Hip function is essential to everyday life. From walking to running, climbing to sitting, our hips ensure we are able to be as mobile as we’d like. So when pain in the hip halts our quality of life, it’s essential that care is given. The Texas Pain Care team in Sugar Land, Missouri City, and Houston areas offers advanced therapies for hip pain back treatment that allow for an efficient diagnosis and the most comfortable and minimally-invasive treatment possible. If your hip pain is getting worse, happening more frequently, or making you sit on the sidelines for your favorite activities, it’s time to reach out for professional help.
Hip pain is described as pain or discomfort in or around the hip joint, which is where the femur connects to the pelvis. Not only is the hip joint one of the largest joints in the body, it is used constantly for movement, maintaining balance and supporting the body’s weight.
Hip pain can be experienced in the short-term, possibly from strain from exercising, or can be more long-term, which points to a larger issue in the body. For pain that occurs in waves, possibly first thing in the morning or late at night, or doesn’t seem to get worse, rest and relaxation could be the best remedy. It might be beneficial to also take a break from physical exercise and take over-the-counter medications (as prescribed) to combat the pain.
There are different parts of the hip that can experience pain, so pinpointing the correct area will help to determine what caused the damage and what treatment option is best. If the pain is felt close to the surface, around or above the hip, then that could point to an issue with muscles, tendons or ligaments. If pain is felt deeper inside the joint itself, that could be an issue with the bone or cartilage. Or, pain from the hip can even radiate to other parts of the body and cause pain in the lower back or or groin region.
If the pain does seem to increase, you’re finding it too difficult to complete simple movements, and at-home remedies aren’t working, it’s best to seek help from a medical professional who can diagnose the cause of the pain and recommend the best treatment possible.
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It’s first important to understand the anatomy of the hip joint to be able to understand the causes of hip pain. The hip joint is a ball and socket joint where the large thigh bone (femur) connects to the pelvis. At the top of the femur is a round ball that fits into the socket formed by the pelvic bone (acetabulum). Ligaments and muscles support and joint, allowing for the ball to glide and rotate, which gives the leg movement. These ligaments and muscles also inhibit any improper rotation, or overextension. To further promote ease of movement, the synovial lining in the joint provides lubricating fluid that decreases friction between the ball and socket joint, and the bursa, or fluid-filled sacs, help to cushion and smooth movement. So when you’re running, twisting, jumping, and walking, you have all of these factors to thank.
Hip pain can be related to leg pain, as pain in the hip prohibits movement in the leg. So while hip pain is directly related to the hip, it can also spread to other parts of the body, including:
Arthritis
Arthritis, which can occur anywhere in the body but commonly occurs in hips, causes inflammation in your joints. This inflammation can cause pain, swelling and stiffness. Two of the main types of arthritis that can occur in the hip are osteoarthritis and rheumatoid arthritis.
Osteoarthritis
Osteoarthritis (OA) is considered a degenerative joint disease that worsens over time, often resulting in chronic pain. It is the most common form of arthritis, and women, people over the age of 55, obese people, and those who have a history of previous joint trauma or disease are at a higher risk for developing the disease. While normal wear and tear contribute to the breakdown of cartilage, car accidents, falls and sports injuries can also exacerbate the breakdown. Symptoms include pain in a joint, stiffness, swelling, decreased range of motion, or joint deformation.
OA occurs when the cartilage that lines your joints is worn down over time and your bones rub against each other when you use your affected joints. The cartilage acts as a shock absorber and lubricant, so when there is no more cartilage, pain is felt anytime the bones are rubbed together. Osteoarthritis can affect any joints in the body, but is most common in hands, knees, hips, neck and lower back. People who experience osteoarthritis have a decreased range of motion, and report pain that increases with activity but does decrease with rest.
Rheumatoid arthritis
Rheumatoid arthritis (RA), on the other hand, is a chronic autoimmune disease where the immune system attacks the tissue lining the joints on both sides of the body, which makes it different from other types of arthritis. The immune system is supposed to protect the body, but in the case of rheumatoid arthritis, the immune system attacks the joints.
The scope of joint pain and inflammation is greater, affecting the fingers, hands, wrists, knees, ankles, feet and toes. This uncontrolled damage causes the cartilage to break down, which deforms the joints and eventually damages the bone. In some cases, this can lead to joint fusion, which is the body’s effort to protect itself against constant pain.
