Hip pain is not as common as other issues, like knee or shoulder issues, we treat in Physical Therapy but it still is fairly common. When it comes to hip pain, people often express their pain as being localized to one of three anatomic regions: the front (or anterior hip and groin), the back (or posterior hip and buttock), or the side ( or lateral hip).
Pain in the front of the hip into the groin is commonly associated with osteoarthritis and hip labral tears. Pain in the back of the hip into the buttock is associated with piriformis syndrome, sacroiliac joint dysfunction and hip abnormalities associated or caused by the back pain. Pain in the side of the hip typically occurs with greater trochanteric pain syndrome or ITB Friction syndrome (1). Let’s break down each now.
Pain in the Front of the Hip
Osteoarthritis(OA): Oseteoarthritis, or OA, is what we think of when we talk about arthritis. It typically presents as deep hip pain and stiffness accompanied with hip pain while weight bearing. Pain presents in the groin and in the front of the hip which worsens with prolonged activity and standing however, may also increase with prolonged rest. Usually common in elderly or people with mechanical alterations of the hip. People may present with loss of range of motion.
Labral tear: Surrounding the hip joint is a labrum that acts as a shock absorber, spreads out the pressure in the hip, and helps to make the joint deeper. The pain is described as either dull or sharp which can radiate into the groin/front of the hip or side. Painful catching or clicking may be present with instability and pain with weight bearing, as well as a decrease in range of motion. May occur as a result of hip dislocations, trauma or repetitive motions. People may report pain with prolonged sitting, getting in/out of the car, difficulty with putting on shoes/socks and hip twisting activities. May be associated with weak glutes.
Pain in the Back of the Hip
Piriformis syndrome: Pain in the back of the hip, usually described as dull ache in buttocks radiating to the back of the thigh. It may occur due to overuse, muscle contracture, direct trauma or prolonged sitting. Patients will report increase in pain with resisted hip extension, pain with rotating the leg in, as well as increase in pain with sitting for a long time, squatting or walking.
Pain in the Side of the Hip
Bursitis: Throughout our body wherever there is a location that multiple muscles or tendons run over a bony prominence we have Bursae sacs. These Bursae sacs act as ball bearings for those muscles and tendons when the move over the bone to prevent any tearing or breakdown. However, at times those bursae sacs can become inflamed and painful. This is called bursitis. Two most common ones in the hip are greater trochentaric and illiopsoas bursitis.
Bursitis usually occurs due to overuse and may be common with soccer players due to repetitive ball kicking with rotating the leg in. Trochantaric bursitis pain usually presents as deep pain on the outside of the leg with it radiating into the groin, while iliopsoas presents more as pain in the front of the hip. Illiopsoas symptoms usually worsen with extreme hip flexion or crossing the legs with the hip flexed and a person may report audible pop or snap when movinf the hip. Pain with trochenteric bursiting tends to worsen with hip rotation and briging the leg in and out.
ITB friction syndrome: May result from repetitive friction and stress due to tightness of the ITB (illiotibial band), or rotation of the lower leg such as walking “pigeon toed”. People may report pain with running downhill or feelings of knee instability. Most pain is felt at a slight bend of their knee (typically 30 degrees of knee flexion) as the ITB is put under most pressure at this angle.
If you are having any symptoms described in this article or have a new pain, numbness, stiffness or tingling in any part of your body, arms or legs, contact us today! With Direct Access in NJ we can get you in for an evaluation without you having to see your Doctor, probably quicker than you could get that appointment, while also saving you both time and money!
Please, call us to schedule your evaluation at one of BeneFIT’s locations, Bridgewater (908.203.5200) or Chester (908.879.5700) with one of our highly trained Doctors of Physical Therapy!
Evaluation of the Patient with Hip Pain. WILSON J., and Furukawa M., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Am Fam Physician. 2014 Jan 1;89(1):27-34
Ortho Notes. Guilick D., 2009 (194-198).