Ask 10 different people to point to their hip and, almost certainly, they won’t point to the same spot. Some will point to the area of their front pocket, some will point to the side of their buttock, some will point to the area of their back pocket, and some will point closer to the midline near their tailbone or sacrum.
Of course, all of these areas could hurt but they will likely hurt for different reasons and they won’t all have to do with the hip joint itself.
What causes hip pain?
Here is a list of some common causes of hip pain:
Strained muscle. Usually sudden but sometimes gradual onset typically from sport or overuse.
- Hip flexors- pain in the front of the hip
- Groin- pain in the inner thigh
- Gluteal- pain on the lateral aspect of the hip or backside of the hip
- Hamstring- Back of the thigh, often right at the top, near the crease of your buttock
Myofascial pain. This may be due to muscle spasm or, if chronic, may involve fibrous adhesion or scar tissue in the muscle and fascial (connective) tissue. This can affect the same muscles as those listed above for muscle strains but the exam findings will differ.
Hip impingement. Pain in the front of the hip when you bring your knee to your chest. There are several reasons why you may experience this.
- Femoral-acetabular impingement
- Labral tears
- Soft tissue impingements
Hip arthritis. Osteoarthritis is wear and tear of the hip joint which occurs as we get older. It can start as early as our 40’s but becomes more common as we age. People with osteoarthritis typically experience pain in the front of the hip but commonly will also experience pain in the side of the hip, butt and even down the front of the thigh and knee.
Lumbar or Sacro-iliac joint pain. Pain in the lower back and pelvic joints can commonly present as pain in the butt or tailbone area and occasionally these joints will cause pain in the groin or scrotal area.
Hernia. Hernias occur when the abdominal contents bulge through a weakness in the lower abdominal wall. This will eventually present as a painful bulge in the front of the hip but may be very subtle at the beginning, showing only with exercise or times of increased pressure.
Sports hernia/ athletic pubalgia. These are not true hernias but the term has occurred because the regions are closely associated. This injury is best described as an overstrain/ damage to the connective tissues/ tendons associated with attaching the lower abdominal muscles to the pubic bone at the front of the pelvis. This injury is typically associated with sport and overuse. This can be treated conservatively (non-surgically) but in some cases may require surgery.
Osteitis pubis/ pubalgia. This may be difficult to distinguish from sports hernia but the pain, in this case, will be originating from the actual pubic joint at or near the midline. This injury may occur in pregnant women or as a result of sport and overuse.
Stress fracture. Gradual onset of hip pain is typically associated with overuse such as increased exercise volume. This eventually leads to a breakdown of the bone in the hip.
Legg-Calve-Perthes disease. Occurs in children aged 4-10. Avascular necrosis of the hip occurs when there is a compromise in blood flow to the hip joint causing deterioration/ deformation of the hip bone. Typically presents as a painful limp with pain in the front of the hip, groin, thigh and knee. This can result in permanent deformity of the joint which can cause chronic pain and lead to osteoarthritis of the hip later in life. This always requires specialist consultation.
Slipped Capital Femoral Epiphysis. Occurs in 8-15-year-olds. The growth plate at the top of the leg bone can slip out of position and cause pain and limping. The pain is typically located in the front of the hip, groin, thigh and knee. This always requires specialist consultation and may require surgery to repair.
Other rarer but serious causes of hip pain could include hip joint infection, cancer, ovarian cysts, bladder infections to name a few. Symptoms such as fever, night pain, night sweats, unexpected weight loss and pain at rest are potentially worrisome symptoms that should be taken seriously.
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