Last updated 27/12/2023 by The pain clinics - Interdisciplinary Health

Pain in the hip. Image: Wikimedia Commons

Pain in the hip.

Having pain in the hip and nearby structures can be extremely bothersome. Hip pain can be caused by several different factors, but some of the most common are overload, trauma, wear and tear / osteoarthritis, muscular failure loads and mechanical dysfunction. Pain in the hip or hips is a disorder that affects a large proportion of the population. Often there is a combination of causes that cause pain in the hip, it is therefore important to treat the problem in a holistic way, taking into account all factors. Any tendinopathies or mucosal bag injuries (bursitis) can in most cases be examined by a musculoskeletal expert (chiropractor or equivalent), and further confirmed by a diagnostic ultrasound or MRI where necessary.

Did you know: - Blueberry extract has a proven analgesic and anti-inflammatory effect?

In case of osteoarthritis (coxarthrosis) it may be desirable to try and wait as long as possible with a possible hip replacement, both because an operation involves a certain risk and because a prosthesis has only a limited lifetime. Among other things, exercises can be a good way to delay such an operation, where possible. According to figures from the NHI, 6500 hip prostheses are now inserted a year, of which 15% are re-operations.

Evidence of preventive and preoperative hip training.

A recent systematic meta-analysis, the strongest form of study (Gill & McBurney), published in January 2013, looked at 18 studies that fell within their inclusion criteria. The purpose of the study was - quoted directly from the article:

... "To investigate the preoperative effects of exercise-based interventions on pain and physical function for people awaiting joint replacement surgery of the hip or knee." ...

The interventions included in the search were physical therapy, hydrotherapy and rehabilitation training. The search was also aimed directly at patients who have already undergone a lengthy examination process and who have already been set up for surgery. There is thus talk of rather heavy knee or hip injuries.

As mentioned towards the beginning of the article, the study showed positive aspects of preoperative exercise before hip surgery, with statistically significant improvement in self-reported pain, self-reported function, gait and muscle strength. Here I would also like to mention that the same research couple did RCT (randomized controlled trial) in 2009, where they compared water-based versus land-based exercises for both knee and hip injuries. Improved function was reported here in both groups, but exercises done in a pool, where the patient did not have to deal with gravity in the same way as on land, were more effective in reducing hip pain.

Hip X-ray. Image: Wikimedia Commons

Classification of hip pain.

Pain in the hip can be divided into acute, subacute and chronic pain. Acute hip pain means that the person has had pain in the hip for less than three weeks, subacute is the period from three weeks to three months and the pain that has a duration of more than three months is classified as chronic. Pain in the hip can be due to tendon injuries, mucous membrane irritation, muscular tension, joint dysfunction and / or irritation of nearby nerves. A chiropractor or other expert on musculoskeletal and nerve disorders can diagnose your ailment and give you a thorough explanation of what can be done in the form of treatment and what you can do on your own. Make sure that you do not have pain in the hip for a long time, rather contact a chiropractor and have the cause of the pain diagnosed.

First, a mechanical examination will be performed where the clinician looks at the hip's movement pattern or possible lack of this. Muscle strength is also studied here, as well as specific tests that give the clinician an indication of what gives the person pain in the hip. In case of hip problems, an imaging examination may be necessary. A chiropractor has the right to refer such examinations in the form of X-rays, MRI, CT and ultrasound. Conservative treatment is always worth trying on such ailments, before possibly considering an operation. The treatment you receive will vary, depending on what was found during the clinical examination.

Normal MRI image showing hip anatomical landmarks, as well as muscle attachments and ligaments. The image is coronal, T1-weighted.

MRI of hip with anatomical landmarks - Photo Stoller

X-ray of the hip

X-ray of the hip - normal versus significant cox osteoarthritis - Photo Wikimedia

Description of X-ray of the hip: This is an AP image, ie it is taken from front to back. To left we see a healthy hip with normal joint conditions. To Høyre If we see a hip with significant cox osteoarthritis, we see that the joint has a significantly reduced distance between the head of the femur and the acetabulum. Bone spurs are also noted in the area (bone spurs).

Clinically proven effect on relief of pain in the hip in mechanical dysfunction and osteoarthritis.

