Hip pain, especially chronic hip pain, can have a significant impact on your quality of life. It can keep you from completing every day physical tasks at home or at work. It can stop you from doing things you enjoy such as taking a walk outdoors.
When you move less, your overall health suffers, too. Staying active helps keep weight off and reduces risks for heart disease, diabetes, and stroke. It also improves your overall mobility and reduces the risk of falls, fractures and other injuries.
If you’re ready to step away from hip pain, orthopedic surgeons Todd Kelley, MD and Dinesh Thawrani, MD, and physical therapist Nancy Kleespies, PT, want you to know about proven treatments and ways you can lower your risk from developing chronic hip pain.
1. There are multiple causes for hip pain
Osteoarthritis is the cause of hip pain that most people are familiar with. It’s the general wear and tear of the hip joint over time.
“This is the big ‘itis,” Dr. Kelley says. “This is the inflammation at the joint and it hits a lot of us. The biggest category of arthritis in the hip is general osteoarthritis.”
There are other “itises” in the hip that can cause inflammation and pain. “’Itis’ in Latin means inflammation,” Dr. Kelley explains. “So tendonitis is literally inflammation of the tendon. ‘Bursa’ is Latin for ‘purse, pouch or sack,’ so bursitis is inflammation of sack of fluid that helps to cushion the tendons around the bone to help us move.”
Physical injury is another big category for hip pain, like cartilage tears, muscle strains, and fractures.
2. Hip pain can originate in different places
When people describe their hip pain, they generally point to one of three locations, according to Dr. Kelley. “There’s the anatomical region that people consider as their hip, and there’s the hip joint itself,” he says.
The backside and lower back
Hip pain in this area is generally caused by a pinched nerve in the lower back called “sciatica.” This can be caused by a bulging or herniated disk or even arthritis in the lower back that pinch the nerves that run down into your backside.
Another cause for pain in this area is sacroiliac joint pain. “This is where your lower back meets your pelvis,” Dr. Kelley says. “Inflammation and even arthritis in this area can cause pain in that lower back area.”
There are proven treatment options to alleviate pain in this area, according to Dr. Kelley. These include:
General medication to alleviate inflammation (NSAIDS such as ibuprofen and naproxen)
Targeted cortisone injection to alleviate inflammation and pain, often around the location of arthritis or a bulging disk
Changing of activities to alleviate pressure that causes pain to allow time for inflammation to go down
Physical therapy, which Dr. Kelley says works more often than not by stretching and strengthening the core muscles around this area. In fact, by incorporating regular stretching and strengthening into your daily routine after treatment, you decrease the chances for recurring pain.
The outside of the hip
“That bulge or bump on the side of your hip is where you usually experience pain caused by tendonitis or bursitis,” Dr. Kelley says. “This is where your muscles and tendons come down from your pelvis.”
Inflammation or tightening of those tendons can cause pain in this area, and can actually cause additional bursitis by pulling harder on the bursa sacs that cushion the muscles and tendons around the bone.
Treatments for pain in this area include:
Anti-inflammatory medications such as NSAIDS
Physical therapy to stretch the muscles out. “This gives the bursa more breathing room and more space so that both of these areas can quiet down,” Dr. Kelley says.
Dr. Kelley explains that cortisone injections are generally not used repeatedly for treatment of pain in this area. “We can do a cortisone injection in this area if you’re miserable, but we try to avoid it because of certain side effects,” he says. “Sometimes cortisone can actually weaken the muscles and tendons in this area, leaving you in worse shape than before. Physical therapy and a home stretching program is generally a better option.”
The hip joint
Pain in the hip joint is generally felt in the area around the groin and the front side and top of your thigh bone, according to Dr. Kelley. In many cases, this is due to arthritis.
With arthritis, the cartilage starts to thin out, and over time the damage to the cartilage worsens to the point of no longer being able to protect the bone, causing the bone to feel more stress.
“Bone is actually really dumb,” Dr. Kelley says. “When it’s stressed, the only way it knows to react is to build more bone. This is how bone spurs develop in the hip, and over time that extra bone outside your joint impedes your motion and causes additional pain.”
While there is no cure for arthritis, Dr. Kelley points out that there are non-surgical and surgical options to help alleviate the pain of arthritis in the hip. The right option for you depends on the severity of the arthritis, its impact on your daily life, and the effectiveness of exhausting all options. Non-surgical options for relieving the pain of hip arthritis include:
Physical therapy to strengthen the muscles and reduce pressure around the joint
Weight loss to lessen the impact on the joint
Use of ambulatory devices such as a cane or walker to take pressure off the joint
Ice to relieve inflammation
Anti-inflammatory medications (NSAIDS)
Total hip replacement.
3. A big picture look at your overall health and its impact on your hip health
Movement starts with the hips, so maintaining your overall health can have an impact on the durability and health of your hips. Physical therapist Nancy Kleespies says adherence to your prescribed regimen of physical therapy is critical, no matter where you are in your treatment. Physical therapy can help by:
Restoring range of motion around the hip and working on flexibility. “It’s amazing what a difference it can make to work on hamstrings, hip flexors, your IT band and even calf muscles,” she says.
Strengthening your core to provide a stronger foundation for your extremities to work from. “Strong core muscles can take a lot of stress off your joints and muscle attachments,” she says.
Nancy urges patients with diseases such as diabetes or cardiovascular diseases to follow through with important lifestyle choices, as these conditions also impact circulation which helps your body to heal. She reminds patients to be consistent with medications, maintaining the appropriate level of activity, maintaining your weight and eating a healthy diet.