RA is commonly seen in women and can develop between the ages of 30 and 60, although anyone can suffer from this disease. It also affects everyone differently. Some people experience joint pain over several years, while others experience a rapid onset of issues and pain. Many people also experience an ebb and flow of pain and no pain, or flares and remission.
Symptoms of rheumatoid arthritis include:
While the causes of RA are unknown, many medical experts credit genetics, hormones and environmental factors.
Bursitis
A bursa is a closed, fluid-filled sac that works as both a cushion and providing lubrication in the joints, which reduces friction between tissues of the body. Bursitis occurs when bursae become inflamed and irritated, which usually happens in joints that undergo frequent and repeated motion. Treatment usually involves resting the affected joint and avoiding additional trauma to the area. In most cases, bursitis pain typically subsides within a few weeks with proper treatment, but it is common to experience recurrent flare-ups.
Injury/Trauma
Injury and trauma are two of the most common causes of hip pain, and can happen to those who experience a completely active lifestyle as well as those who are very sedentary. After all, trauma doesn’t discriminate. An athlete can experience a collision on the soccer field, anyone operating a motor vehicle can get into an accident, and someone who lives a very calm lifestyle can slip and fall in their home or bathroom.
While some incidences of pain that result from a traumatic accident can resolve themselves with proper at-home methods, including rest and possible medication, there are instances where chronic pain can occur because of poor post-accident treatment, or lack thereof. The most common causes of hip pain in regard to trauma can include:
Avascular femoral head necrosis
Labral Tears
A hip labral tear is an injury to the labrum, the soft tissue that covers the acetabulum. The labral helps the ball move smoothly within the socket, so when a tear occurs, pain is felt. This particular type of tear can be caused by injury; structural problems such as femoroacetabular impingement (FAI), where the femoral head doesn’t fit into the socket properly; or degenerative issues, such as osteoarthritis.
Symptoms of a hip labral tear include hip pain or stiffness, pain in the groin or buttocks area, a clicking or locking sound in the hip area that happens with movement, and a feeling of instability when standing. Pain or discomfort can occur when you bend, move or rotate the hip. A hip labral tear unfortunately won’t heal on its own, and recommended treatment often includes anti-inflammatory medications, steroid injections, and physical therapy.
Lumbar Radiculopathy
Lumbosacral radiculopathy is a disorder that causes pain in the lower back and hip that most often radiates down the back of the thigh into the leg. The most common origin of lumbar radiculopathy is nerve root compression, which either results from disc herniation or spondylosis. A disc herniation can be either due to an acute injury or secondary to chronic degeneration of the spine.
This type of pain is called referred pain because it is felt in an area other than where the pain originated. Most often the pain comes from the lower back but is felt in the hip. Symptoms of radiculopathy vary by location but most often include sharp pain in the back, arms, legs or shoulders that could worsen with certain activities; weakness or loss of reflexes in the arms or legs; numbness of the skin, a feeling of “pins and needles,” or other abnormal sensations (paresthesia) in the arms or legs.
Lumbar radiculopathy is also referred to as sciatica because nerve roots that make up the sciatic nerve are often involved. The lower back is the area most frequently affected by radiculopathy.
Non-surgical treatments are most often a physician’s first recommendation, and include medications (nonsteroidal anti-inflammatory drugs and muscle relaxants), weight loss strategies to reduce pressure on the affected area, physical therapy with the aim to strengthen muscles and reduce the possibility of additional damage, and steroid injections to relieve pain by reducing inflammation.
When non-surgical options fail to provide the patient with needed relief, surgery is the next best option. The goal of surgery is to reduce the pressure on the nerve root by widening the space where the nerve roots exit the spine.
The best way to diagnose and address hip pain is to work together with your pain care specialist. He or she will begin by performing a comprehensive exam and discussing your medical history. It’s especially helpful if you are able to keep a pain journal, including when in the day your pain is felt, in what area of the body, what remedies (if any) you were able to do to relieve the pain yourself, any physical or mental symptoms, and how long the pain lasts. Additionally, it’s helpful to mention what medications, if any, you’re currently taking, as well as any family history of medical issues, specifically arthritis or autoimmune diseases.
On top of health history and an exam, your provider will more than likely perform a series of tests, including imagine techniques and blood work. These are useful for helping the provider see what is happening inside the hip joint, and of the hip and pelvis, all of which is not able to be seen from the naked eye. These techniques include X-rays, which help to see bone structure; CT Scan, which helps to see bones, muscles and organs; and MRIs, which allow the provider to see detailed images of the structures within the body.
