Hip pain is one of the most common things we see on a daily basis in our clinic. And there’s a very good reason why!
Unlike, for example, the knee, people’s definition of “hip” covers a much larger area, from the back lower buttocks to the lower back, around the side, and into the front of the abdomen & groin!
So when people tell us they’ve got hip pain – we always get them to show us exactly where!
1. Hip Pain Causes
Like other regions, there are so many causes of hip pain.
But you can categorise hip pain into just a couple of actual causes:
- Structural Causes
- Referred Causes and
- Emotional Causes.
Let’s look at these in a bit more detail, to understand how the brain interprets pain, and tells you it’s “from your hip”.
Structural causes of hip pain
What this means – is there is an issue with one or several of the structures that make up your hip. The structures are:
- Muscular causes of hip pain
- Joint causes of hip pain
- Bone causes of hip pain
- Ligament causes of hip pain
- Lower back disc causes of hip pain
- Nerve causes of hip pain and
- Lymphatic System
And all of these things, are really useless to you, because you’ll come in and say “my hip hurts on the side” or “my hip hurts in the front”.
Hip Pain in the front:
There are a number of reasons why the hips will hurt in the front as you can see in the image.
Is it nerve pain? Is it a tendon issue or ligament? Or is it muscular?
Sometimes the issue is slightly deeper in the joint itself, or the labrum surrounding the joint.
So – there are a number of possible reasons for that “hip” pain.
So many possible reasons – it take a professional such as an Osteopath to figure this out.
Hip Pain in the back:
Again – so many possible reasons, the majority of what we see are muscular involving the glutes in some way.
For example, one muscle might be working “harder” for another one that is “weaker”… And to really help decrease pain, you need to strengthen the weaker one.
Sometimes the hip pain is referred from various parts of the lower back, including the often mentioned “sciatica” which is relatively common.
You can “think” you’ve got sciatica – but actually don’t – and merely have referred pain from another structure.
Ligament pain can be quite severe if there’s major tension in some of the ligaments from postural issues.
Hip Pain in the side:
This is relatively common in middle aged women and older – where they get very sore lying on their side in bed at night.
It can be because of an inflamed “Trochanteric bursa” giving them a “bursitis”.
This is one of the few structures we advocate potentially doing a guided injection into as it’s very superficial, and can be quite successful.
You can have very tight side muscles and even glute muscles that refer into the side of the hip as well.
Lot’s of reason for hip pain – that’s for sure!
It pays to have a proper assessment – and that’s what we’re trained to do.
2. Hip Pain Assessment
As you’re now aware, hip pain has so many possible causes, with the most common being muscular.
Osteopaths will look at your hip based on the history.
History questions can include (but not limited to):
- How long have you had this pain?
- Where exactly is the pain?
- What does it feel like? i.e. is it sharp or achy etc
- Does it hurt to do any movements?
- Can you take the pain away?
If there is a genuine tear in a structure, the ways that you reproduce pain are going to match how we reproduce pain.
Sometimes, you’ll report pain in (for example) the front of your hip and you will test as if you’ve got a joint related issue.
We can recreate your exact pain with specific movements, but then… we can then eliminate this pain in seconds just by getting you to activate a glute muscle in a specific way.
So easy for clinicians to miss things like this when you’re not trained as well as an Osteopath is!
Sometimes you might do a specific movement and it hurts every single time.
All of these “tricks” enable us to figure out whether or not you’ve got a pathology, and need referral for further examination or a diagnostic ultrasound.
But generally, before we go down this pathway, we’ve done the standard sequence of:
- Active range of motion
- Passive range of motion
- Active resisted strength tests
- Special tests
3. Hip Pain Diagnosis
To diagnose hip pain, Osteopaths will:
Check active hip range of motion.
We’re trying to see how good your movement is. How far can you bend forwards?? Can you do it all the way forwards, to the side?
Can you squat?
Is there pain at any point in movement? At what stage of the movement is it sore?
