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.

What are the common causes of hip pain?

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.

These pains may be a result of an acute injury or a flare up of a longstanding issue. Simple advice is keep active and keep moving, it will often settle with time.

Click on the following information to find out about common conditions related with hip pain.

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Early management of sprains and strains

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:

Ibuprofen

Paracetamol

Go to an urgent treatment centre or emergency department if you:

  • have severe pain or feel faint, dizzy 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
  • Click here to self-refer to a physiotherapist.

How to manage a sprain or a strain

DAY 1 – Early Management

Protect by minimising use of the affected area and initially avoiding stretching the area which could cause further injury. You may require the use of a walking aid to offload pressure on the affected side. 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 knee and ankle 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 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 in your knee, try to keep it level or slightly higher than your hip. You can help achieve this with use of pillows.

Click here for a video of how to manage a sprain or strain at home

WEEK 1 – Early Mobilisation

After 72 hours is important to start using your hip 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 then let it return.

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

3. Sitting on a chair, slowly straighten your knee as high as it can go and slowly lower it down again. 

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 knee closer to you and then progress to 

b) standing from a lower height.

4. In standing with feet apart, hold on to something in front to steady yourself. Keeping your back upright, slowly let your knees bend and return to upright. To begin with you may not do much of a dip and that is ok, the important thing is to be in control. Gradually progress to a deeper dip or a 5 second hold at the deepest part. 

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. 

3. Standing up and holding on to something if you need to. Lift your knee towards your chest and then lower it down.

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 should reduce the number and gradually build up again. 

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 a few days however for some it can take a number of months.

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.

Osteoarthritis of the hip

What it is?  

Osteoarthritis is a wear and repair process and a commonly affected joint is the hip. It can lead to joint pain with limitation of movement, which can affect daily activities.  Osteoarthritis is the most common type of arthritis, affecting approximately 9 million people in the UK.

Versus arthritis have produced a video summary of ‘What is Osteoarthritis?’

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.

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. Osteoarthritis has varying degrees on functional limitation and effect on quality of life. Contrary to popular belief does not affect everyone as you get older and does not necessarily get worse with age.

What are the common symptoms of Osteoarthritis of the hip?

With osteoarthritis of the hip you’re likely to have pain mainly in the front of your groin, around the front of your thigh, sometimes down to and including your knee and occasionally into your buttock. Morning stiffness lasting less than 30 minutes is also very common. Other symptoms can include difficultly walking, going up and downstairs, standing for long periods. A reduction in movement, bending over to put on your shoes and socks can be difficult.

How to manage it?

If you think you have, or have been diagnosed with osteoarthritis of the hip by a healthcare professional 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:

Exercises for the hip from versus arthritis

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:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

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, some advice or treatment from a physiotherapist can be helpful in managing hip pain. Click here to self-refer to a physiotherapist.

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.

The classes are being run in a number of physiotherapy departments. There is also an online programme to follow and escape pain app available to download. Please click here for more information.

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 x–rays but no symptoms. These changes are best thought of as normal age–related changes.

Many people have signs of osteoarthritis on x–rays but no symptoms. We often find that the changes seen on x-rays do not always correlate to the level of pain a person will report. These changes are best thought of as normal age related changes. The pain is believed to be as a result of a flare up of your osteoarthritis. This often settles as the body repairs itself. This is the wear and repair cycle.

Lateral (Outer) 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 trochanteric bursitis, gluteal tendinopathy or greater trochanteric pain syndrome (GTPS).

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 or activity you do or a trauma such as a fall. Symptoms frequently start without an obvious cause.

Outer hip pain – Greater trochanter pain syndrome (GTPS)

Common area of pain, outer hip shown by the blue arrow

 

What are the common symptoms?

Pain is often worse when lying on your side or aggravated by activities such as running, climbing stairs or prolonged standing – especially cross legged. It can sometimes spread down the outside of your thigh.

How to manage 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

Modify your activity

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.

Exercises

Strengthening muscles around the hip has been shown to be very effective in improving this condition. It is important to gradually build up your exercises and strength.

Please see the descriptions below for an example of rehabilitations exercises for hip strengthening. These exercises will help activate and strengthen the gluteal muscles. With each exercise start repetition of 8-10.

It is important to get control of your hips and pelvis. Try to avoid leaning heavily on one side, if you do, try to change position regularly.

By working on the below exercises regularly you will help strengthen your gluteal muscles, core muscles and improve your control.

Sit to stand

 

 

     Sitting in a chair.  Stand up and sit down slowly. Make sure you are putting equal weight through your feet. 

Try not to use your hands if possible.

Make this harder by standing from a lower height.

