Hip pain: Where does it come from and how can it be treated?

Hip pain (coxalgia) can occur at any age and regardless of gender. It can be induced by a variety of causes, often harmless, such as inflexible muscles and fascia or after certain movements.

However, a number of other conditions may be responsible for hip or groin pain, and severe or prolonged pain and additional swelling, deformity or redness should be investigated by a doctor.

If you're affected by hip pain or want to get a full insight into the subject, you've come to the right place. Welcome to the Akina Blog!

Anatomy of the hip joint

Before looking at the different possible causes of hip pain, we would like to give a brief insight into the anatomy and functioning of the hip joint.

A joint is a mobile connection between two or more bones. Together with the surrounding soft tissues, muscles, fascia and tendons, they allow us to do a variety of movements. So, the hip joints are the connecting links between the legs and the pelvis. As with the shoulders, the hips are a ball joint: the cartilage of the hip head meets the cartilage of the so-called hip socket. The cartilage layer ensures fluid movement and normally prevents excessive joint wear. This structure of the joint allows leg movements in all directions, as well as the extension, flexion and rotation of the pelvis.

Symptoms - How do hip problems manifest?

Hips don't lie - that's what a popular song says. Our hips tell us when something's wrong. It's important to know that hip problems don't just show up in pain, and that other parts of the body can also be affected. For diagnosis, it's important to ask the following questions:

Where does the pain occur?
Hip pain often occurs in the groin area. It can radiate to the legs, buttocks or lower abdomen. Problems with the lower back (e. g. lumbar spine problems, ISG syndrome) also cause pain in the hips.

When does the pain occur?
Hip pain can occur both after heavy exercise and after prolonged periods of rest. It often appears as morning start-up pain or in phases. In particular, climbing stairs, lying sideways or walking over longer periods of time causes or increases hip pain.

What are the consequences?
Frequently, joint pain is associated with stiffness and reduced mobility, as well as a marked feeling of instability and a change in gait pattern. For those affected, this can lead to a significant reduction in the quality of life, as sport or other activities are no longer possible or only limited.

How long does the pain last?
A distinction is made between acute and chronic pain - chronic pain refers to a duration of more than three months.

What are the most common causes of hip pain?

Overuse of the hip joint due to exercise or heavy physical labor:
Excessive physical stress, whether from intense workouts at the gym or heavy physical labor, can lead to hip pain and strain. This often happens due to repetitive stress on the hip joint (from improperly performed movements), which can lead to wear and injury in some circumstances. Sports such as tennis or soccer place particular stress on the hips, as the frequent jumps, abrupt stops, and twisting movements put strain on the joint. The resulting pain can usually be relieved with physical therapy and an adjustment in training.

Accidents, fractures, trauma:
An accident, fall or severe trauma, such as from a car accident, can lead to hip injuries. Not only do injuries to the hip joint itself cause pain in the hip, but fractures to the femur (thigh bone) also affect the hip joint. These injuries cause severe pain and usually require immediate medical attention and surgical intervention to stabilize the injured bones and begin their healing.

Hip Impingement:
Hip impingement describes a change in shape or deformity of the hip joint that causes limited motion. Over time, this causes cartilage wear or abrasion of the rim of the socket, which can cause hip or groin pain. If the deformity cannot be counteracted with physical therapy and muscle building, surgical correction is necessary to prevent irreversible damage to the cartilage and thus reduce the risk of hip osteoarthritis.

Metabolic diseases:
Metabolic diseases such as rheumatism, gout and diabetes can cause inflammation in the hip joint. These chronic conditions cause damage to the joint cartilage and can lead to long-term hip pain.Treatment in this case focuses on treating the underlying condition and relieving its symptoms.

Osteoporosis:
Osteoporosis (bone loss) can affect the entire skeleton. However, it most commonly occurs in the spine and hips, which is why hip pain is one of the main symptoms of osteoporosis. Osteoporosis makes the bones porous and thus brittle, which is why the risk of hip or femoral neck fractures is increased. Treatment focuses on strengthening the bones and muscles through exercise therapy, diet and medication.