A meta-study (French et al, 2011) showed that manual treatment of hip osteoarthritis had a positive effect in terms of pain relief and functional improvement. The study concluded that manual therapy is more effective than exercise in the treatment of arthritis disorders. Unfortunately, this study contained only four so-called RCTs, so no firm guidelines can be established from this - but it probably means that specific training with manual therapy will have a greater, positive effect.

What does a chiropractor do?

Muscle, joint and nerve pain: These are things that a chiropractor can help prevent and treat. Chiropractic treatment is mainly about restoring movement and joint function that can be impaired by mechanical pain. This is done by so-called joint correction or manipulation techniques, as well as joint mobilization, stretching techniques, and muscular work (such as trigger point therapy and deep soft tissue work) on the involved muscles. With increased function and less pain, it may be easier for individuals to engage in physical activity, which in turn will have a positive effect on both energy and health.

Exercises, training and ergonomic considerations.

An expert in muscle and skeletal disorders can, based on your diagnosis, inform you about the ergonomic considerations you must take to prevent further damage, thus ensuring the fastest possible healing time. After the acute part of the pain is over, in most cases you will also be assigned home exercises that also help to reduce the chance of relapse. In the case of chronic ailments, it is necessary to go through the motor movements you do in everyday life, in order to weed out the cause of your pain occurring time and again.

Exercise and movement are good for body and soul:

• Chin-up / pull-up exercise bar can be an excellent exercise tool to have at home. It can be attached and detached from the door frame without the use of a drill or tool.
• Cross-trainer / ellipse machine: Excellent fitness training. Good for promoting movement in the body and exercising overall.
• Grip-cleaning tools can help strengthen relevant hand muscles and thus help to work out muscle dysfunction.
• Rubber exercise knit is an excellent tool for you who need to strengthen the shoulder, arm, core and more. Gentle but effective training.
• Kettlebells is a very effective form of training that produces fast and good results.
• Rowing Machines is one of the best forms of training you can use to get good overall strength.
• Spinning ergometer bike: Good to have at home, so you can increase the amount of exercise throughout the year and get better fitness.

What can you do yourself?

• General exercise and activity is recommended, but stay within the pain limit.

• One so called foam roll or foam rollers can also provide good symptomatic relief for musculoskeletal causes of hip pain. Click on the image below to learn more about how a foam roller works - in short, it helps you to loosen tight muscles and improve blood circulation in the affected area. Recommended.

• En foam roll can be used directly on tight muscles and trigger points. It is also an excellent way to strengthen the core muscles. Click on the picture or here to learn more.

• Did you know: - Blueberry extract has a proven analgesic and anti-inflammatory effect?

Lecture or ergonomic fit for your business?

If you want a lecture or ergonomic fit for your company, please contact us. Studies have shown positive effects of such measures (Punnett et al, 2009) in the form of reduced sick leave and increased work productivity.

Also read:

- Backache?

- Headache?

- Pain in the neck?

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References:

1. NHI - Norwegian Health Informatics.
2. Gill & McBurney. Does exercise reduce pain and improve physical function before hip or knee replacement surgery? A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2013 Jan; 94 (1): 164-76. doi: 10.1016 / j.apmr.2012.08.211.http://www.ncbi.nlm.nih.gov/pubmed/22960276 (Full text available via elsevier)
3. Gill & McBurney. Land-based versus pool-based exercise for people awaiting joint hip or knee replacement surgery: results of a randomized controlled trial.Arch Phys Med Rehabil. 2009 Mar; 90 (3): 388-94. doi: 10.1016 / j.apmr.2008.09.561. http://www.ncbi.nlm.nih.gov/pubmed/19254601
4. French, HP. Manual therapy for osteoarthritis of the hip or knee - a systematic review. Man Ther. 2011 Apr; 16 (2): 109-17. doi: 10.1016 / j.math.2010.10.011. Epub 2010 Dec 13.
5. Punnett, L. et al. A Conceptual Framework for Integrating Workplace Health Promotion and Occupational Ergonomics Programs. Public Health Rep. , 2009; 124 (Suppl 1): 16–25.

Frequently asked questions regarding hip pain:

Q: Can pain be caused by coxarthrosis?

Answer: Cox means hip in Latin. Osteoarthritis is degenerative changes in a joint. In moderate or significant coxarthrosis, pain and impaired joint movement can be experienced, especially in flexion and inward rotation. Based on studies, manual physical therapy seems to be a good idea in a treatment program, together with specific training.