When needed, your provider may also recommend and perform an arthrocentesis, which is when a needle is injected into the joint wherein some fluid is removed. This fluid is then evaluated to see how much fluid is in the joint, and what the consistency of the fluid is.
As the causes of hip pain vary greatly, so can the treatment methods. The Texas Pain Care pain management specialists work together with each patient to ensure the proper diagnosis is made, and the proper treatment utilized, which is unique to each patient.
The goal for medical professionals is to provide the most amount of relief with the most minimally-invasive treatment therapies. For patients who experience hip pain, the first step should always be RICE, which stands for rest, ice, compression and elevation. Other lifestyle changes could remedy the pain, and include activity modification, pain medication (NSAIDs), physical therapy and walking aids, such as canes or walkers. If the pain does not subside, or gets worse, it’s necessary to consult a healthcare professional for more in-depth treatment.
Steroid Injection
Pain and inflammation (swelling) in the hip joint(s) are the main reason that doctors prescribe steroid injections. A steroid injection contains two main ingredients. The first is a steroid (cortisone) that helps reduce inflammation. The second is a numbing agent or anesthetic that reduces pain. The steroid, most commonly corticosteroids, are injected directly into the hip joint and results can last between a few weeks or a few months, with results varying from person to person. This is a popular treatment method for patients who experience pain from bursitis, arthritis, labral tear, injury and trauma, as well as overuse/misuse of the hip joint.
Femoral-Obturator Nerve Blocks
This particular nerve block targets the two main nerves in the leg and lower abdominal, pelvic, and thigh regions. The femoral nerve is one of the largest nerves in the leg and controls the muscles that help straighten the leg and move the hips. It also provides feeling to the lower part of the leg and front of the thigh. The obturator nerve is located in the inner thigh and its main function is to provide movement to the hip, including flexing the hip and rotating the leg away from the body. A nerve block in this particular thigh region is used to treat chronic hip pain, and is most often used to provide relief to patients who have undergone hip surgery or who have experienced trauma directly to the hip.
During this procedure the nerves that are believed to be causing the pain are blocked or numbed temporarily via the injection of an inflammation-reducing steroid mixed with local anesthetic. This is meant to determine and confirm if these nerves are responsible for the pain. If a large portion of the pain has been treated, then radiofrequency nerve ablation of these two nerves may be recommended for more long-term pain relief.
Patients who often undergo femoral-obturator nerve block treatment are those who experience chronic hip pain, have osteoarthritis, or who have undergone hip replacement and still experience pain, who want to avoid hip replacement, or who is too medically unstable for hip replacement to be a treatment option.
Radiofrequency Nerve Ablation
Radiofrequency nerve ablation minimally invasive outpatient surgery that treats hip pain and inflammation. It is an attractive solution for individuals who want to avoid hip surgery or who have pain after undergoing hip surgery. Prior to ablation, the physician will perform nerve block injections to see if the believed nerves are the specific nerves that are causing pain. If the injections provide short-term pain relief, then the next step is radiofrequency nerve ablation.
This treatment entails the provider creating a heat lesion around the identified nerves by using a gentle electric current to “ablate” or burn off the nerves, which will help to prevent pain signals from traveling to the brain. Pain relief typically improves each day with maximum improvement after a month. Nerves typically regenerate in six months, so while pain relief varies from person to person, pain relief typically lasts anywhere from six to 14 months. It is possible to repeat ablation.
While many larger hip issues are caused by trauma, an underlying medical condition, or even an issue with your bone structure, there are some steps you can take to reduce your risk for creating hip issues in general. While no one knows when they might trip and fall, or get into a car accident, minimizing your daily risks of injuring yourself is a great way to reduce your chances of developing even minor hip pain. These include:
Hip pain, regardless if it’s mild to moderate, or even severe, can bring your life to a screeching halt. Pain could be acute, caused by working out too hard, or it could be the sign of a greater issue in your body. There are certainly many reasons a person could be experiencing hip pain, and, thus, many differing treatment options available to reduce and manage the pain. Most often, a doctor will need to get involved.
If you’ve tried at-home pain management therapies but have yet to experience any relief, the pain is growing in intensity or duration, or the hip pain has started to interfere with your day-to-day life, it’s time to reach out to a Texas Pain Care pain specialist in Sugarland, Missouri City and Houston. The team is dedicated to providing you with pain relief and will recommend minimally-invasive options first, with surgery as the last resort.
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