Hip Pain: When Is It More than a Strain?

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Hip pain is a common reason that people see an orthopaedist.  Some of the time, it is just a muscle strain and will get better with conservative treatment and time.  Other times, it may be something more serious such as a labral tear, hip impingement, hip dysplasia, or hip arthritis.  How do you know if your hip pain is serious enough to see a doctor?  Ask yourself the following questions to help you decide.

Did the pain start suddenly?

Many times, pain that started suddenly, especially if it started with a sudden movement such as sprinting or cutting, may be indicative of a muscle pull or strain.  Hamstring sprains (proximal ones) can cause pain in the back of the hip and pelvis.  A hip flexor strain can occur with sprinting, kicking, abdominal exercises, etc. and cause pain in the front of the hip and in the groin.  A hip adductor (groin) pull or strain can occur again with athletic activities or fall where the thigh is stretched beyond its normal limit (“doing the splits”), and typically causes pain in the inner part of the hip and thigh/groin region.  All of these types of muscle strains can cause pain that lingers for several weeks, but it typically steadily improves with rest and time.  Many times, these injuries can be treated without a trip to your orthopaedist as long as you are making steady improvement.

Has the pain been present for a long time?

Hip pain that has been present for months or more may indicate a more serious problem with the hip joint.  Hip impingement can cause pain with certain movements of the hip, especially flexion and rotation combined.  This pain is often felt in the groin but can be referred to the buttock or the lateral side of the hip.  Impingement type pain that is accompanied by mechanical symptoms such as catching of the hip and sharp sudden pains with movement can be a sign of a tear in the acetabular labrum.  Long-standing pain that also leads to a progressive loss of motion of the hip may be a sign of osteoarthritis of the hip.  Most people notice hip loss of motion by having trouble putting on their shoes and socks or getting in and out of a car.  All of these problems are best treated by seeing an orthopaedist and getting the appropriate treatment initiated.  Surgery is usually not the first option, but it may be necessary as these problems progress.

Does your hip pop?

A popping or snapping hip can be caused by different mechanisms.  The two main types of hip snapping are called external and internal.  External snapping is caused by a tight IT band as it pops over the bone of the greater trochanter of the femur.  This is usually felt on the lateral side of the thigh, and can occur with any hip flexion and extension, even walking.  Internal snapping is caused by a tight hip flexor, the iliopsoas, as it passes over the front of the hip.  This is usually felt in the front of the hip and in the groin, and most often occurs when taking the hip from a flexed to an extended position.  Both of these snapping conditions can be painful, but usually are more of a nuisance.  They are generally treated with therapy and stretching, but severe cases may require surgery.  These are best evaluated by an orthopaedist to rule out other conditions and to start the appropriate therapy.

How old are you?

The hip is unique in that many of these hip conditions can occur at any age.  Don’t base your decision to see a doctor about your hip pain on age alone.  Conditions such as a slipped epiphysis occur in adolescence and definitely need to be seen by an orthopaedist or long-term damage can occur to the hip joint.  Hip dysplasia (underdevelopment of the hip socket) occurs in infancy, but may be missed and not symptomatic until early adulthood, but it can lead to early arthritis of the joint and early hip replacement.  If caught early, dysplasia can be corrected with surgery and the hip can be preserved for many more years.

In summary, if your hip pain started with an acute injury and improves every day with rest then you can usually follow this on your own with conservative treatment.  If your pain is long lasting, is not improving or especially if it is getting worse, then make an appointment to see your orthopaedist.  Many hip problems, if caught early, can be treated and prevent further damage from occurring.