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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.

Chronic 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).

What causes hip pain?

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