Hip Pain
Symptoms
Hip pain can vary from sharp, shooting pain, a dull ache, or even a throb. Unfortunately the type of pain a patient experiences does not tell us exactly what is causing the hip pain.
Nonetheless, it is still important to take note of the specific symptoms that a patient experiences when they suffer from hip-related issues as that will help a specialist determine the best course of action.
In hip injuries, the location of the pain is particularly important as it can provide information about what underlying structure has been injured. Symptoms accompanying the pain, such as pain in the low back, or pain down the legs or numbness, will also provide valuable information that could assist in providing a more accurate diagnosis.
The type of hip pain you experience can vary depending on the injury. This can range from a burning sensation, an ache, or even a throb. In the sections below, we will distinguish between hip flexor pain, hip joint pain, hip labrum pain (cartilage), groin pain, and hip nerve pain. These injuries can all cause hip pain but it is important to accurately diagnose the injury to ensure the correct treatment plan is set in place.
Below are some accompanying symptoms that often occur with hip injuries:
The patient may be limping when they walk
There might be joint pain
Pain may spread toward the groin region
The hip may be tender, especially when touched
There may be swelling and inflammation that develops in the surface of the area affected by the pain symptoms
The hip may suffer from a loss of motion
Some patients may find that the hip is warmer than usual
Causes of Hip Pain - Location of Pain
When trying to diagnose what is causing the hip pain, the location of the pain is a critical piece of information to determine the underlying cause. In the following sections, we have categorised the potential causes of hip pain based on the location of the pain.
What Causes Front Hip Pain?
Pain that affects the front region of the hip can be caused by various problems. One of the most common causes of front hip pain would be joints sprains and muscle strains.
There are several muscles that are located in the front of the hip and determining exactly which muscle has been injured requires a thorough physical assessment. With sprains and strains, patients typically experience pain with movement and there may also be some swelling/inflammation. The front of their hip can also become stiff if they remain still for a period of time (ie. Sitting at work).
The muscles in the front hip region that may become strained include:
Pectineus
Iliacus
Psoas
Rectus Femoris
Sartorius
Adductor Longus
Tensor Fascia Latae
In addition to sprains and strains, front hip pain can also be the result of a hip labral tear. In this instance, the pain will be much deeper. This injury can be hard to differentiate without a proper assessment and unfortunately takes much longer to heal. In extreme circumstances, surgery may be required.
What Causes Back Hip Pain?
Pain in the back area of the hip can also occur due to a large number of potential causes in both the hip as well as the lower back.
It is not uncommon for injuries to cause both lower back and hip pain. For example, when the hips and low back are overworked from lifting or bending, this may cause pain in these two regions simultaneously. Although we need to do some amount of lifting in our everyday lives, lifting something too heavy, a sudden twist, doing too much in one go, or poor lifting technique can often result in overworking these regions. In addition to injuring the hip and back joints, we may also injure the muscles in these areas, which can contribute additional pain.
Most common, sprains, and strains affecting this area are caused by trauma, falls, and sports-related injuries. Engaging in certain physical activities without doing some stretches or warm-up exercises first may also increase the risk of a sprain or strain in the region.
The most commonly sprained joint in the back of the hip is the sacroiliac joint, which is where the hip bone meets the tailbone. These joints are typically aggravated with lifting, bending, or prolonged sitting.
Unfortunately this injury can be quite painful and can be accompanied by referral sciatic pain down the back of the leg. With back hip pain, we highly recommend patients to have this assessed as this can also be due to irritation of nerves in the low back, which requires immediate attention.
Lastly, another potential cause of hip pain in the buttock region is piriformis syndrome. In this injury, the sciatic nerve is compressed at the piriformis muscle, which can cause pain in the buttock but also referred pain down the back of the leg.
What Causes Side Hip Pain?
Side hip pain, or outer hip pain, is a common hip injury that can last weeks to months. There are typically 2 common causes of pain in this area of the hip and they can be difficult to differentiate. It’s important to make sure you diagnose the problem correctly, otherwise the prescribed treatment may not fix the injury. The 2 common causes of side hip pain are:
Gluteal tendinopathy – Tendons connect muscle to bone. When these tendons become overloaded, they become irritated and eventually lead to further inflammation. The development of tendonitis is often linked to a strain or tear of the gluteus medius. This injury can also cause pain in the buttocks and hip since the gluteus medius runs from the hip towards the buttocks.
Hip Bursitis – A bursa is a small sac of fluid that is located between the muscle and bone. When this bursa is irritated, it can cause outer hip pain. Bursitis occurs when the bursae that are found between bones and the soft tissue in the hip region develop inflammation. This injury is also known as trochanteric bursitis, which signifies that the bursa found at the hip bone's outer point becomes swollen. Patients often experience hip and leg pain, as well as pain down the leg and thigh.
Causes of Hip Pain Based On Activity
Apart from considering the specific location of hip pain, it is also important for a patient to take note of when these symptoms become worse or if the pain is aggravated with specific activities. Some hip injuries are only painful during particular movements so this can help determine the cause of the pain.
Below is an overview of some reasons why hip pain may develop during certain activities.
What Causes Hip Pain When Walking?
It is quite common for people to experience hip pain when they walk, and there are several reasons why this may happen.
In some cases, a previous injury, particularly trauma from a fall, may weaken the joints, muscles, or bones. As a result, when you return to walking, it might be strenuous on the hip if you haven’t done the appropriate rehabilitation exercises to build up the strength again. Although walking may seem like an easy activity for most people, many patients underestimate how strenuous this can be after returning from a significant injury.
