Hip pain, especially as we get older, is more common than you realize. It can come on without apparent cause, while at other times it follows an accident, trauma, injury, prolonged sitting with legs crossed, or an episode of overuse.
First, let me describe the most common musculo-skeletal causes of hip pain. 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…restricting 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 osteonerosis 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 & 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 2-3 weeks, you’ll most likely be referred to a physician specialist (Orthopedist, Rheumatologist, Pain Physician, and Sports Medicine). However, a Doctor of Physical Therapy should be your primary care physician’s first choice for a specialist referral - even if your problem appears to be more than just inflammation. It’s a fact that 85-90% of hip pain has to do with soft tissue and movement problems.
Physical therapy is your best Choice for bone, joint and muscle pain problems. A more conservative approach is best! Physical therapy is natural (does not involve medications, injections or surgery), with no side effects and will address the root cause(s) of the pain problem. While some people remain on pain medication being treated by a physical therapist (PT), others do not and many reduce or stop the amount of medication needed as the therapy progresses. PT will address, eliminate or appropriately manage all the causes noted above except for Osteonecrosis and Hip fractures -- in these instances, you must see your doctor for other treatment options. A highly skilled PT will tell you exactly why you’re having hip 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, 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. Your physician will be informed about your pain problem and plan of care.
Injections of Corticosteroid are 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. A temporary solution that does not address the root cause.
Prescription Medications are 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, increase ease of movement, and decrease the amount of medication or number of injections they receive. Medications are not a cure, and could lead to possible pain medication addiction.
Surgery is required if you’ve fractured your hip, or if more conservative methods have not been successful (physical therapy). However, after surgery it is important to be referred to physical therapy. This is the key to your full recovery. In many cases, physical therapy can begin immediately after surgery.
As always, speak with your physician about a referral to physical therapy. You will be pleasantly surprised about how much medical knowledge and conservative treatment options physical therapy offers. 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!