Hip pain: why does it hurt? when to consult?

Our hips are the largest joints in our body. They are located at the junction between the head of the femur (thigh bone) and the pelvis and contain many ligaments, tendons and muscles. Daily, they support our weight and play a crucial role in our mobility. Hence the very disabling nature of hip pain… If they subside after a period of rest, it may be so-called « mechanical » pain. Conversely, when they persist and increase, we speak of inflammatory pain. But other causes can also come into play. Anyway, it is better to consult a doctor without delay, to benefit from appropriate care and limit the damage.

Hip pain can manifest itself locally, or more diffusely. They are often difficult to identify precisely, due to a great diversity of locations and intensities. Indeed, we can feel « misleading » pain in several areas, such as thighs, groin or buttocks. It also happens that a hip problem can be detected following intense pain in the knee. Conversely, the pain may be felt in the hip and actually come from a more distant point. We then speak of « referred pain« .

Concretely, we can feel one ssetation of heaviness at the level of the pelvis or a pinch in the groin crease, which radiates to the front or inner thigh. Whatever the case, these symptoms have a considerable impact on everyday life, by limiting the range of motion and preventing the hip, or even the leg, from moving freely, when standing, sitting, or even lying down, during sleep.

To note : they can also worsen following physical overuse, for example after an intense workout, a long walk or a jog. In the most intense cases, it will cause a limp.

The hips are designed to accommodate repetitive motion and wear. Sometimes, however, muscles, nerves, ligaments and tendons (soft tissues) wear out from the passage of time or from overuse (as discussed above). Several situations can thus be the cause of hip pain:

• a hip osteoarthritis, or coxarthrosis (in most cases),
• different types of inflammatory rheumatism (rheumatoid arthritis or psoriatic arthritis),
• a infection of infectious or viral origin (hip cold, infectious arthritis), vascular (arteriosclerosis and osteonecrosis) or muscular (adductors, iliopsoas, sacroiliac joint pelvic pain),
• too intensive sports practice which can lead to lesions (acetabular labrum for example),
• a hip fracture or a hip dislocation caused by injury or inflammation of the fluid-filled pockets between the hip bones (bursitis).
• malformations coxa valga type or acetabular protusion.

Finally, an inguinal or crural hernia, a « pinching » of the nerve (due to a herniated disc, sciatica, vertebral stenosis), or even a bone tumor can generate pain.

Better to consult a doctor as quickly as possible. Ideally, to a general practitioner, who will direct you, if necessary, to a specialist. As a first step, he will first proceed to a clinical examination to better understand the causes and origin of the pain: what is your history? Does the pain radiate to the buttock, leg, lower back? How did she settle down? How does it impact your mobility? How does it affect your daily life? X-ray or MRI may be necessary to clarify or confirm the diagnosis, especially in the case of osteoarthritis, fracture, inflammatory causes, etc .

The solutions depend on the cause of the hip pain. We are talking about « etiological » treatment.

If the pain is mechanical, or of traumatic origin, its management and the most classic: rest and taking analgesics (paracetamol, in particular), depending on its intensity. Simple exercises and stretches can also soothe pain and improve joint mobility. If this treatment is not effective enough, cortisone injections can be proposed.

In case of osteoarthritis, analgesic treatments are also recommended during crises. It is necessary to continue gentle physical activities, such as walking, water aerobics, stretching, etc. They help maintain mobility and strengthen the muscles in the area. Physical therapy exercises can also help move the joint, without hurting it.

In case of inflammatory rheumatismmedications such as corticosteroids, methotrexate or sulfasalazine will be prescribed.

Hip surgery and fitting a prosthesis are only considered as a last resort, when the pain and functional impotence become too great. Because ? Rehabilitation can be heavy, and the life of the prostheses is limited.