Hip Pain
Hip pain can be quite annoying as it gets in the way of daily activities, from walking, to climbing the stairs, to playing your favourite sport. Thankfully, there is often a good amount that can be done to help relieve hip pain. The hip is a complex area and there is a lot of crossover with the back, so figuring out what kind of problem you have is the first step to implementing a plan that will get you back to where you want to be.
What hip pain can feel like
Patients describe their hip pain to me in all sorts of different ways and some of the most common are:
- A deep ache in the groin or front of the hip
- Pain that is worse after walking, sitting for a while or being on your feet all day
- A hip that feels stiff and may often be worse in the morning or after periods of inactivity
- Discomfort or difficulty putting shoes and socks on, getting in and out of a car or bending down
- Pain on the outside of the hip or into your buttock, and can sometimes spread into your thigh
- Pain that is worse when climbing the stairs
- A pinching or catching feeling in your hip that may be particularly noticeable squatting, kneeling or sitting
- A feeling of instability in the hip or that it might give way
- Pain in the hip or buttock area when sleeping
If you recognise some of these symptoms then it’s worth an assessment. Finding out what is causing your pain is important as this then informs what kind of plan we put together to help resolve it.
Why hip pain happens
There is a lot going on around the hip and pelvis and many different causes of pain. Some of the causes are:
- Muscles, tendons or ligament problems such as strains or overuse
- Hip socket problems such as dysplasia or femoroacetabular impingement
- Issues with the joint cartilage such as labral tears
- Bone injury such as stress fractures
- Joint issues such as arthritis
When muscles or tendons get overworked or irritated, they can cause pain and sometimes aggravate other structures such as the bursa, often causing discomfort on the outside of the hip and when lying on that side. Joint problems such as arthritis, impingement and labral tears are often felt more in the groin region and a more ‘deep’ pain. Hip pain can also be referred from the low back, and this can often be the case if pain is felt in the back of the pelvis, the buttock or the thigh. So it’s important to determine if the pain you’re experiencing is actually the hip, or coming from somewhere else.
The most common fear I hear from patients is that their hip is wearing out, or damaged to the point that it will end up needing replaced. While some patients do end up having hip replacements, this is far from the norm and many things can be done to help calm down an irritated hip and get you functioning better again without necessarily having to have surgery.
Another comment I hear often is attributing pain to our age. While some natural wear and tear occurs as we age, it’s not always the sole cause of pain. Many older patients can get good relief and maintain an active life for many years despite their age.
How I assess and treat hip pain
Finding out where your pain is coming from is important in putting an appropriate plan together. I’ll start by asking you questions about your pain, how it came on, what it’s stopping you from doing, etc. This tells me a great deal straight away. I’ll then run through a comprehensive assessment with you to see how your hip moves, where you’re limited and what movements are hurting. I’ll also look at your low back and the rest of your lower limb so that we’re being thorough and ruling out any other cause that might be showing up as hip pain.
Once we’ve figured out why your hip is hurting, we can then put together the right plan based around your particular issue, the goals you have and what you’re wanting to get back to doing.
I find the best approach to managing hip pain is using a mixture of hands-on osteopathic treatment to reduce the pain and improve your movements, and specific exercises to do at home to continue that work we’ve done in session. This is aimed at continuing to improve your movement quality and building up strength and tolerance in your hip. I’ll also give you practical advice in terms of managing your activities so we’re giving the hip enough time to settle and at the same time, challenging it without overdoing it and further irritating things.
It’s highly unlikely you need referrals or scans for your hip problem, but there are a small number of cases where I can’t help, or someone else is better placed to help. I’ll be looking for this when I assess you and if I feel you need to be referred, I’ll help arrange that for you.
If you’ve got a hip issue that’s holding you back, let’s put a plan together to help.
What to expect
While some simple hip problems, especially those that haven’t been there too long, may resolve quickly, some people may take longer for things to settle down, especially if you’ve had it for a long time. The roadmap is different person-to-person. One patient might notice their pain settle and movement quality improve quite quickly, whereas others may notice smaller changes first, such as being more comfortable sitting or lying in bed. If your problem is coming from tendon strain or irritation, it’s important to know that this can take a bit longer, often weeks to months, rather than a quick fix.
You may also experience some ups and downs along the way and this is entirely normal. Recovery is rarely a simple clean linear progression from pain to no pain. Small setbacks can be managed, so long as things are moving in an overall positive direction, and I’ll give you advice on managing these along the way.
