Hip pain is a common type of pain suffered by many people in the U.S. The location of the pain can offer clues as to its cause as well as keys to its treatment. Read on to learn more about the most common hip pain causes.
What are the most common hip pain causes?
The hip is a ball and socket joint of the body. Hip pain can involve the actual joint itself or the soft tissues, muscles, and tendons surrounding the joint. If the pain is located inside the leg or groin area, the pain most likely originates within the ball and socket joint itself. If the pain is located on the outside of the hip or wraps around the back to the buttocks, the muscles, tissues, or tendons in the area are probably the source. Hip pain can also radiate up the back and down the leg, causing what is called “referred pain.”
The hip, a ball-and-socket joint that ranks as one of the body’s largest, sustains a great deal of wear and tear throughout the day. Because it’s designed to move back and forth while supporting your body, a healthy hip can withstand a large amount of usage. It can even withstand a certain level of impact without causing pain.
Over the years, however, disorders such as osteoarthritis and bursitis can develop. Other skeletal conditions, including osteoporosis, can affect the hip joint, leading to pain or other, potentially more serious damage. Hip pain affects about 7% of U.S. adults at any given time, according to the Centers for Disease Control and Prevention (CDC).
You can learn more about hip pain causes and treatment in the following video..
Who suffers from hip pain?
The demographics of hip pain, including who has it and its economic impact, are changing with advances in treatment options and changes to the healthcare system.
It is difficult to accurately assess the number of people who suffer from hip pain because many never seek medical treatment, choosing over-the-counter (OTC) medications to cope with the pain instead. A 2011 report from the Institute of Medicine (IOM) found that approximately 116 million people in the U.S. suffer from chronic pain, some of which is under treated by medical professionals. An estimated 2.5 million people in the U.S. have total hip replacement (THR) surgeries, which gives some idea of the issue, but many more have untreated pain in that area, or pain that is not resolved with surgery.
Age
There has been an increase in THR treatments, up 73% from 2000 to 2009, with a 123% increase for patients ages 45 to 64 and 54% for ages 65 to 84. The largest increase in surgical interventions occurred in the younger age group. THR is also rising for patients younger than 45 due to year-round athletics and other repetitive motion injuries. Hip pain in adolescence can be successfully treated non-surgically if it is diagnosed and treated early.
Hip pain may also be underreported in some groups. Elderly patients are more likely to suffer from hip pain but less likely to report it.
Race and income status
There is also evidence that minority and low income patients do not report hip pain as often as it is experienced. This may be partly due to the expense associated with seeking treatment, as well as the perceived stigma of reporting pain in general.
In a 2014 presentation to the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), lead study author Jacob M. Drew, MD, of the University of Massachusetts Medical School said:
“While shifts in age strata seem to be ongoing, race and gender distribution have remained relatively stable for…THR. This suggests that well-documented racial disparity in total joint replacement (TJR) persists, and that there remains a substantial population in whom TJR is underutilized.”
Whatever the demographic, the economic impact of pain is skyrocketing. Chronic pain is the number one cause of disability in the U.S. According to the American Chronic Pain Association (ACPA), one in six people are living with chronic pain.
The cost of chronic pain
The IOM report “Relieving Pain in America” puts the economic cost of chronic pain at an estimated $560 to $635 billion annually.
It is difficult to allocate a percentage of that number to certain types of pain, but because hip pain causes typically affect mobility it stands to reason that the price tag for hip pain is high. According to the results of a National Health and Wellness survey, individuals who suffer from osteoarthritis, a common source of hip pain, were less likely to be employed and highly likely to be on disability. Missing work due to pain or being perceived as unemployable due to pain can be devastating financially to individual families and society as a whole.
Beyond the dollar signs, the cost of chronic pain is personal and rising. People with chronic pain are more likely to be depressed to the point of attempting suicide, and there are social costs as well. Christopher L. Edwards, PhD, assistant professor of psychiatry at Duke University School of Medicine notes in a WebMD article:
“The [social] costs are incalculable. How do you estimate the value of lost self-worth? How do you estimate the loss of family, friends, and a sense of accomplishment?”
Common hip pain causes
Common hip pain causes vary widely and have many options for treatment. Hip pain can be caused by arthritis, including juvenile, rheumatoid, and osteoarthritis. It can also be caused by injury to the joint itself, as in a hip fracture or dislocation, or it can be caused by injuries to the soft tissues and tendons surrounding the joint. Bursitis, tendonitis, inguinal hernias, and sprains or strains can all cause significant, long-lasting hip pain.
Other causes of hip pain may not originate in the hip itself. A herniated disc or trauma to the sciatic nerve can cause significant hip pain, as can spinal stenosis (narrowing of the space in the spine that places pressure on the spinal cord), and meralgia paresthetica (caused by compression of the nerves). More severe hip pain causes can include bone cancer, leukemia, or metastatic cancer that has spread to the bones. Osteoarthritis, however, is the most common hip pain causes in people as they age.
Many conditions can cause hip pain, varying from acute and treatable to more serious conditions for which treatment options are more limited. Here are the five most common hip pain causes.
