Pain - hip

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

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

A hip fracture can change your quality of life significantly. Fewer than 50% of people with a hip fracture return to their former level of activity. While you recover from a hip fracture, several possible complications can be life-threatening. These include pneumonia and a blood clot in the leg, which can break loose and travel to cause a clot in the lungs. Both are due to lack of movement after 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
• Bursitis -- it hurts when you get up from a chair, walk, climb stairs, and drive
• Infection
• Low-back pain such as sciatica
• Osteonecrosis of the hip
• Strain or sprain
• Tendinitis from repetitive or strenuous activity

General tips:

• 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.

For hip pain related to overuse or physical activity:

• Always warm up before exercising and cool down afterward. Stretch your quadriceps and hamstrings.
• Avoid running straight down hills -- walk down instead.
• Bicycle or swim instead of run.
• Reduce the amount of exercise you do.
• Run on a smooth, soft surface, such as a track, instead of on cement.
• Lose weight if you are overweight. Ask your health care provider for help.
• If you have flat feet, try special shoe inserts and arch supports (orthotics).
• Make sure your running shoes are made well, fit well, and have good cushioning.

If you think you may have arthritis in your hip, see your health care provider before exercising your hip.

Tips to relieve hip bursitis pain:

• Use ice three to four times a day for the first 2 to 3 days. Cover your hip with a towel and place ice on it for 15 minutes. Do not fall asleep while using ice -- you can leave it on for too long and get frostbite.
• Try not to stand for long periods of time. If you must stand, do so on a soft, cushioned surface. Stand with an equal amount of weight on each leg.
• When you sleep, do not lie on the side that has bursitis. Place a pillow between your knees when you lie on your side to help decrease your pain.
• Wear flat shoes that are cushioned and comfortable.
• If you are overwegiht, losing weight may also help.

Go to a hospital or call 911 if:

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

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

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 health care provider will ask medical history questions, such as:

• Do you have pain in one or both hips?
• Do you have pain somewhere else, 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 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 you are on steroids, for how long have you been on them?

X-rays of the hip may be needed.

Your health care provider 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.

• 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.

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.

Shah A, Busconi B. Hip, pelvis, and thigh: Hip and pelvis. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 21, section A.

Huddleston JI, Goodman SB. Hip and knee pain. In: Firestein GS, Budd RC, Harris ED Jr, et al, eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 42.