WHY DOES MY HIP HURT?
Pain can arise from structures that are within the hip joint or from structures surrounding the hip. The hip joint is a potential space, meaning that there is a minimal amount of fluid inside it to allow the femoral head to glide in the socket of the acetabulum. Any illness or injury that causes inflammation will cause the space to fill with fluid or blood, which stretches the hip capsule and results in pain.
There are thick bands of tissue that surround the hip joint, forming a capsule. These help to maintain joint stability, especially with movement. The movement at the hip joint is possible due to the muscles that surround the hip and the tendons that attach across the hip joint, allowing motion in different directions. Aside from movement, these muscles act in concert to maintain joint stability. There are large bursas (closed fluid-filled sacs) that surround areas of the hip where muscles intersect and allow the muscle and tendon to glide more easily. Any of these structures can become inflamed.
Pain from other sources can be referred to as the hip, meaning that while the hip hurts, the problem originates elsewhere. Hip pain is a non-specific complaint that requires the health care practitioner to find the underlying cause.
TRAUMA
Hip Fracture
Falls are the most common reason that elderly patients break their hips. The fracture is due to a combination of two effects of aging, osteoporosis (thinning of bones) and a loss of balance. The precise location of the fracture is important because it guides the decision of the orthopedic surgeon as to which type of operation is needed to repair the injury.
Aside from a fall, any trauma can potentially cause a hip fracture. Depending upon the mechanism of injury, the femur may not break: rather, a portion of the pelvis may be fractured. The initial pain may be in the hip area, but examination and X-rays may reveal a different source of the injury. Trauma can also cause a hip dislocation, in which the femoral head loses its relationship with the acetabulum. This is almost always associated with an acetabular (pelvic bone) fracture.
Contusions (Bruises)
Contusions (bruises), sprains, and strains may occur as a result of trauma, and even though there is no broken bone, these injuries can still be very painful. Sprains are due to ligament injuries, while strains occur because of damage to muscles and tendons. Because of the amount of force required to walk or jump, the hip joint is required to support many times the weight of the body. The muscles, bursas, and ligaments are designed to shield the joint from these forces. When these structures are inflamed, the hip cannot function, and pain will occur.
Overuse Injuries
Hip pain may also arise from overuse injuries in which muscles, tendons, and ligaments can become inflamed. These injuries may be due to routine daily activities that may cause undue stress on the hip joint or because of one specific strenuous event. Overuse may also cause gradual wearing of the cartilage in the hip joint, causing arthritis.
Certain other structures should be mentioned as a cause of hip pain because they become inflamed. The iliotibial band stretches from the crest of the pelvis down the outside part of the thigh to the knee. This band of tissue may become inflamed and cause hip pain, knee pain, or both. This is a type of overuse injury that has a gradual onset associated with tightness of the muscle groups that surround the knee and hip.
Bursa Inflammation (Hip Bursitis)
The trochanteric bursa is a sac on the outside part of the hip that serves to protect muscles and tendons as they cross the greater trochanter (a bony prominence on the femur). Trochanteric bursitis describes the inflammation of this bursa. The bursa may become inflamed for a variety of reasons, often due to minor trauma or overuse.
NON-TRAUMATIC HIP PAIN
Synovitis
Hip pain may be caused by a variety of illnesses. Anything that causes systemic inflammation in the body may also affect the hip joint. The synovium is a lining of tissue that covers those parts of the hip joint not covered by cartilage. Synovitis, or inflammation of this lining tissue, causes fluid to leak in the joint, resulting in swelling and pain.
Arthritis
Osteoarthritis is the most common type of hip arthritis. Also called wear-and-tear arthritis or degenerative joint disease, osteoarthritis is characterized by progressive wearing away of the cartilage of the joint. As the protective cartilage is worn away by hip arthritis, bare bone is exposed within the joint. Hip arthritis typically affects patients over 50 years of age. It is more common in people who are overweight, and weight loss tends to reduce the symptoms associated with hip arthritis. There is also a genetic predisposition to this condition, meaning hip arthritis tends to run in families. Other factors that can contribute to developing hip arthritis include traumatic injuries to the hip and fractures to the bone around the joint.
Summary
By learning more about hip injuries, we can better understand how to prevent and treat symptoms associated with them. When hip injuries are present, whatever is required depends on the area affected and the symptoms present, and that is why it is important to have a team of doctors that is able to identify the root cause.
At BBC Health in Lewisville, Texas, we know how to identify, treat, or refer in the proper direction for any problems with your hips. As a primary care provider, we can quickly provide medical, chiropractic, and rehab treatments in order to get you well as fast as possible. If you’re suffering from hip pain, don’t delay, and contact us immediately to see how we can help.
