Finding Healing for Chronic Hip Pain

Jonathan Vellinga, MD

Hip pain, whether chronic or acute, can alter your life significantly. Labral tears, many types of arthritis, and even iliopsoas tendonitis are all common causes of hip pain that affect a wide portion of the population. While those who are older tend to have the most hip-related pain (up to 50% of those over 65 have some form of arthritis), athletes, dancers, and even physical laborers of all ages may find themselves with hip pain (1). While there is no one set treatment at this time, functional and regenerative treatments can go a long way in bringing relief and healing to hip pain.

What are the symptoms of these types of hip problems?

Chronic pain in the hip, groin, or buttocks is the most obvious symptom that there is an issue with the hip. Other symptoms include (1, 2, 4):

• Hip stiffness or reduced range of motion

• Clicking, locking, snapping sound when moving hip

• Feeling unsteady on your feet

• Walking with a limp or difficulty walking normally

• Pain or discomfort that increases when moving the hip

• Flare-ups (periods of worse hip pain followed by minimal or no hip pain)

• Pain that first arises as a sharp and intense feeling, but reduces to a dull ache over time

• Tenderness, inflammation, or slight swelling of the hip area

• General fatigue or weakness

Interestingly, it is also possible to have no symptoms at all but still experience hip dysfunction (2).

What causes hip pain?

The hip socket is a brilliant design that, when functioning properly, enables us to do amazing things. However, there are a lot of ways that things can go wrong! The thigh bone (called the femur) ends in a rounded ball shape, called the femoral head (2). It connects to the pelvis in a bowl-shaped socket called the acetabulum (2, 3). Both the femoral head and acetabulum are coated in cartilage, and there is soft tissue and many small fluid-filled sacs (bursae) between the bones, and cartilage (2, 3, 4). These sacs allow each part of the hip to glide smoothly by adding cushion and reducing friction (4).

Since each part of the hip needs to be shaped specifically and placed properly to function together in harmony, a change to any part of the hip can cause dysfunction and pain. Arthritis can cause inflammation, erosion of the cartilage, and eventually lead to the bones grinding together, leading to further damage (1). Soft tissue called the labrum covers the acetabulum (hip socket) and helps the femoral head move smoothly (2). Due to a number of factors, the labrum can tear, leading to a number of issues, and eventually can even cause osteoarthritis in the hip (2). Another source of hip pain is iliopsoas tendonitis. Iliopsoas refers to the muscle group that lies along the inside of the pelvis and connects the pelvis to the femur and the lower spine - more commonly known as hip flexor muscles (4, 5). When there is an issue with these muscles or the bursae become inflamed, it can lead to pain and problems with movement, including creating an audible snapping sound (4, 6)!

Many Types of Arthritis May Affect the Hips

While labral tears and iliopsoas tendonitis are generally caused by only one injury or overuse, there are many causes and types of arthritis that can affect the hips. Arthritis is a progressive disorder that worsens over time and is one of the most common sources of hip pain (1). While any type of arthritis may eventually cause hip pain, most often it is one of the following five types of arthritis that cause hip pain (1):

• Osteoarthritis. This is the most common type of arthritis, which develops due to wear and tear. Because of this, it is most common in older people, and damages the cartilage and bones of the hip, affecting the structural integrity.

• Rheumatoid Arthritis. This autoimmune disorder occurs because the immune system is overactive, and attacks healthy, normal cells. Rheumatoid arthritis causes swelling and inflammation of the lining of the hip joint, eventually leading to deterioration of the cartilage and bone.

• Systemic Lupus Erythematosus. As another autoimmune disorder, lupus can also cause inflammation and damage to the hip joint.

• Ankylosing Spondylitis. This type of arthritis inflames the lower back, where the spine meets the pelvis. Inflammation can spread to the hip, damaging the joint and causing pain.