Check passive hip range of motion.
Can we take your hip through range?
Will your brain let us?
If it doesn’t – the overriding “self protection” mechanisms are at play – usually indicating a structure that’s injured such as joint, tendon, or ligament.
This might be a pathology in the joint.
Check “active-resisted” muscle strength.
Your brain is in control at all times…
We’ll test your strength against us – in specific ways. Can you do it reliably?
Can you activate what you want to activate – or do you fail on some movements?
We then look to see WHY it’s like this. Is there a pathology? Is there something else at play?
Check “special” Orthopaedic tests.
There are several tests which, when positive, lead us more down a path that requires you to possibly have another opinion, as manual therapy can only go “so far”.
When combining all the above, and looking at the possible reasons the pain is there, we can arrive at a hip diagnosis – but not always!!
Most of the time, hip pain is relatively straight forward, and can be treated by an Osteopath successfully.
4. Hip Pain Exercises
As you can imagine – there are endless numbers of video online explaining hip pain and telling you all the reasons why their video will solve your hip pain.
Like this video:
It’s really awesome that there’s some brilliant content out there!
We just say… “what if”…
What if your body doesn’t NEED that?
What if your body is WORSE after doing it?
All of these things are going through our mind when we’re looking at programs and exercises for you to help with hip pain.
Sometimes, mobility and stretches will make your hip pain worse.
Sometimes activating and strengthening will make your hip pain worse.
It’s truly so variable – that only skilled practitioners like Osteopaths can help you as fast as possible.
5. Hip Pain Relief
How do I get hip pain relief?
Relief comes to the brain when it’s allowed to eliminate or reduce what it sees as a “threat”.
If there is a pathology, such as a joint probem, your brain sees this as a “threat” and will give you PAIN to try and force you to move differently, or slow down.
Pain is there for a reason.
Your brain is in control folks. We say this sort of thing a lot!
If the brain is getting information from your hip that tells it there’s an injury there, it automatically goes to work to help heal that injury by creating pain, inflammation and swelling.
It’ll also give you WEAKNESS in a certain way – and TENSION in another way!
In order to get hip pain relief, it is best done by a practitioner that understands most of the reasons why the pain is there.
Sometimes this is purely exercise. Often massage techniques. Sometimes it’s manipulation.
Very rarely, injections or surgery is a last option in hip pain treatment.
Thankfully there is a lot that can be done about hip pain with manual therapy and exercise!
6. Hip Pain Prevention
Prevention of hip pain is impossible.
Even if you’re not using them (i.e. wheelchair bound) you’ll still get hip pain.
It’s definitely more common in sporting people, and elderly people that’s for sure.
It seems that to prevent hip pain – don’t do sport, and don’t get older??
Not quite an easy thing to do…
In western culture, we just do not take our hip joints through range enough on a daily basis because essentially, we live 1 metre off the ground.
We sit too much. We don’t get down to the ground enough.
Provided that you have NO hip joint pathology – there’s a great 6 minute hip sequence we love:
As with anything though – any generic video sequence like this may actually make you worse.
Hopefully not, but this is why appointments with an Osteopath can be beneficial, as we’ll guide you towards appropriate things to do!
7. Osteopathic Treatment of Hip Pain
Manual therapy with an Osteopath can involve many standard “treatments” but we never EVER just look at your hip.
Osteopathic treatment of hip pain will be dependent on what you present with, and why.
After consideration as to the actual cause of your problem, typical Osteopathic treatment can/may involve a combination of:
- Soft tissue massage
- Joint mobilisation
- Dry needling
- Mobility exercises
- Ergonomic advice
The whole point of seeing an Osteopath for hip pain is to a) diagnose the problem, and b) do something about it.
We look further into the problem to help you get great results that last.
Sometimes people do require further intervention such as surgery – and depending on the reason why, this may just be the only solution.
But most people we see get excellent results with a combination of therapeutic interventions we use.