a physiotherapist can be helpful 

ESCAPE Pain

Your GP or physiotherapist may refer you to an ESCAPE Pain class.  This is an evidence based programme of 12x one hour sessions over the course of 6 weeks which comprise a 15-20 minute education/discussion element and a 30-45 minute exercise programme. The aims of the course are to help you better manage your symptoms, carry out normal activities, become more active and to continue to exercise. See link below 

Important information to know: 

Being overprotective and doing less can mean that you will get weaker and stiffer and eventually have more symptoms.   

It is safe to exercise, and exercise doesn’t speed up the osteoarthritic process. 

Many people have signs of osteoarthritis on xrays but no symptoms. These changes are best thought of as normal agerelated changes.

Labral tears/Hip impingement

What is it? 

The labrum is a type of cartilage that surrounds the socket of ball-and-socket joints. A labrum is found in both the shoulder and the hip joint. The labrum forms a ring around the edge of the bony socket of the joint. It helps to provide stability to the joint by deepening the socket, yet unlike bone, it also allows flexibility and motion.

There are two general types of hip labral tears: degenerative tears and traumatic injuries.

degenerative tear is a chronic injury that occurs as a result of repetitive use and activity. Degenerative labral tears can be seen in the early stages of hip arthritis.

traumatic hip labral tear is usually an acute injury as a result of a sports injury, fall, or accident. Hip labral tears are commonly associated with sudden, twisting movements that cause immediate pain in the hip.

Please note a labral tear is not always a worrying sign and it can be a completely normal finding. It is common for a person to have a labral tear in the hip and not have pain or symptoms. For others it can be very uncomfortable. However, by following the simple steps below and advice from a health care professional a lot of people can self-manage very effectively and symptoms can settle with time.

How to deal with it? 

To deal with a labral tear, reduce any activity that makes your symptoms worse.

  • You should also keep the muscles in your legs and hips flexible and strong by performing stretching and strengthening exercises regularly.

How to avoid it? 

  • Keep the muscles in your legs and around your hip flexible by doing stretches regularly

Keep the muscles in your legs and around your hip strong by doing regular strengthening exercises

Lateral Hip Pain

What is it?  

A number of terms have been used to describe pain on the outside of the hip.  Commonly it may be called bursitis, gluteal tendinopathy or greater trochanteric pain syndrome (GTPS).  It can sometimes spread down the outside of your thigh. 

It is caused by irritation to the tendons of the buttock muscles (gluteals), there may also be irritation of a fluid sac on the outside of the top of the thigh bone which reduces friction called the bursa.   

It is more common in females and in people older than 40. It can sometimes be brought on by a change in the amount or type of exercise / activity you do or a trauma such as a fall. Often it starts on its own with no obvious cause. 

Pain is often worse when lying on your side or aggravated by activities such as running, climbing stairs or prolonged standing – especially cross legged. 

How to deal with it?  

A number of things have been shown to help with lateral hip pain. It is something that typically improves with time but there are lots of things you can to do help 

Activity Modification 

This is key to settling down a flare up of lateral hip pain.  

Limit activities, movements and positions that aggravate the area.  Common irritable habits are crossing your legs when sitting, lying on either side and standing with weight biased on one leg.  If you do lie on your side place a pillow between your legs. 

Strengthening 

Strengthening muscles around the hip has been shown to be very effective in improving this condition.   

Weight loss

Losing weight will reduce the amount of pressure on the tissues around the outside of the hip and can improve it and reduce of the chances of it coming back. 

Simple painkillers 

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

Important information to note: 

Other causes of hip pain may include muscular injuries or pain from structure with in the joint. It is important to use painkillers if the pain is stopping you from doing normal activities 

If you have had a significant fall (particularly if you are elderly), pain is keeping you awake at night and / or you are having difficulty weight bearing it is important to seek an opinion from a Health care professional. 

How to avoid it?

Simple advice such as keeping the hip moving, strengthening your muscles, becoming active and keeping your weight under control can often help. If you follow this and the advice above you can make some very positive measures to prevent future problems. 

Other causes of hip pain

Coming soon.

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Soft tissue injuries

Hip injuries

Minor injuries to the hip, such as a mild sprain or strain should settle with time and can be managed at home. 

A soft tissue injury to the hip may result in the following: 

  • Pain 
  • Swelling 
  • Bruising 
  • Stiffness and loss of function 

The pain can be particularly strong in the first three weeks as this is the inflammatory phase of your body healing itself. Typically, these injuries last 4 to 6 weeks depending on the severity.  