• Psoriatic Arthritis. Psoriasis, a skin disorder, can also cause arthritis in joints. When it affects the hip, the joint can swell, become stiff, and eventually be damaged. While the skin is normally affected first, some people find that they have joint issues before noticing any skin changes.

What treatment options are available?

For all types of hip problems mentioned above, conventional treatment recommends using anti-inflammatory medications (such as NSAIDs), physical therapy, and potentially corticosteroid or hyaluronic acid injections (1, 2, 4, 7). NSAIDs focus on daily pain management, and injections work to slow the progression of disease and damage. Unfortunately, neither of these are a permanent solution, and both of these can lead to harmful side effects when taken for long periods of time. For those who are still unable to function with these treatments, surgery is an option, although the success rates are low, and the long-term benefit is often not considered worth the risks that it can bring (1, 2, 6).

Physical therapy is another common treatment option recommended to help people who are experiencing hip dysfunction (2, 4). This can help stretch and strengthen the muscles, stabilize the joint, and build strength (1, 7). While this is an incredibly helpful part of a treatment plan, it cannot address underlying issues such as arthritis. Similarly, making lifestyle changes (such as decreasing overall weight, changing daily activities, or introducing exercise) can be a great part of a treatment plan, but will not fix the issue (1, 2).

Regenerative Therapies and Functional Medicine

Unfortunately, what is listed above is about as far as conventional treatment options currently go. Functional medicine and regenerative therapies offer some alternative options that, while not yet mainstream, have been studied in clinical trials and have proven to be effective, safe, and generally side-effect free.

Pulsed electromagnetic field (PEMF) therapy works by radiating an electromagnetic field over the hips. It emits low-level pulses which permeate every part of the body it touches (tendons, bones, organs, muscles, cartilage, etc.). It affects the body’s cellular metabolism, creating an energy boost that increases poor-functioning cells’ ability to do their jobs, including repairing and healing damaged cells. PEMF is a great option for hip pain, especially for osteoarthritic pain. One study found that just one month of treatment created a significant reduction in pain, an increase in pain tolerance, and an improvement in overall physical health (8). PEMF therapy is used in conjunction with all of our regenerative therapies since we have found it to be such a great help to improve general health.

Platelet Rich Plasma (PRP) therapy is the process of drawing blood, separating that blood to isolate plasma and growth factor-rich platelets, and then injecting the platelet-rich plasma back into the body at the site of pain. This therapy actively stimulated healing in the area of injection for about 24 hours, leading to greater healing and pain relief than the body would naturally be capable of. This is true for hip pain, as well! Studies have shown that PRP therapy can bring effective healing and pain relief for the many different types of hip dysfunctions and pain listed above (9, 10, 11).

Ozone therapy is helpful for arthritis, bursitis (inflammation), tendonitis, and other hip problems that cause pain (12). Ozone refers to O3, a highly reactive form of oxygen (the same that is in the atmosphere!). When it is injected into the body at the site of pain or dysfunction, it stimulates the body to form new cells and heal damaged tissue. Ozone therapy can reduce or eliminate pain and inflammation, improve healing for torn muscle and tendons, and repair damage due to degeneration in all joints, including the hips (12).

Lastly, stem cell therapy can bring healing where other treatment methods were not able to. Mesenchymal stem cells (MSC) promote cell renewal, repair damaged cells, and stimulate the body to produce more regenerative cells. Essentially, this therapy shifts the body into a state of boosted healing and repair. While this therapy has not been approved by the FDA, stem cell therapies have been studied for years in countless clinical trials. Some of these studies have shown that this therapy can bring great pain relief, repair damage, and increase function in patients with arthritis, iliopsoas tendonitis, and similar dysfunctions (13, 14). Stem cell therapy actually works best in tandem with PRP therapy, so these therapies are often paired together to promote even greater healing.

