The ultimate guide to hip pain

Hip pain is a very common condition but can make everyday life more difficult. Usually, hip pain has a very simple explanation, other times, it might be more complicated and requires more comprehensive treatment. Professor Ali Ghoz has put together this patient-friendly guide which covers the most common causes and various treatments available for hip pain.

What causes hip pain?

There are several causes of hip pain, but the first thing to determine is if the pain is coming from the hip joint or outside the hip joint. Pain on the inside of your hip is usually a result of problems with the hip joint, however, pain on the outer part of your hip is normally caused by problems with the soft tissues that surround your hip, not in the joint itself.

The most common causes of hip pain include:

• hip arthritis;
• hip impingement;
• hip flexor strains.

Less common causes of hip pain can be from a hip fracture, an infection in the bone or joint, or bursitis; an inflammation of the fluid-filled sacs over your hip joint that prevent muscles rubbing against the bone.

How can I find relief from hip pain at home?

If you believe that your hip pain can be managed at home, here are some tips and home treatments for you to consider to help alleviate any hip pain and aid recovery.

Avoid activities that make hip pain worse. If your hip pain was caused by an injury, the first and most important thing to do is to stop the activity that caused the injury in the first place and avoid all activities that make the pain worse. There are certain movements that trigger hip pain, such as lunges and squats.

Rest and take medication for hip pain. Usually a period of rest, between 6-8 weeks, is recommended. The next step is to take medication, locally or orally, starting with paracetamol or ibuprofen.

Apply ice. If it’s a strain, applying ice to the affected area in the acute (early) stage helps to reduce pain and swelling and promotes quicker healing.

Keep your weight under control. If you are overweight, you should consider losing weight to minimise excess pressure on your hips.

Exercise regularly. There are stretching exercises you can do, such as yoga and Pilates to gradually build strength in your joints. Remember, it’s essential to stretch before and after any exercise to maintain healthy hips and prevent injuries.

See a physiotherapist. If there is an injury, a course of physiotherapy focusing on your core muscles, gluteal muscles and hamstrings will aid recovery.

What kind of treatments can a doctor offer for hip pain?

General hip pain will often get better without the need to visit a doctor. However, there are times when hip pain doesn’t get better and a trip to the doctor is necessary.

Typically, a doctor will check your medical history first and then try to establish the cause of the pain by conducting a clinical assessment. This may or may not be followed by X-rays or an MRI scan to study the hip joint and surrounding structures. Following a diagnosis, your doctor will give you the appropriate treatment or medication. This may include:

• Pain killers or steroid injections – to manage general pain or conditions such as osteoarthritis your doctor might prescribe some pain killers or administer steroid injections, so you can get on with your day-to-day activities without pain. If the hip pain is severe, then you and your doctor may need to discuss a hip replacement procedure.
• Surgery – the treatment for impingement (if home treatments haven’t worked) may include hip impingement surgery. Keyhole surgery is often used to reshape the hip and repair any cartilage damage.
• Anti-inflammatory meds and physiotherapy – in some cases, hip pain can be felt from a groin sprain. This commonly happens because of overtraining, turning suddenly or moving your hip awkwardly. The doctor may prescribe anti-inflammatory medication and pain killers and advise you to rest. This may also be followed up by guided physiotherapy.

It is essential to include enough vitamin D in your diet to maintain strong bones and muscles. Vitamin D helps the body absorb calcium and phosphorus from the food you eat, however, quite often, this is overlooked. So, getting adequate amounts of this essential vitamin help increase bone density and prevent bone fractures and diseases like osteoporosis.

When is hip replacement a good option for hip pain?

Hip replacement is a suitable option for you if you are experiencing severe, chronic hip pain and your mobility has been reduced. Patients who suffer severe osteoarthritis or rheumatoid arthritis are often more likely to need a hip replacement at some point in their lives.

A hip replacement is major surgery and carried out under a general anaesthetic. A surgeon will make an incision in your hip, remove the damaged hip joint and replace it with an artificial one made of metal (in some cases, ceramic). The outcome is very good with the success rate being higher than 90 per cent and the risk of serious complications being very low - at around one in 100. Nowadays, artificial hips are known to last longer than 20 years!

Is there a way to avoid having surgery?

The most effective way to reduce the chance of any long-term damage to your hip joints, and consequently avoid hip surgery later on in life, is to make some small lifestyle changes. These small changes, such as keeping fit by cycling, swimming, etc. will keep your muscles and joints healthy and will have a positive impact on your overall health. There are some sports, such as running which are good but too much of it can cause injuries, such as impingement.

Making sure that you carry out activities in a balanced, safe way and reduce high impact activities are the best ways to avoid injuries: ensure you wear good sportswear, invest in some customised running/sports shoes, maintain your spinal muscle strength and always get the right nutrition in your diet.

How do I choose a surgeon for hip surgery?

Choose an orthopaedic surgeon who is confident and can demonstrate they have enough experience in performing this procedure. Your GP may be able to offer a recommendation. It is very important that you feel comfortable with the specialist that treats you and you’re able to discuss the results and any doubts you have before and after the surgery.

Professor Ali Ghoz is a London and Reading based consultant trauma and orthopaedic surgeon who specialises in hip and knee surgery. If you are suffering from any of the symptoms in this article, make an appointment with him via his Top Doctors profile.