Three Common Causes of Hip Pain

by | Jun 13, 2022

Hip

Hip Pain is one of the top five reasons patients come to our practice for help.  Identifying the cause or source of your hip pain is important, because different causes of hip pain are treated differently.  Whilst there are many potential causes of hip pain, our experience over 10 years reveals that 3 of those causes account for 75-80% of all our patients who write “hip” as their problem on their New Patient Registration Form.  In this key article we discuss the three most common causes of hip pain we see in our practice, week-in, week-out, as well how physiotherapy can help in each situation.

1. The Lower Back

Why are we discussing the lower back in an article about hip pain?  The reality is that what you think of as your hip is often not your hip joint at all and our experience is that what many patients feel is their hip is actually the very base of their lower back.  This is especially true if your pain is on one side of your body and you feel it is at the “top of the hip”, near the dimple in your lower back or somewhere in your buttock.  In addition, there are many cases where your pain may be close to your hip joint but is actually referred pain from your lower back.  For more information on how we treat lower back pain, read our article by clicking here.

How do I know if my lower back is causing my hip pain?

Because of the reasons outlined above, one of the things we must do for every hip pain patient is screen your lower back to see if it could be a source of your pain.  This involves taking you through some specific movements and 1-2 special tests to rule in or rule out your lower back as a source of pain.  If we can reproduce your usual “hip” pain by moving or testing your lower back, it means that your lower back is relevant to your hip problem and treatment should begin with the lower back rather than the hip.  Sometimes patients may have two sources of pain – their lower back AND their hip.  For these patients we need to decide about the relative contribution of both areas to your pain and prioritise which one to treat first.

2. Hip Osteoarthritis

Osteoarthritis (OA) is a condition that affects the major joints of the body and is characterised by loss of the hard wearing cartilage that lines the ends of the bones forming a joint.  OA is not just about cartilage loss, however — change occur in the supporting tissues of the joint, including the capsule and ligaments, as well as the supporting muscles.  Any of these structures can be a source of pain in hip OA.

How do I know if I have Hip Osteoarthritis?

The diagnosis of hip OA is made based on several features.  The first is activity-related pain in or around the hip (often in the front of the hip) in patients over 50 years of age.  You may have pain with walking, pivoting when standing, getting in or out of your car, or dressing yourself.  An x-ray should show the hallmark features of osteoarthritis.  Other causes of hip pain should be excluded — this is done by taking a careful history and if needed, ordering other tests.  In physiotherapy, you should have pain and loss of movement when we test your hip.

Can Physio help if I have Hip Osteoarthritis?

Although we have no cure for osteoarthritis, physiotherapy can help patients improve their function and reduce their symptoms.  The main goals in physiotherapy are to restore the best possible movement in your hip, strengthen the muscles around your hip and tune-up your movement – especially your walking.  Treatment usually involves targeted stretching and movement of the affected hip, a home exercise program that includes both strengthening and stretching, and advice on your activities.  We typically see patients weekly or fortnightly for several months in an effort to get you moving and feeling as best as possible.  For more information on hip osteoarthritis read our article on this particular topic by clicking here.

3. Gluteal Tendinopathy

Gluteal Tendinopathy is a condition affecting one or two of the gluteal tendons — the strong bands of tissue that connect your hip muscles to the bony outside point of your hip.  In some patients these tendons are sore and swollen, whereas in other patients there may be a small tear in the tendon.  Patients with gluteal tendinopathy describe pain on the outside of the hip, in the buttock and often down the outside of the leg.  Gluteal tendinopathy affects women in their forties and fifties – men do develop this problem but often a little bit later in life (in their 60’s and 70’s).

How do I Know If I have Gluteal Tendinopathy?

Gluteal tendinopathy is a common condition and a diagnosis can be made without an x-ray or ultrasound.  Often there is no  specific incident but the patient will describe their hip becoming worse with activity and also at night.  There are four physical tests for gluteal tendinopathy and if you test positive for two or more of these our confidence about your diagnosis is high.  Your doctor may order an ultrasound of your hip but beware – it is normal to see some age-related changes in the gluteal tendon even when it isn’t sore, so you should never rely on your ultrasound alone to make a diagnosis.

Can Physio help if I have Gluteal Tendinopathy?

Most patients with gluteal tendinopathy get better with the help and guidance of a good physio.  Treatment should follow three stages:
  1. Decrease pain and Inflammation
  2. Restore strength, and
  3. Return to Normal activities.
There are key things to do in each stage and you need to be patient!  A common mistake patients make is they complete stage 1 (meaning they no longer have pain at night and can do their everyday activities) but then skip stage 2 and try and return to their normal activities as soon as their pain settles.  If you DON’T restore strength in your hip before returning to normal activities the pain often comes back! For more information on gluteal tendinopathy read our article on this particular topic by clicking here.

Key Take Home Message for Patients

Understanding the physical cause of your hip pain is important and we know from treating patients for over 10 years that you want to know what has gone wrong with your hip.  The next step, identifying the key impairments and contributing factors to your pain paves the way for a treatment program tailored to you and your individual situation.  This is not a “cookie cutter” approach but rather a problem-solving process to give you the best chance of success with physiotherapy. If you are experiencing trouble with hip pain, reach out and call us today on 6056 6616. Our helpful front desk team will help you find a day and time that works for you to come in and see one of our experienced physio’s and get you started on moving and feeling better!  If you would like to see our physio’s in action, watch one or more of our videos on how to do common hip exercises by clicking here. To Your Better Health, The Team at Personal Best Physiotherapy

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