Treating Hip Pain
I'm 68 years old and still very active. I exercise 5 days a week and have maintained a healthy weight for the past 30 years. So why am I experiencing hip pain? I woke up a few weeks ago with hip pain. Since then it has gotten progressively worse to the point where I can't work out, even in the pool. My doctor told me to take over the counter medication and not exercise for two weeks. It's been two weeks, but I'm still in pain. Now what?
This is a great question! Hip pain, especially as we get older, is more common than you realize. As you described, it can come on without apparent cause, while at other times it follows a trauma, an injury, a prolonged sitting with legs crossed, or an episode of over-exertion. First, let me describe the most common musculo-skeletal causes of hip pain, and then I'll address the different treatment options.
Bursitis - inflammation of the fluid filled sacs between the tendon & skin/bone (bursa). Bursitis is often caused by overuse, trauma, arthritis, gout or infection.
Tendonitis - tendons (rope-like tissues connecting muscles and bone) become inflamed due to repetitive or strenuous movement.
Muscle strain - small tears in the muscle from overuse, trauma, or over-exertion.
Nerve Irritation - Pain, weakness & numbness resulting from nerve irritation. A common example is sciatica pain coming from the sciatica nerve.
Herniated Disc - A disc is the small spongy "shock absorber' that separates the vertebrae in your back. If the disc is moderately damaged, it may bulge or break open. Trauma, injury, over-exertion, work related and the aging process can all contribute to a herniated disc. If the disc presses against the nerve, it can cause the nerve to become irritated.
Arthritis - Bones are protected by cartilage, loss of this cartilage from trauma, injury, age, and inflammation can create pain, stiffness, and swelling, which restricts normal daily activities of life. This is one of the most common causes of hip pain in those 65 and older.
Osteonecrosis - Occurs when insufficient blood flows to the bone, destroying bone cells. Years of Corticosteroid use, alcoholism, and other conditions can cause osteonecrosis and the hip is the most common site affected by this condition.
Hip Fractures - Most hip fractures occur in people older than 65 because bones weaken with age, patients take multiple medication or have poor vision and balance problems. All of these factors can increase the risk of falls which is the most common cause of hip fracture.
In all of the above, except numbers 7 and 8, treatment often begins with rest and over the counter pain/anti-inflammatory medication as your own doctor prescribed. If rest and medications don't do the trick after 2-4 weeks, you'll most likely be referred to a specialist. A physical therapist should be your physician's first specialist referral even if your problem appears to be more than just inflammation. Let me describe several possible treatment options:
PHYSICAL THERAPY:
Your best choice for bone, joint and muscle pain problems. Physical therapy is a more conservative approach, as it is natural (does not involve medications, injections or surgery), has no side effects and will address the root cause of the pain problem. While some people remain on pain medication while being treated by a physical therapist (PT), others do not, and many reduce the amount of medication needed as the therapy progresses. PT can address, eliminate or appropriately manage all the causes noted above, except for Osteonecrosis and Hip fractures, for which you must see your doctor about treatment options.
A highly skilled PT will tell you exactly why you're having pain and will have many treatment options available at his/her disposal. These treatments include; manual therapy (hands on treatment), manipulation, Trigger Point Dry Needling, targeted exercises, taping and stretching, electrical stimulation, and occasionally ultrasound or traction and hot/cold treatments. In addition, the PT will work with you to adjust your plan of care if you are not progressing as planned. Physical therapy looks for the root cause (s) of your hip pain problem.
INJECTIONS OF CORTICOSTEROIDS: administered by a physician directly into the hip joint. The purpose is to reduce the inflammation, and thus the pain and discomfort. The injections are normally done at specific intervals. When swelling is severe, fluid may need to be drained from the hip. This is a temporary solution that does not address the cause.
PRESCRIPTION MEDICATIONS: often given to those with arthritis depending on the severity of their disease. However, someone with arthritis might also use physical therapy to decrease pain, protect the joint and increase ease of movement and decrease the amount of medication or number of injections they receive. Medications are not a cure.
SURGERY: required if you've fractured your hip or if more conservative methods have not been successful. However, after surgery it is important to seek physical therapy, as it is key to recovering your mobility. In many cases, physical therapy can begin immediately after surgery. Getting out of bed and putting weight on the joint can often speed recovery.
Be sure to speak with your physician about a referral to physical therapy. Be your own health care advocate and request physical therapy. Lean more towards a more conservative treatment approach before seeing a physician specialist who may or may not diagnose the cause of your continued hip pain problem. You can also contact a physical therapist directly. As more insurance companies and the government reduce healthcare benefits or restrict your healthcare benefits, it is imperative that you become a wise consumer of healthcare services. You can no longer afford to be passive in your recovery process; you must ask questions and become involved in your treatment options. Further, just as any other consumer, you need to choose wisely. Ask questions about experience, training, and specific treatment options, because the final choice is yours. As a healthcare provider I want you to be comfortable and satisfied with your decisions. You deserve the best care. Don't be afraid to call a physical therapist today!
If you are in search of treating your pain and want a pain-free life, contact my clinic at 979-776-2225 to set up an appointment. I promise you that physical therapy can change your life for the better.