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

DAY 1 – Early Management

Protect by minimising use of the affected hip and initially avoiding stretching the area which could cause further injury. You may need to use a walking aid to take pressure off the affected leg. You may find it easier to go upstairs leading with good leg first, and downstairs with the affected leg first.   

Rest can be beneficial in the very early stages of the injury (days 1-4). Complete rest, however, is not advisable. In the early stages, gentle active movements and specific exercises can help decrease pain and swelling, they also promote good tissue healing with less unwanted scar tissue and joint stiffness. It is important to make sure you keep your hip and knee moving as able, so they do not stiffen up. 

Ice pack/frozen peas wrapped in a damp cloth, placed on the swollen area for up to 20 minutes at a time, 3 times a day. So long as there is swelling you will need to continue ice therapy, often beyond the third week.   

  • Please note only use ice if you have normal skin sensation  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Compression of the of the hip is very difficult to achieve. But you can use tubigrip or crepe bandage. It should compress firmly but not restrict blood flow and create a tourniquet.  Remove if there are signs of poor circulation, or if you start to experience pins and needles or numbness.   

Elevation. If you have swelling down to your knee, try to keep your leg horizontal or slightly higher than your hip. You can help achieve this with use of pillows. 

WEEK 1 – Early Mobilisation

After 72 hours is important to start using your hip and knee as your pain allows. Start to do normal everyday activities. You should also try doing these exercises 3 – 4 times a day. Repeat each one 10 times. 

Knee exercises

1. Lying on your back, bend your knee up towards you, sliding your foot and the let it return

2. Sitting on a chair bend your knee back as far as it can comfortably go 

Hip exercises

1. Lying on your back, lift your knee towards you and then let it come back down 

2. Lying on your back, slide your whole leg out to the side in an arc and return

WEEK 2 – Strengthening Exercises

You can start these when pain is starting to settle.  

Knee exercises 

1. Lying on your back, squeeze your knee in to the bed.  Hold up to 5 seconds and relax 

2. Lying on your back, lift your leg up straight approximately 30 cm off the floor / bed.  Hold up to 10 seconds and slowly lower it down. 

 

 

 

3. Sitting in a chair.  Stand up and sit down slowly.  Try not to use your hands if possible.  Make this harder by:

a) moving the foot of your affected closer to you and then progress to

b) standing from a lower height

Hip exercises 

1. Standing up and holding on to something if you need to.  Take your leg out to the side and return 

2. Standing up and holding on to something if you need to.  Take your leg behind you and return. Remember to keep your back up right and don’t lean forward.

As you start to do these exercises you may feel there is some discomfort, however, this is okay and you should continue. If you have discomfort and pain for more than 2 hours after these exercises, then you shoulder reduce the number or vigour of the exercise and gradually build up again. 

Further progression on exercises can be found following the link below: 

https://www.poole.nhs.uk/a-z-services/t/therapy-services/therapy-outpatients/patient-information-leaflets.aspx 

Recovery time and returning to activity 

It usually takes 6 weeks to heal from simple soft tissue injuries to the hip or knee.  However, everyone recovers from injuries at different rates. Some may be back in 2 weeks however for some it can take up to 3 months.  If symptoms are persisting longer than this, it is advisable you see a GP or Physiotherapist. 

Returning to work – Gradually build up your strength and function, practice doing similar tasks that you would do at work before returning. Start doing this little and often ensuring there is minimal pain or swelling. 

Returning to hobbies/sport – it is advised not to return to these activities until you have full strength and range of movement without pain or swelling. Try to practice the specific movements of your hobby / sport in a controlled manner and build up the time and intensity that you do the movements before returning to your activity fully.    

Go to an urgent treatment centre or A&E if you: 

  • have severe pain or feel faintdizzy or sick from the pain  
  • heard a snap, grinding or popping noise at the time of the injury 
  • you are unable to weight bear because of the pain 

These might be signs of a more severe injury which may need medical attention. 

See a GP or physiotherapist if: 

  • the pain is severe or stopping you doing normal activities 
  • the pain is getting worse and/or keeps coming back 
  • the pain has not improved in any capacity after treating it at home for 2 weeks 

Further links

External links for further information on hip pain 

https://www.csp.org.uk/conditions/managing-your-bone-joint-or-muscle-pain/managing-your-hip-pain 

https://www.versusarthritis.org/about-arthritis/conditions/hip-pain/ 

https://www.nhs.uk/conditions/hip-pain/ 

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