There are a number of conditions that can cause pain in and around the hip. Effective treatment depends on the proper diagnosis, and then providing the right treatment for that condition. The history of the problem – your age, what it feels like, how long it's been there, how it started, what helps/what doesn't help, etc – helps us to narrow down the diagnosis.
Some common causes of hip pain include myofascial trigger points (muscle knots), arthritis, bursitis, scar tissue, and pain referred from a pinched nerve in the back (sciatica).
Myofascial trigger points are common causes of pain in and around the hip and buttocks. Myofascial trigger points, generally known as trigger points (TPs), are small regions of a muscle that are in spasm, squeezing a small nerve ending, which causes pain, often described as a deep aching. Myofascial trigger points are treated with massage, stretching, ischemic compression, and ArthroStim among other treatments.
When a muscle has been injured, or has been in spasm for a long time, scar tissue (adhesions) will stick adjacent muscle fibres together, or sometimes stick a muscle to a nerve, bone, or other muscle. This will hurt when the muscle moves, as the pain sensitive scar tissue gets pulled on. These adhesions are treated with myofascial release, including Active Release Therapy (ART).
Hip pain caused by piriformis syndrome occurs when the piriformis muscle is in spasm, or has become fibrotic, and squishes the sciatic nerve which runs underneath it, or occasionally through it. This can cause buttocks and hip pain or pain all the way down the leg. Massage therapy, myofascial release (ART), stretching and other techniques are used to relieve piriformis syndrome.
Osteo Arthritis is a wear and tear injury of the cartilage. The outer surface of the cartilage has no pain fibres, but as the cartilage breaks down, it cracks and erodes, exposing the nerve endings located deeper down toward the bone, which does cause pain.
We can't fix arthritis, but many people get relief, or reduction, of arthritis pain with cold laser therapy, and continuous passive motion. Continuous passive motion (CPM) is especially effective at helping newly damaged cartilage to heal.
Continuous passive motion (CPM) is performed on our Primus machine, which slowly moves an injured joint back and forth through your full range of motion to release tight muscles, increasing its range of motion while bathing the joint cartilage in synovial fluid, the lubricating oil inside the joint. Continuous passive motion of a joint has been found to be the best way to heal injured cartilage (for example a fracture through a joint) relieving pain and preventing the development of arthritis at the same time.
Rheumatoid arthritis is an autoimmune disorder in which your body attacks your own joints, and can be a cause of hip pain. There are other similar types of arthritis like psoriatic arthritis, which is associated with psoriasis and can also affect the hip joint. These conditions are usually best treated with medication, but can also be helped with cold laser therapy, dietary changes and other treatments to help ease the pain.
Hip pain caused by bursitis is due to an inflammation of a bursa. A bursa is a sac that contains a small amount of fluid, and is located between tissues that slide over each other to reduce friction. If injured, however, the bursa will fill with fluid and become very painful.
Bursitis can be treated many ways. Shockwave therapy can help the injured bursa to heal, thereby reducing the pain. Anti-inflammatories may help, and sometimes it's necessary to use a needle to withdraw fluid from the bursa and inject cortisone to reduce the inflammation.
Hip pain caused by sciatica is due to irritation of the sciatic nerve. Sciatica pain follows the nerve out of the lower levels of the low back and through the hip. Hip pain due to sciatica can be relieved by reducing mechanical irritation and/or chemical inflammation on the nerve. Usually a disc bulge or herniation can be reduced with non-surgical spinal decompression, which helps heal internal tears in a lumbar disc, allowing it to shrink away from the nerve and thereby relieve the hip pain. Lumbar extensor muscle strengthening on our MedX Medical Lumbar rehab machine helps to prevent recurrence of symptoms. Occasionally (less than 1% of the time) surgery is required to remove disc or bone spurs that are pressing on the nerve to relieve hip pain due to sciatia.
In order to relieve pain from chemical irritation on the nerve, cold laser therapy is often very effective. Occasionally, epidural steroid injections are recommended to bath the inflamed tissue in anti-inflammatory medication to ease the inflammation and pain.
Other less common causes of hip pain include labral tears, sacroiliitis, avascular necrosis, and osteomyelitis.
Hip Pain due to Labral Tears
The labrum is a cartilaginous extension of the acetabulum (socket) of the hip joint. Its purpose is to make the socket of the 'ball-and-socket' hip joint deeper to increase its stability. But being made of fibrocartilage, it is not as strong as bone and is sometimes torn with trauma. Since it is pain sensitive, when it is torn it can cause deep, aching hip pain. Because fibrocartilage has a poor blood supply, labral tears don't heal very well.
The pain of a labral tear often causes psoas muscle spasms, clicking, and other symptoms and is often misdiagnosed, and only after multiple treatments fail to provide any significant, lasting relief, is it diagnosed, usually on MRI. Sometimes cortisone injections provide relief, or surgical repair may be necessary.
Hip Pain caused by Sacroiliitis
Sacroiliitis is inflammation of the sacroiliac joint, located between your tailbone (sacrum) and your pelvis (ilium) at the bottom of your back/top of your glutes. It can be caused by a number of conditions, mainly types of inflammatory arthritis. It is usually best treated with medication, but cold laser therapy and joint mobilization are often helpful in increasing or maintaining movement and reducing pain.
Avascular Necrosis Hip Pain
Avascular necrosis, or osteonecrosis, is the death of bone cells in the ball of the hip joint due to loss of blood supply to this bone, usually associated with a hip fracture or dislocation, or long term steroid use or alcohol abuse. It leads to collapse and deformation, or 'mushrooming' of the normally round ball of the joint, and consequently severe osteoarthritis and pain develop. Ultimately, a hip replacement is usually required although other treatments may give some relief in the earlier stages.
Hip Pain due to Osteomyelitis
Osteomyelitis is a bone infection that can develop in the hip from bacteria traveling through the blood from an infection elsewhere in the body, such as a diabetic foot ulcer or after an injection. It is treated with antibiotics, and often requires surgery to remove the infected bone.
If you are dealing with hip pain, we can help! You should not have to live your life in pain –contact Alberta Back and Neck Rehab & Sports Injuries Clinic for treatment to relieve your hip pain.