Nerve-related problems have also been found to contribute to hip pain when walking. A pinched sciatica nerve is one particular cause of hip pain with walking, which can also cause pain to spread down the leg.
Another cause of hip pain with walking is a hip labral tear. The hip labrum is a ring of cartilage that sits in the hip joint. When this cartilage is torn or bruised, walking can illicit pain due to the excessive movement and weightbearing on the joint itself.
Alignment of the lower body can also cause hip pain with walking. If patients tend to stand or favour one side, this can lead to excessive pressure on one hip and thus lead to pain. Alignment issues are most common after major injuries, such as a fall, or any surgeries.
In addition to these, it is also important to take note that certain forms of arthritis may cause hip-related pain symptoms with walking. Osteoarthritis and Rheumatoid arthritis are the most common forms. Nonetheless, there are other forms of arthritis that can also cause hip pain with walking:
Psoriatic arthritis
Juvenile idiopathic arthritis
Septic arthritis
Ankylosing spondylitis
What Causes Hip Pain When Running?
Hip pain is a relatively common in runners. Most often, this is a result of a strain to the hip muscles or overload of the hip joints. However, there are cases where a more serious underlying issue may be causing the pain.
Flexor tendinitis and hip flexor strains are a common cause of front hip pain in runners. Pain in the back or side of the hip is more related to strains and tendonitis of the gluteal muscles. If you also experience some low back pain, it may be caused by sprains to the sacroiliac joints.
In some more severe circumstances, stress fractures can also occur in those who run frequently.
A labral tear, which refers to cartilage in the hip being injured to the point where a small tear develops, is another potential cause. In these cases, you will find that the hip pain is deeper within the join and takes much longer to heal in comparison.
Osteoarthritis is another noteworthy cause that leads to hip pain in many people who are trying to make running a part of their fitness routine.
What Causes Hip Pain after Sitting?
Sometimes, hip pain can occur after a person has been sitting for a while. The pain symptoms may start to develop while the person is sitting, or after they get up from the seated position.
The most common cause of pain in the back of the hip is sacroiliac joint sprains. When we sit, all the weight from our upper body loads into these 2 joints and we don’t normally feel this as we’re sitting. Unfortunately, as soon as we get up, there can be quite a strained feeling in the back and it can be quite uncomfortable to stand up straight.
Hip bursitis and gluteal tendinopathy can cause pain at the side of the hips. This can result from a variety of different causes. For more information on hip bursitis and gluteal tendinopathy, read our article on ‘Causes of Side Hip Pain’.
Pain at the front of the hip with sitting can be a result of hip flexor strains or femoroacetabular impingement. In these instances, prolonged sitting causes impingement of the hip flexor tendons. This ultimately results in pain at the front of the hips which can feel like an ache or even a bit of sharpness and weakness down the front of the leg.
What Causes Hip Pain at Night?
Hip pain at night can be very unpleasant. In the majority of cases, patients tend to experience side hip pain when they are in bed. This is a type of pain that affects the outer region of the hip. In some people, the pain may develop suddenly, while others may find it starts out mild but gets worse gradually every night.
Poor gluteal muscle strength is one of the major causes of hip pain at night. This condition is often referred to as greater trochanteric pain syndrome. Other causes include tendinopathy, bursitis, and osteoarthritis.
In cases of hip bursitis, the pain will be worse on the side of the hip that you are laying on. This pain will typically get worse the longer you lay on that side. However, if the pain is worse on the side of the hip that you are NOT laying on, the pain is more likely from gluteal tendinopathy.
Hip Pain Stretches
In many cases, a patient may find that their hip pain symptoms improve with specific types of exercises, as well as stretches. There are various activities that have shown to help with these symptoms. It is important, however, that the cause behind the symptoms are identified first, and to ensure all activities are safe for the patient.
Some of the best stretches that patients can use to help improve symptoms of hip pain include:
Hip flexor stretches
Pigeon pose
Butterfly stretch
Yoga squat
Leg swing
Figure four stretch
Here’s a video of hip stretches that we frequently prescribe to our patients:
Hip Pain Strengthening Exercises
There are also excellent strengthening exercises that people can rely on to help improve the overall strength of the muscles and ligaments located in the hips. Some of the best exercises that can help to target these particular muscles include:
Side-lying leg raise
Banded walk
Donkey kick
Single-leg glute bridge
Fire hydrant
Lateral squat
Here’s a video of hip clam strengthening exercises that we frequently prescribe to our patients:
Chiropractic Treatment for Hip Pain
Treatment for hip pain will largely rely on identifying the cause for the symptoms and then providing a targeted therapy that addresses the underlying problem.
Sports chiropractors frequently work with patients who suffer from hip pain as it is a common injury in athletes. Nonetheless, we also help lots of patients who experience hip pain that is not sport related.
In muscle injuries, we may use a variety of soft tissue techniques such as active muscle releases or dry needling. If the injury is more related to the hip joint or cartilage, we may need to look at techniques that help unload pressure off the hip joint.
In chronic cases, we may also perform a gait evaluation, which assesses the way you walk. In these tests, we look for overloading or misalignment, which may be causing recurrent hip pain.
The hip joint is a highly mobile joint that the bodies relies on for many daily activities. In our physical assessments, we also look for any major lack of mobility or asymmetries that may explain any overloading of the hip joints.
Lastly, strength tests are a vital part of our assessment. As we mentioned earlier, we rely heavily on our hips on a daily basis to get us from point A to point B. If we are lacking strength in some of the major hip muscles, we are likely to experience ongoing pain. In this case, we would need to build a small series of exercises to help patients build up their hip strength.