PAIN AND ORTHOPAEDICS · Health guide
What Causes Hip Pain? Assessment and Rehabilitation
The possible causes of hip pain, assessment of groin and lateral hip symptoms, and the approach to walking and rehabilitation.
Updated: · General information
Why does it matter, and who is affected?
Hip pathology is an important problem that can cause prolonged functional limitation at almost any age. Because the hip is a weight-bearing joint, degenerative changes are common. Although patients describe the pain as being in the hip, pain genuinely arising from the hip joint is most often felt in the groin, the front of the thigh and even the knee. It can occur at any stage of life, including infancy, childhood, adolescence and particularly older age.
Causes and diagnosis
Possible causes include soft-tissue injuries around the hip, osteoarthritis, inflammatory rheumatic diseases, developmental dysplasia of the hip, fracture, tumour, infection and pain referred from musculoskeletal structures outside the hip. A detailed physical examination is essential to the diagnosis; blood tests and imaging (radiography, MRI) may be requested where needed. For intra-articular pathology (osteochondral lesions, labral tears), MRI is the gold standard; for superficial problems such as tendinitis, ultrasound can be helpful.
Treatment approach
Although it varies with the diagnosis, treatment options include rest, heat or cold application (cold is preferred in acute trauma and inflammation), stretching exercises, physical therapy, exercise, anti-inflammatory and muscle-relaxant medication, weight loss and the use of assistive devices. In advanced degenerative cases, hip replacement surgery may be required.
What does the site of the pain tell us?
Pain in the groin, on the outer side of the hip and at the back of the hip can arise from different structures. Pain referred from the lower back may also be felt in the hip. Difficulties in sitting down and standing up, on stairs, when putting on shoes and when walking are assessed at examination; the site of the pain alone is not a definitive diagnosis.
Walking and weight transfer
Muscle strength, joint movement and the pattern of weight bearing are examined together. Where needed, a walking aid and adjustments to activity are discussed. In particular, if after a fall the person cannot bear weight or has severe pain, causes such as fracture must be excluded before exercise is started.
Your questions
Patient information
Is hip pain always osteoarthritis?
No. Tendons, the tissues around the joint, the lower back or other causes may be involved. The diagnosis rests on examination.
What if walking increases the pain?
Distance, speed and surface can be adapted to need. However, a newly developed inability to bear weight or rapidly worsening pain requires assessment before any routine adjustment of exercise.