Of course, physical therapy and lifestyle changes can be a huge asset to the regenerative therapies listed above. Our chiropractors, massage therapists, and functional nutrition lifestyle practitioners can work with you to help alleviate pain and get you set up to be the healthiest you possible to enhance the regenerative treatments.

If you or a loved one are experiencing hip pain, reduced function, or trouble walking, please contact us! We would be honored to partner with you to understand your health history, determine the root cause of your discomfort, create a treatment plan, and work toward greater health and healing for you.

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Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.​

Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.

info@tcimedicine.com

951-383-4333

www.tcimedicine.com

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Sources:

1. Arthritis of the Hip - Types, Symptoms, Diagnosis, Treatment. Washington University Orthopedics. (n.d.). https://www.ortho.wustl.edu/content/Patient-Care/3207/Services/Hip-Knee/Adult-Reconstruction-and-Hip-Preservation-Overview/Arthritis-of-the-Hip.aspx.

2. “Hip Labral Tear: Symptoms, Causes, Treatments.” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17756-hip-labral-tear.

3. Hip Anatomy, www.novaorthospine.com/specialties/hip/hip_anatomy.

4. Quinn, Elizabeth. “Hip Pain Could Be Iliopsoas Syndrome.” Verywell Health, 19 July 2020, www.verywellhealth.com/iliopsoas-syndrome-3119340.

5. Bordoni, Bruno. “Anatomy, Bony Pelvis and Lower Limb, Iliopsoas Muscle.” StatPearls [Internet]., U.S. National Library of Medicine, 7 Feb. 2021, www.ncbi.nlm.nih.gov/books/NBK531508/#:~:text=The%20major%20and%20minor%20psoas,Commonly%20called%20iliopsoas%20muscle.

6. “UC San Diego Health.” UC Health - UC San Diego, https://health.ucsd.edu/specialties/surgery/ortho/hip/Pages/iliopsoas-tendonitis.aspx#:~:text=Iliopsoas%20tendonitis%20is%20characterized%20by,fairly%20close%20to%20the%20skin.

7. Dall'Oca, Carlo, et al. “Mesenchymal Stem Cells Injection in Hip Osteoarthritis: Preliminary Results.” Acta Bio-Medica : Atenei Parmensis, Mattioli 1885, 10 Jan. 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503401/.

8. Bagnato, Gian Luca, et al. “Pulsed Electromagnetic Fields in Knee Osteoarthritis: a Double Blind, Placebo-Controlled, Randomized Clinical Trial.” Rheumatology (Oxford, England), Oxford University Press, Apr. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4795538/.

9. AC;, Singh JR;Haffey P;Valimahomed A;Gellhorn. “The Effectiveness of Autologous Platelet-Rich Plasma for Osteoarthritis of the Hip: A Retrospective Analysis.” Pain Medicine (Malden, Mass.), U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/30958873/.

10. Kraeutler, Matthew J, et al. “The Use of Platelet-Rich Plasma to Augment Conservative and Surgical Treatment of Hip and Pelvic Disorders.” Muscles, Ligaments and Tendons Journal, CIC Edizioni Internazionali, 21 Dec. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193533.

11. Zhou, Yiqin, and James H-C Wang. “PRP Treatment Efficacy for Tendinopathy: A Review of Basic Science Studies.” BioMed Research International, Hindawi Publishing Corporation, 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5004020/.

12. Seyam, O., Smith, N. L., Reid, I., Gandhi, J., Jiang, W., & Khan, S. A. (2018). Clinical utility of ozone therapy for musculoskeletal disorders. Medical gas research, 8(3), 103–110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178642/.

13. “Iliopsoas.” Iliopsoas - an Overview | ScienceDirect Topics, www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/iliopsoas.

14. Dall'Oca, Carlo, et al. “Mesenchymal Stem Cells Injection in Hip Osteoarthritis: Preliminary Results.” Acta Bio-Medica : Atenei Parmensis, Mattioli 1885, 10 Jan. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6503401/.