1. Osteoarthritis
The hip, like other joints, has a protective layer of cartilage that cushions the joint as it moves back and forth. With osteoarthritis, the cartilage gradually wears away, leaving less and less material to insulate the bones from rubbing against one another. The condition may manifest early on as stiffness that slowly gives way to inflammation and pain as the condition progresses.
With osteoarthritis in the hip, pain may also flare up in the buttock, thigh, or groin areas. Walking, standing, or twisting may exacerbate pain.
Risk factors for osteoarthritis include being older than 45, overweight, and having family members with the condition. Some injuries to the hip, including labral tears, increase the risk of developing osteoporosis later in life. The exact causes of the disorder aren’t known.
Overuse does not, in itself, necessarily lead to osteoarthritis in the hip, according to the University of Washington Orthopaedics and Sports Medicine school, since many people grow older without developing the condition. What’s more, runners have a lower than average risk of developing osteoarthritis in the hip, according to research published in Medicine and Science in Sports and Exercise.
Treatment for osteoarthritis may include a mix of exercise, heat treatment, physical therapy, and in severe cases, surgery.
2. Osteoporosis
Osteoporosis is a degenerative skeletal condition defined by abnormally thin bone density. Bones are living tissue that go through a creation and absorption process throughout a person’s entire life.
Peak bone mass—the most dense a person’s bones will ever be—develops between the ages of 25 and 30. In young people, the bone creation process is rapid and a bank of bone develops to protect against future loss.
Around age 40, the process reverses, with bone loss outpacing bone growth. Although bone continues to be created throughout a person’s lifetime, bone growth never reaches that youthful state of high density.
Although everybody loses bone density, some people lose excessive amounts, resulting in weakened bones and osteoporosis. Osteoporosis can develop in any part of the body, but the hips are a commonly affected joint. There typically aren’t any symptoms, but the disorder can be caught through bone density scans.
Weak bones increase the risk that a fall will result in a fracture. In 2010, 258,000 people were admitted to the hospital following a hip fracture, according to the CDC, with more than 95% of those cases resulting from falls.
Sometimes, the hip weakens so much that a bone could break while standing or walking. Fractures result in pain and limited mobility, and frequently require surgery to repair. To prevent osteoporosis, eat a calcium-rich diet and do weight bearing exercises, such as walking.
3. Labral tear
The hip’s labrum is a piece of cartilage that seals the femoral head—the ball at the top of the thigh bone—into the socket. It helps to absorb shock, and stabilizes and lubricates the joint. However, this all-important stabilizer and shock absorber is not immune to injury.
Labral tears can result from traumas sustained from playing sports or from a car accident, although repetitive twisting or turning in some sports can also lead to the injury. Sometimes, structural deficiencies in the hip lead to tears.
Symptoms include the sensation of something clicking in the joint, along with pain or stiffness. A labral tear may improve on its own with rest within six weeks, but medical attention may be necessary if pain does not ease. Doctors typically diagnose the condition with a physical examination followed by an X-ray or other screening test.
Treatment includes physical therapy or surgery.
4. Hip bursitis
Bursitis occurs when small, fluid-filled sacs called bursa become inflamed from overuse. Bursa provide cushioning between the hip joint and surrounding muscles and tendons. Although bursitis can occur in any joint, the hip ranks as one of the more common spots, according to the Mayo Clinic. It also means it’s one of the more common hip pain causes.
Hip bursitis symptoms include pain and swelling. A doctor may diagnose the condition by performing an X-ray or MRI, or testing fluid present in the swollen area. Treatment includes rest and ice with pain medication as necessary. Inflammation may last a few weeks, although additional flare-ups may occur. In lingering cases of bursitis, surgery is available to address damage that hasn’t healed.
5. Femoroacetabular impingement (FAI)
Sometimes, hip pain causes develop due to structural abnormalities within the hip socket.
During childhood, people with FAI develop bone spurs that interfere with movement in the hip socket. The bone spur may occur on the femoral head or the acetabulum—the socket of the hip that curves around the femoral head, cupping it.
FAI first develops during childhood when the hips are still growing. It’s unknown how common the condition is, according to the American Academy of Orthopaedic Surgeons.
There are three different types of FAI: pincer, cam, and combined. With pincer, the excess bone growth extends over the acetabulum. With cam, the bone growth gives the femoral head an unnatural shape, making it impossible to smoothly rotate inside the acetabulum. In combined FAI, patients show a mix of the two types.
FAI doesn’t always cause problems. However, symptoms can include stiffness, pain, and limping. Resting or avoiding activities that cause pain may alleviate symptoms. Surgery is available to treat persistent cases. During the procedure, a doctor shaves excess bone growth to help the joint move smoothly.
Treating hip pain
Treatments for hip pain is progressive in nature, and statistics on utilization of the early stages of treatment are hard to come by. Doctors generally recommend rest and icing when pain is initially reported, accompanied by OTC non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. If these actions do not successfully alleviate the pain, X-rays are called for followed by whatever course of treatment they indicate.
A total hip replacement is not the only surgical intervention. Hip debridement is a procedure whereby surgeons will remove bone in the hip that may be impeding movement of the ball in the socket, and hip pinning may be used to connect and stabilize hip fractures.
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