Another important goal is regaining confidence in using your hip again, without worrying about the pain, or that it might mean something bad is going on. I find pain can make some patients fearful and cautious about engaging in activity. Rebuilding your confidence and tolerance is a key part of the plan we put together.
I’ll always be honest with you about the progress and I’ll be making sure you’re happy with how things are going too. Even where the progress is expected over weeks or months, we’ll reassess regularly to make sure we’re on the right path and if we aren’t making good progress in the first three to six treatments, we’ll change the plan or look to see what else needs to be done to help you.
The majority of hip pain is not serious and not a cause of worry. There are a small number of things to be aware of that require medical help. If you have any of the following, you should get checked out at A&E:
- Severe pain after a fall or injury, particularly impact injuries
- You’re unable to walk or put any weight on your leg
- Tingling or loss of feeling in your leg after an injury
The following are things that should be checked out by your GP or calling NHS 111:
- Your hip is swollen and feels hot
- Sudden severe pain that started without any fall or injury
- Changes in skin colour around your hip
- Hip pain and a feeling of being unwell with high temperature, or feeling hot, cold or shivery
These are all uncommon, but they are best assessed by a doctor first before booking with me.
Sources: NHS — Hip pain
Written by David Graham, GOsC Registered Osteopath (reg. no. 10852)
Common questions about hip pain
Osteopaths can help with hip pain. There are a lot of different things that can cause the pain and they require slightly different management. I’ll assess you to see what specifically is causing yours, and put a plan together to help. If I think it’s not something I can help with, I’ll let you know and point you in the right direction.
Most of the time you won’t need an x-ray or MRI and many issues can be identified by a thorough assessment and managed conservatively. Even arthritis can be identified and managed without a scan and the amount you have doesn’t always correlate to your level of pain, and can often cause more worry. If I think you do need a scan, I’ll let you know and help you get it.
A lot of hip problems, including arthritis, can be managed conservatively, using a mix of hands-on osteopathic treatment and exercise. Pain from irritation in the tendons on the outside of your hip actually fares better with this approach compared to injections.1 In some cases, when patients haven’t been helped by conservative treatment, injections or surgical opinion may be needed. If this is the case for you, I’ll explain this to you and help get you in front of the right person.
Osteopathy can help with arthritis and the best approach is a mixture of hands-on treatment, advice and exercise to build strength and tolerance in your hip. Despite the arthritic changes going on, it doesn’t mean you will definitely need a replacement and many people manage without ever needing one. If surgery ever becomes a necessary option for you, I’ll discuss this with you and help make the appropriate referral.
Pain on the outside of the hip, particularly over the bony point, is quite common and often caused by irritation in the tendons of your glute muscles, and/or irritation of other structures in the area such as bursa. This irritation will often calm down over time and can be managed conservatively with hands-on treatment, advice and the right exercise.
Pain that is worse when lying on it at night is commonly caused by the tendons or other structures, such as bursa, that don’t like pressure when they’re already inflamed and irritated. I’ll give advice based on what I think your pain is caused by and what changes you can make so it’s more comfortable while things are calming down.
Most of the time, complete rest is not recommended. Sometimes backing off certain activities or movement, particularly those that are aggravating your pain, is wise to let things calm down. I’ll recommend how much movement, and what exercises, are right for you and help build up your tolerance over time.
My default is to not tell patients to stop doing the things they love. Sometimes it may be necessary in the short-term to let things calm down so you can keep doing more of it in the long-term. It doesn’t always mean stopping completely, and may just mean modifying or lowering your volume for a bit. I’ll advise you on what is right for you based on your problem.
Yes, I can often help if you’ve had it for a long time. It may require different management and the timeframe may well be longer. I’ll assess you properly and make sure we know what’s going on and then let you know how long I think it may take. I won’t overpromise and I’ll be up front with you so you’re never left with false expectations.
This is very hard to answer and it really depends on what specific hip problem you’ve got, how long you’ve had it, your lifestyle and other factors. Some problems settle in a few weeks, others take months. I’ll be honest with you about that and won’t ask you to commit to long treatment plans unnecessarily. If we’re not making progress in three to six sessions, we’ll change plan or I’ll make a referral if that is more appropriate.
Does this all sound familiar?
Let’s take a look.
If you’re suffering with hip pain that is affecting your daily life, let’s figure out where it’s coming from and what can be done about it.