If you’re a tobacco user, Nancy says the best thing you can do to improve the health of your hips or any of your joints is to stop. “Whether you’ve had surgery or not, healing in general is impacted by smoking. Smoking greatly decreases your circulation,” she says.
“Finally,” she says, “get moving. A lot of people today live a sedentary lifestyle. We want to make sure that movement is part of your everyday life. If you tend to be sedentary, just try to walk a little bit more, park a little farther away when you have to go places, so you have to walk a little bit more.”
If you live in an area where you don’t feel safe walking, she suggests walking at a mall or other large indoor options, or even looking into a new or used stationary bike or stepper that you can use in the home. She says that even starting small and setting achievable goals can have a lasting impact. That advice carries over for your approach to physical therapy.
“The important thing is consistency, and if you get the right routine and you know what it is you're working toward, and you establish a good time of day to do something you enjoy doing, it'll become a habit,” she says.
Nancy also notes the importance of approaching treatment with a healthy mindset, and for getting help if you feel your condition is impacting your mental wellbeing.
“Studies show that the psychological component has a lot to do with outcomes,” she says. “Decreased activity and not being able to spend time with friends can increase the risk of depression. Being aware of this and taking the steps to see to your overall wellbeing can help you approach your treatment with a better mindset and increase your chances for success.”
4. Total hip replacement comes with a high success rate
Of course, sometimes arthritis of the hip becomes so severe that hip replacement is necessary. In other cases, such as traumatic injuries and severe fractures, it’s the only option.
Total hip replacement has a high rate of success, and with adherence to prescribed post-operative care and physical therapy, patients are usually able to resume full activities in very little time.
What happens during total hip replacement?
During a total hip replacement, surgeons replace the damaged joint with a highly-advanced artificial socket and ball. This alleviates the pain caused by the damaged joint.
“The technology, instrumentation and quality of the implants are very advanced,” Dr. Thawrani says. “We use a direct anterior approach that is minimally invasive and less traumatic to the muscles, which means a faster recovery.”
"Hip replacement has proven so successful, that the Lancet Journal calls it the operation of the century," Dr. Thawrani says. “Our patients are getting back to the activities they like to do like going back to regular long walks or golf, or other things that they want to enjoy at that particular age but could not do,” he says.
"Hip replacement has proven so successful, that the Lancet Journal calls it the operation of the century."
The success is long-lasting, as Dr. Thawrani points out, due to the advances in the construction of the implants. “Ninety to ninety-five percent of current implants last at least 20 years,” he says. “I point to that statistic when a patient asks if they are too young for a total hip replacement. There is no such thing as too young.”
So who is a candidate for hip replacement surgery?
As Dr. Thawrani pointed out, age is not a limiting factor. When asked if a patient is too old, Dr. Thawrani says there is no limitation. “Most patients are in the 75 to 85 age group,” he says. “Their ability to undergo successful surgery really depends on their overall health.”
“It really comes down to some simple questions,” he says. “Does your hip pain interfere with your daily living, and have you exhausted other treatment options? If yes, you are probably a candidate.”
Is hip replacement painful?
The minimally invasive approach to total hip replacement means less trauma to the surrounding muscles and other tissue, leading to shorter recovery times. In addition, Dr. Thawrani points out, advances in medication and the approach to pain management offer additional relief.
“We use a multimodal approach to managing pain, which means we target different pain generators,” he says. “We target separate pain generators such as the nerve or muscle at the hip joint or areas of inflammation and swelling with different medications.”
He also points to advances in anesthesia such as nerve blocks around the hip joints as helping to reduce the pain during the initial recovery time. In this case, pain relief during the days following surgery can focus on the pain and swelling around the incision itself.
5. Here’s what to expect following total hip replacement
The success rate of a total hip replacement is dependent on adherence to post-operative care, but the good news is that the same improvements that lead to a higher success rate, also mean a quicker recovery time.
“Previous patients had to go to a rehab facility or nursing home after surgery,” Dr. Thawrani says. “But now, 90 percent of our patients actually go home the same day.”
Here are answers to other leading questions following hip replacement surgery:
Q: When do I start post operative physical therapy?
A: Most patients begin outpatient physical therapy within 1-2 days. Of surgery.
Q: How soon should I be walking?
A: Initially, walking will be under supervision of the physical therapist, and this generally happens the day of surgery.
Q: What should I expect with post-op physical therapy?
A: Your physical therapist will assist you with learning to use an aid such as a cane or walker, if needed, during your initial recovery period, then help you progress to regaining normal walking mechanics. They will work with you on regaining your strength, balance and flexibility, and they will also assess your progress and ability to resume regular activities such as walking up stairs to ensure you progress safely with minimal risk for falls.
Q: How long will the initial recovery period last?
A: Nancy says you can expect to take a month-to-month approach to your recovery, with three distinct phases:
First Month – During this phase, you’ll be getting over surgery and will still experience pain and swelling and your daily activities will revolve around your joint care. “You’ll ask yourself, ‘why did I do this,” she says.
Second Month – Daily walks will be easier and you’ll be able to climb steps pain free. Your walking endurance will improve, as should your sleep patterns. In some cases, you can return to work during this period. “Now you’ll tell yourself you understand why you did this,” she says.
Third Month – You should have good pain control and be able to return to all activity and your functionality should be even better than before surgery. “This is where you ask yourself, ‘why didn’t I do this sooner,” she says.