A real pain in the arse!

Hip pain – common causes and treatment (Part 1)

Hip pain is one of the most common complaints among the adult population, resulting in large costs and often contributing to poor health among those affected (1). But what is the hip, what’s causing the pain, and how to I help to alleviate it?

The hip is a ball and socket joint connecting your femur (thigh bone) with your acetabulum (socket on your pelvis – see image on the right). It’s an extremely important joint for daily functions including walking, sitting, standing and squatting. While it is a very stable and strong joint, it can also be a source of pain. Here we discuss some of the most common causes, how we can identify them, and how we can help to reduce pain and improve function.

Osteoarthritis

The hip (after the knee) is 2nd the most common joint affected by osteoarthritis (2). Osteoarthritis refers to changes to the bones of the hip joint and surrounding surfaces, which may then result in pain or loss of function. While osteoarthritis is a disease, it could be more appropriately described as ‘age related changes’ to the joint – in other words, as we age our joints experience small changes, hence why osteoarthritis is most common when we’re over 50. Think of it this way – just as we change of the outside as we age (grey hair and wrinkles!), our joints, muscles and tendons on the inside change over time too.

Thankfully these age-related changes don’t mean that we can’t manage pain and improve our function. Firstly, osteoarthritis can generally be identified based on your symptoms, age and joint range of movement. Once identified we can help to alleviate your symptoms and improve day to day function. Evidence tells us that the best way to do this is with weight management, manual therapy and an exercise plan suitable for your condition that can help to strengthen the hip joint. In some cases, a total hip replacement may be required to get you the best outcome. In this case, we can help to prepare you best for surgery and refer you to an appropriate specialist.

Lateral hip pain (typically ‘Glute Medius tendon pain’)

The Glute Medius muscle runs down the side of your buttock/upper thigh and plays a key role in lateral and rotational movement of the hip and is crucial in single leg balance. As this muscle plays a key role in functions like walking, balance and climbing stairs, it can occasionally become overworked resulting in pain along the tendon on your upper lateral thigh. This can occur both in active and inactive individuals, but most often occurs if you’ve recently increased your activity significantly (e.g. more walking, hiking or a new gym routine). There are other causes of lateral hip pain, such as inflammation to a bursa, but the Glute Medius tendon is the most common cause (3).

Glute Medius tendon pain can be identified in assessment by understanding your history and looking at physical characteristics including range of motion, muscle strength and pain location. Once identified, the recommended treatment for this type of tendon injury is a graded and specific strengthening plan for the muscle and tendon, as the tissue will respond positively to appropriate exercise by growing and becoming stronger. This can be used alongside specific manual therapy techniques and lifestyle modification in order to alleviate your pain, get you stronger and ultimately get you back to full function.

1. Pinto, D., Robertson, M.C., Hansen, P. and Abbott, J.H., 2012. Cost-effectiveness of nonpharmacologic, nonsurgical interventions for hip and/or knee osteoarthritis: systematic review. Value in Health, 15(1), pp.1-12.

2. Zhang, Y. and Jordan, J.M., 2010. Epidemiology of osteoarthritis. Clinics in geriatric medicine, 26(3), pp.355-369.

3. Chamberlain, R., 2021. Hip pain in adults: evaluation and differential diagnosis. American family physician, 103(2), pp.81-89.