Femoral Head Necrosis:
Femoral head necrosis refers to the death of living bone tissue in the hip area. Due to a circulatory disorder, an undersupply of oxygen and nutrients occurs. The consequence is demineralization and resulting instability of the bone. If left untreated, this disease leads to irreversible damage to the joint and bone in 85% of those affected, including collapse of the femoral head and hip osteoarthritis. If the necrosis of the femoral head has not progressed too far, there is a chance of recovery through drug therapy and reducing the load on the joint. In later stages, surgery is often the only way to preserve the hip joint. If the joint surface of the hip area has already collapsed, the artificial hip joint is the only solution.

Hip Dysplasia:
Hip dysplasia is a malformation of the acetabulum that is either congenital or developed during life. In this case, the acetabulum inadequately roofs the femoral head, resulting in increased stress on the hip joint. A possible consequence is hip joint arthrosis. According to Balgrist University Hospital, hip dysplasia affects an estimated 6% of all newborns, making it the most common skeletal maldevelopment. Surgical treatment is useful for hip dysplasia, as it significantly reduces pain and limited mobility and delays the development of osteoarthritis. If hip osteoarthritis is already present, it is usually treated with conservative therapies such as physical therapy, anti-inflammatory pain medications or cortisone injections.

Labrum lesion:
Injury to the lip of the hip joint (labrum acetabuli) is called a labral lesion. The joint lip is made of fibrous tissue and lines the acetabulum. Thanks to its springy, cushioning function and smooth surface, a healthy hip joint lip allows the head of the femur to move effortlessly within the acetabulum. Often, the labrum lesion results from a sports injury or as a consequence of hip dysplasia. It manifests as jamming, stabbing pain as well as impaired mobility. If conservative treatment methods such as physiotherapy, anti-inflammatory drugs or injections are not sufficient, a hip arthroscopy must be performed to fix the joint lip to the acetabular rim. This surgery prevents hip osteoarthritis.

Hip Osteoarthritis:
Hip osteoarthritis (also known as coxarthrosis) is a degenerative joint disease in which the articular cartilage in the hip joint usually deteriorates gradually, over the course of several years. This leads to increasing pain, stiffness and limited mobility. Treatment includes pain management and physical therapy. In advanced cases, an artificial hip joint is the only long-term solution.

Bursitis:
There are several bursae in the hip joint - these form a kind of protective layer for body structures that line up. In the case of bursitis trochanterica, this protective layer becomes inflamed, often due to overloading and one-sided movements - as a result, pain typically occurs over the greater trochanter. This is the lateral bony prominence of the large thigh bone (femur). Physiotherapy and plenty of rest is often recommended as treatment. Shock wave therapy or anti-inflammatory drugs may also provide relief.

Transient synovitis (irritable hip)
So-called irritable hip s a temporary, aseptic inflammation of the hip joint. It usually affects children between the ages of four and ten, but adults can also be affected. Transient synovitis manifests itself in pain, which can radiate into the legs, and an associated limp. Rotational movements are severely restricted in this case. Transient synovitis is often preceded by a viral respiratory infection with fever. Treatment in case of irritable hip is characterized by reducing load on the joint and taking painkillers. As a rule, this disease heals on its own and without late effects.

Medical evaluation for hip pain

A targeted treatment of hip pain depends on the symptoms and causes. Therefore, a medical clarification should urgently take place in order to determine the correct treatment method. Apart from a verbal anamnesis, imaging procedures such as X-rays, magnetic resonance imaging (MRI), or sonographies (ultrasound examinations) can also provide clarity about the origin of the pain.

Preventing hip problems: How to

Prevention is better than cure - this saying also applies to hip problems. The most important and effective means of prevention is regular exercise. This not only strengthens the muscles, but also mixes the joint fluid, which promotes the absorption of nutrients in the joint cartilage. Below we have compiled some tips and tricks that you can integrate into your everyday life:

1. As already mentioned, exercise is the be-all and end-all for a healthy hip joint. Sports that are easy on the joints, such as swimming, aqua fitness, Nordic walking or cycling, are particularly suitable.
2. Excess body weight promotes cartilage wear and stresses the joints. With a healthy body weight, the entire musculoskeletal system is relieved, which is also good for the hip joints.
3. Well-fitting shoes help with a balanced, stable stance and have a corresponding effect on posture. In the case of malpositions in the feet or legs, appropriate orthopedic insoles should always be worn.
4. Sitting is known to be the new smoking - one should therefore at least pay attention to ergonomic sitting in everyday working life. The height of your desk and chair as well as the position of screens should be adjusted to your body size.