Side stepping

 

 

 

Start by standing shoulder width apart. Lead with your injured leg. Side step one way for 10 steps and then side step back. Rest for 1 minute and then repeat 3 times.

Mini squat

 

 

In standing with feet apart, hold on to something in front. Keeping your back upright, slowly let your knees bend and return to upright.

    Gradually progress to a deeper dip

Squat

 

 

 

Stand tall with feet slightly wider than hip-width apart. Toes pointing forward or turned a few degrees outwards.
Squat down by sitting back and bring your arms forward. Push back up through the heels, chest up, and straighten your hips.

Bridge

 

 

Lie on your back with legs bent.
Squeeze your buttock muscles and roll your pelvis off the floor.
In a controlled manner, return to the starting position.

Single leg stand with control

 

 

Stand close to a wall. Lift your unaffected leg and stand on the injured.
Try to maintain control and good alignment from your hip, knee and foot. Squeeze your buttock muscles and do not let you pelvis drop away from the wall.
Hold for 10 seconds and repeat 3 times.

Remember changes to the muscles and tendons takes time, you may need to do the exercises for a number of months to aid recovery.  Be patient and continue to do them regularly.

A mild discomfort during exercise is acceptable but if you get severe pain or increased symptoms stop. Try to return to the exercises again, but at a lower intensity.

If you are having difficulty or need guidance on the right exercises, speak to a physiotherapist.

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.

Pain relief

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:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

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 knee 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 three 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, some advice or treatment from a physiotherapist can be helpful in managing hip pain. Click here to self-refer to a physiotherapist.

Important information to note: 

If you have had a significant fall and pain is keeping you awake at night and / or you are having difficulty weight bearing it is important to seek an opinion from a healthcare professional.

How to prevent and manage future flare ups?

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

Hip impingement

What is it? 

Hip impingement is caused by abnormal contact between the ball and socket of the hip joint. This can be due to changes to the bones or as a result of repetitive and extreme range of motion activities at the hip. For example, the extreme range of motion required for gymnastics, or the repetitive nature of kicking sports. Weakness and tightness of the muscles around the hip can increase the stress at the joint contributing to the symptoms.

 

Hip joint anatomy

1 Ilium (Pelvis)
2 Acetabulum (Socket)
3 Femoral head (Ball)
4 Greater trochanter
5 Lesser trochanter
6 Femur (thigh bone)

 

 

 

Hip impingement can also be a cause of injuries to the labrum of the hip joint. 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, reducing stress to the socket, yet unlike bone, it also allows flexibility and motion.

Labral tears are usually as a result of repetitive use and activity.

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.

What are the common symptoms?

Symptoms may be felt as a deep, intermittent discomfort in the groin during or after activity. This may be associated with a catching or pinching sensation in the groin. Less common symptoms are buttock pain, pain on the outside of the hip or low back pain.

Sprinting, kicking sports, hill walking and prolonged sitting in a low chair are common activities which can cause pain.

How to manage it? 

Modify your activity

Reduce activities that aggravate the symptoms. This may mean doing the activity less frequently, changing the activity or simple things such as sitting on a different height chair. Sometimes complete rest, especially from a sporting activity may be required for a short period time to allow symptoms to settle.

Exercises

Strengthening and stretching weak or tight muscles in the leg and around the hip is important to restore the normal control around the hip joint.

 

Hip Abduction

 

 

Standing up and holding on to something if you need to.

Take your leg out to the side and return

 

 

Side abduction with resistance band

 

Stand with an exercise band firmly attached around one ankle and secured to the other side. Hold to something if you need to.

Keep your pelvis still and use your buttock muscles to lift one leg out to the side (away from the midline). Return to the starting position in a controlled manner.

Resistance bands can be purchased online.

 

 

Resisted abduction in sitting

Sit on a chair.

Put a rubber exercise band around your knees. Spread knees apart as far as you can.

Slowly bring knees back together.

 

 

 

 

Hip Extension

 

Stand straight holding on to a chair.

Bring your leg backwards keeping your knee straight and then return

Do not lean forwards.

 

 

 

Bridge

Lie on your back with legs bent.

Squeeze your buttock muscles and roll your pelvis off the floor.

In a controlled manner, return to the starting position.

 

 

Quadriceps (front of the thigh) stretches

 

 

Lying face down, take hold of your foot and draw towards your buttocks until you feel tension in your thigh muscle.

Hold still for 30 seconds. Repeat 3 times.

 

 

 

 

Hip flexor stretch

  Stand with one foot in front of the other and take support if needed.

  Have you affected hip behind you.

  Slightly bend your legs, shift your weight forwards, until you can feel a stretch in front of your affected hip.

  Hold for 30 seconds and repeat 3 times.

