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Hip pain

Definition

Alternative Names

Pain - hip

Considerations

Hip-related pain is not always felt directly over the hip. Instead, you may feel it in the middle of your thigh or in your groin. Similarly, pain you feel in the hip may actually reflect a problem in your back, rather than your hip itself.

See: Low back pain

Causes

Hip fractures are a significant and serious cause of sudden hip pain. Hip fractures become more common as people age because falls are more likely and bones become less dense. People with osteoporosis can get a fracture from simple, everyday activities, not just a dramatic fall or injury.

A hip fracture can change the quality of your life significantly. Fewer than 50% of those with a hip fracture return to their former level of activity. In addition, while recovering from a hip fracture, several possible complications can be life-threatening. These include pneumonia and a blood clot in the leg, which can dislodge and travel to cause a clot in the lungs. Both are due to immobility following a hip fracture and hip surgery.

Other possible causes of hip pain include:

• Arthritis -- often felt in the front part of your thigh or in your groin
• Osteonecrosis of the hip
• Trochanteric bursitis -- hurts when you get up from a chair, walk, climb stairs, and drive
• Tendinitis from repetitive or strenuous activity
• Strain or sprain
• Low-back pain such as sciatica
• Infection

Home Care

• Try to avoid activities that aggravate the pain.
• Take over-the-counter pain medication, like ibuprofen or acetaminophen.
• Sleep on your non-painful side with a pillow between your legs.

A hip fracture is considered a medical emergency. Therefore, if suspected, you should get medical help right away.

As the pain improves, gradually begin to exercise. It is best to work with a physical therapist to learn proper exercises and how to advance your activity. Swimming may be a good option because it stretches the muscles and builds good muscle tone without straining your hip joint. However, swimming does not build bone mass. When you are ready (a physical therapist can help determine that), slowly and carefully resume walking or another activity against the resistance of gravity.

When to Contact a Medical Professional

Go to a hospital or call 911 if:

• Your hip pain is caused by a fall or other injury
• Your hip is misshapen, badly bruised, or bleeding
• You are unable to move your hip or bear any weight

Call your doctor if:

• Your hip is still painful after 1 week of home treatment
• You also have a fever or rash
• You have sudden hip pain, plus sickle cell anemia or long-term steroid use
• You have pain in both hips or other joints

What to Expect at Your Office Visit

Your health care provider will perform a physical examination, with careful attention to your hips, thighs, back, and gait.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Do you have pain in one or both hips?
• Do you have pain elsewhere like your lower back or thigh?
• Do you have pain in other joints?
• Did your pain begin suddenly, or slowly and mildly?
• Did the pain begin after an injury, fall, or accident?
• Does any particular activity make the pain worse?
• Have you done anything to try to relieve the pain? If so, what helps?
• Are you able to walk and bear weight?
• What other medical problems do you have? Osteoporosis or other signs of bone loss? Sickle cell anemia?
• Do you take any medications? If so, which ones? If on steroids, for how long have you been on them?

X-rays of the hip may be necessary.

Your doctor may tell you to take a higher dose of over-the-counter medication, or give you a prescription anti-inflammatory medication.

Surgical repair or hip replacement may be recommended for osteonecrosis. Hip replacement is necessary for hip fracture and severe arthritis. With current technology, an artificial hip should last at least 10 to 15 years. Expect recovery from surgery to take at least 6 weeks. Plates and screws may be used to fix fractures around the hip.

Complications can occur from surgery. A blood clot in the leg is the most common complication, which can lead to a blood clot in the lungs.

Prevention

• Avoid activities that raise one of your hips above the other for extended periods of time, like running on an uneven surface. Running on a treadmill can keep your hips level.
• Warm up before exercising and cool down afterward. Stretch your hips, low back, and thighs.
• Avoid falls.
• Wear hip pads for contact sports like football and hockey. For those at high risk for a hip fracture, pads with a streamline design can be worn in undergarments.
• Learn how to prevent osteoporosis.

References

Daboy G. Miscellaneous nontraumatic disorders. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 25.

LeVelle DG. Fractures and dislocations of the hip. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 52.

Cornell CN, Sculco TP. Orthopedic disorders. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 4th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 37.

Wong TK, Lee RY. Effects of low back pain on the relationship between the movements of the lumbar spine and hip. Hum Mov Sci. 2004; 23(1): 21-34.

Dohnke B, Knauper B, Muller-Fahrnow W. Perceived self-efficacy gained from, and health effects of, a rehabilitation program after hip joint replacement. Arthritis Rheum. 2005; 53(4): 585-592.

Tak E, Staats P, Van Hespen A, Hopman-Rock M. The effects of an exercise program for older adults with osteoarthritis of the hip. J Rheumatol. 2005; 32(6): 1106-1113.

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