Q: Why do you get pain in the hip?

Answer: As mentioned earlier in the article:

Hip pain can be caused by several different factors, but some of the most common are overload, trauma, wear and tear / osteoarthritis, muscular failure loads and mechanical dysfunction. Pain in the hip or hips is a disorder that affects a large proportion of the population. Often there is a combination of causes that cause pain in the hip, it is therefore important to treat the problem in a holistic way, taking into account all factors. Other causes may be tendinopathies, myofascial restrictions or mucosal irritation / bursitis.

Q: Why do you get lumps in the hip?

Answer: Iling is usually a sign of a mild nerve irritation, a bit depending on where in the hip you feel it - so there can be different reasons for this. Sensory changes can occur in meralgia parastethetica or sensory changes in the L3 dermatome. Piriformis syndrome can also cause such irritation to the buttocks and hip region.

Q: Can one get pain in the hips from inactivity?

Answer: Yes, just as you can get pain in the hips from overactivity, you can also get it from inactivity. This is usually due to a decrease in the strength of the support muscles around the hip, which can result in other muscles being overloaded or that you get pain in the hip joint itself. It is therefore important to find a balance in the training, and do what suits you best.

Q: Can jogging cause hip pain?

Answer: The hip joint can be affected by the muscles around the hip or by changes in function in the hip itself. When jogging, it can, for example due to incorrect loads or overload, reproduce pain in the hip. Jogging on hard surfaces in particular tends to result in hip pain, due to shock loads from the non-movable surface. If you are wondering how to run properly, then we recommend the free guide 'Start Running in a Few Steps'which, among other things, deals with injury prevention.

- Related questions with the same answer: «Why can you get pain in the hips after jogging?», «Why do I have pain in the hips after exercise?

Q: Can you have an increase in the angle of the hips?

Answer: Yes, you can have both increased and decreased angle of the hips. A normal hip angle is 120-135 degrees. If it is less than 120 degrees, this is called coxa vara or cox varum. If it is more than 135 degrees it is called coxa valga or cox valgus. With coxa vara, you will also have a shorter leg on that side, and the person will then limp - a common cause of this can be a relatively heavy trauma, such as a fracture injury. The most common cause of coxa vara is that it is congenital / genetic, but as mentioned, there are several reasons for such angle changes.

Here is a helpful illustration showing the hip angles:

Hip angle - Photo Wikimedia Commons

Q: Can one train a wound hip?

Answer: Yes, specific exercise, often in combination with a couple of symptom-relieving treatments (eg physiotherapy or chiropractic), is one of the best evidence for the relief of hip symptoms / ailments. Remember that it is important that the exercises are specially adapted for you, to reduce the chance of overload and to ensure the fastest possible progress. Contact a musculoskeletal expert and set up a training tutorial, and then you can do the exercises on your own for a period of time before contacting the clinician for further progression exercises.

Q: Can hip pain be caused by mucus irritation?

Answer: Yes, hip pain can occur due to so-called trochanter bursitis, also known as trochanter mucus irritation. The pain is then most often located to the outside of the hip and more clearly when the person is on the affected side or stepping down on the involved side. The main treatment is rest, but NSAIDS can also be helpful in bringing down any inflammation. Strengthening of the hip muscles and stretching of the iliotibial ligament can also be helpful in helping and relieving the hip.

Q: Having an overloaded hip, what should I do with exercise?

Answer: First of all, it is important that the hip is recovered from the overload, so a rest period from training may be applicable, then you can start with light functional exercises and gradually increase the load as the weeks go by. Find exercises that don't hurt, preferably low-load exercises in the beginning such as e.g. thera band exercises.

Q: Can one take MRI of the hips, and what does the normal MRI of the hip look like?

Answer: Thanks to your question, we have now added an MRI image that shows a hip of normal appearance in the article. Feel free to ask more questions.

Q: I have pain in my hip when I walk, what could be the reason for this?

Answer: Hi, the cause of pain in the hip when I walk you ask - the answer is that there can be many causes for this. You do not mention age, but wear and tear in the joint can play a role, so-called cox osteoarthritis, but in most cases it is muscular dysfunction that causes pain in the hip, especially overuse of the tensor fascia latae, iliotibial band, piriformis or gluteus minimus. If you give us more information about the problem in the comments field below, we can answer in more detail about this.