 

 

A mild discomfort during exercise is acceptable but if you get severe pain or increased symptoms stop. Try to return to the exercises again, but at a lower intensity.

If you are having difficulty or need guidance on the right exercises, speak to a physiotherapist.

Pain relief

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:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing hip pain. Click here to self-refer to a physiotherapist.

How to prevent and manage future flare ups? 

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

 

Iliopsoas Tendinopathy or Syndrom (anterior hip pain)

What is it?

This is irritation of the tendon or structures at the front of the hip joint. This can be caused by biomechanical factors such as overload of the tendon at the front of the hip (iliopsoas) combined with weakness of the muscles at the back of the hip (gluteal muscles). This is a similar process to the cause of lateral (outer) hip pain.

What are the common symptoms?

Pain is felt at the front of the hip and the thigh. On occasions you may feel a clicking sensation of the structures at the front of the hip. Pain is often worse with lifting your knee up to your chest as this tends to load the tendon that is irritated.

In a small number of patients, it can be a complication post hip surgery.

How to manage it?

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

Modify your activity

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

Limit activities, movements and positions that aggravate the area such as excessive hip flexion (cycling, step ups)

Reduce the overload on the front of the hip by strengthening the muscles at the back of the hip 

Strengthening Exercises

  • Strengthening muscles around the hip has been shown to be very effective in improving this condition
  • There has been shown to be a link with gluteal weakness and iliopsoas tendinopathy
  • Gluteal strengthening exercises are very helpful to achieve a muscle re-balance around the hip
  • Static strengthening exercises (isometric) of the iliopsoas muscle combined with gentle stretching of iliopsoas can also be helpful

See below for a few simple exercises to help the hip and improve your symptoms.

Mini squat

In standing with feet apart, hold on to something in front. Keeping your back upright, slowly let your knees bend and return to upright.

Gradually progress to a deeper dip

 

 

Squat

 

Stand tall with feet slightly wider than hip-width apart. Toes pointing forward or turned a few degrees outwards.

Squat down by sitting back and bring your arms forward. Push back up through the heels, chest up, and straighten your hips.

Note:
– Keep your hips, knees and toes aligned
– Keep your weight evenly on your whole foot.

 

Bridge

Lie on your back with legs bent.

Squeeze your buttock muscles and roll your pelvis off the floor.

In a controlled manner, return to the starting position.

 

 

Hip flexor stretch

   Stand with one foot in front of the other and take support if needed.

   Have your affected hip behind you.

   Slightly bend your legs, shift your weight forwards, until you can feel a stretch in front of your affected hip.

   Hold for 30 seconds and repeat 3 times.

 

 

Isometric hip flexion

  Lying down on your back. Place your hand on the affected leg knee,

  Apply resistance to your knee and try to lift your leg towards your chest.

  Hold for 5 secs and repeat 10 times

  Do this as pain allows.

  Gradually increase the resistance and the length of hold.

 

 

Remember changes to the muscles and tendons takes time, you may need to do the exercises for a number of months to aid recovery.  Be patient and continue to do them regularly.

A mild discomfort during exercise is acceptable but if your get severe pain or increased symptoms stop. Try to return to the exercises again, but at a lower intensity.

If you are having difficulty or need guidance on the right exercises, speak to a physiotherapist.

Pain relief

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:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing hip pain. Click here to self-refer to a physiotherapist.

How to prevent and manage future flare ups? 

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.

 

When to seek medical advice

Referred pain

Hip pain may be as a result of referred pain from your lower back. If you think that this is the case please discuss this with your health care professional or refer yourself to a physiotherapist for help with management.

Your hip may also cause referred pain into the thigh, knee or lower leg. This referred pain should improve as your knee improves.

When to seek medical advice

The above advice can help you to manage your condition at home. The majority of musculoskeletal conditions get better within six to eight weeks although sometimes they can persist for longer but this doesn’t mean there is something seriously wrong.

However, rarely, musculoskeletal symptoms can be caused by something more serious and it is important for you to know when to seek advice. We would advise if you experience any of the following you should seek the advice of you GP.

  • the pain you are experiencing is getting worse rather than better despite following the self-management guidance above for the condition  in the time frame expected
  • symptoms have not been significantly helped by a trial of medication as expected
  • you feel unwell and suffer symptom such as fever, night sweats or weight loss
  • you experience pain at night, possibly worse than during the day that prevents you from sleeping due to increasing pain and/or difficulty lying flat.
  • you experience a change in your ability to walk including balance problems or weakness/heaviness in your legs
  • you develop a hot and swollen joint for no apparent reason
  • early morning stiffness, lasting for longer than 30 minutes

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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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