​​​​​​​​​​​​​​Hip pain can strike when you least expect it, whether you’re out on the golf or tennis course, or all in on an intense pickleball match.

“We’re seeing lots of pickleball injuries,” says Michael Palmer, MD, an orthopedic surgeon and sports medicine specialist with The Christ Hospital Physicians-Orthopaedics & Sports Medicine. “In fact, pickleball is the biggest thing that’s happened to orthopedics since CrossFit.”

To help you stay active and learn the common causes of hip pain, Dr. Palmer joined a recent webinar to break everything down.

Common causes of hip pain

Hip pain can have a number of causes. For better or worse, it’s not always an easy diagnosis.

For instance, the pain could mean you’ve damaged the soft tissues around the joint or suffered a break in a bone. Or you may have bones that are impinging on each other.

Hip pain could be from a back problem or a more systemic issue of inflammation.

The culprit of your hip pain could also be the most common cause: arthritis.

Soft-tissue issues

Hip pain related to soft-tissue issues can manifest in different areas with varying levels of severity and impact on your day-to-day activities.

Lateral pain

When you have pain on the side of the hip, it’s referred to as lateral pain or called Greater Trochanteric Pain Syndrome (GTPS).

GTPS is an umbrella term for several conditions, but one of the most common is iliotibial band syndrome, or IT band syndrome, which occurs when the iliotibial band—the thick piece of tissue that runs from the pelvis down to the knee—tightens and causes pain. Another is bursitis. It develops when the layer of bursal tissue, which acts as a lubricant to allow the hip to rotate, gets inflamed.

It’s important to understand the difference between bursitis and a more serious condition, such as a tear or inflammation in the hip tendons. “When a patient says it hurts on the side of their hip, the first thought is typically bursitis,” Dr. Palmer says, “But if they’re also limping, experiencing weakness in the area and significant pain, especially at night while lying on their side, it could be an indication that it’s more than just bursitis.”

Posterior pain

The most common cause of posterior hip pain is a hamstring tear, which can be either acute or chronic.

“An acute tear feels like you got shot in the rear end, or you hear a pop and feel a significant amount of pain and zing down the back of your leg,” Dr. Palmer says.

Chronic tears can make it hard for you to sit down. They can also cause cramping in the thighs with prolonged activity or fatigue and a feeling of weakness in the back of the thigh.

In many cases, a hamstring tear can get better with rest, recovery and rehabilitation. But sometimes, your doctor may recommend surgery.

Bone and joint-related issues

Hip pain from bone and joint-related issues is often felt in the front of the hip near the groin, and from deeper within the hip than most soft tissue issues. However, like soft tissue-related pain, there can be different causes.

Hip impingement

The term “hip impingement” is associated with labral tears, where there’s an incongruity between the ball and socket in the hip joint. This leads to a collision between the two every time you bend your hip. Over time, that can damage the cartilage and labrum, which creates a suction seal around the socket that keeps the joint healthy.

Hip impingement is one of the causes of osteoarthritis in the hip, but not everyone with impingement develops arthritis. Also, not everyone who has arthritis started with impingement.

Typically, if it’s found early due to symptoms like pain, orthopedic surgeons can treat a hip impingement arthroscopically. This involves repairing and smoothing out the bony incongruity to decrease those collisions. Through this treatment, most patients return to normal activity within five to seven months.

Many factors affect outcomes. Even after arthroscopic surgery, there is still a chance that someone might need a hip replacement later in life.

“Patient selection is key for labral tears,” Dr. Palmer says. “The more degenerative changes that are present at the time of surgery, the more likely you are going to need a hip replacement afterward. But for the right patients, these surgeries work really well.”

Osteoarthritis

The most common cause of hip pain is arthritis, which is wear and tear on the joint. When a joint’s cartilage starts to wear down, the surface of the joint goes from being very smooth to very rough.

“It’s like going from dry ice to sandpaper to a road with potholes,” Dr. Palmer says. “Eventually, it just wears out and causes a lot of friction.”

That friction becomes painful.

Arthritis in the hip tends to relate to aging. The older you are, the more likely you are to develop arthritis because the body wears down over time. Other factors that increase your chances of developing arthritis are genetics, previous traumas and surgeries, as well as other medical issues.

Symptoms of osteoarthritis include stiffness, limping, difficulty bending over or tying your shoes, or trouble getting up from a chair or low-seated position.

Although there isn’t a cure for osteoarthritis, there are ways to manage it. Surgical and nonsurgical treatments are available.

Hip pain treatments

Nonsurgical treatments for hip pain

Most nonsurgical treatments for hip pain include lifestyle modifications, like getting more exercise and losing weight.

“Motion is lotion for the joints,” Dr. Palmer says.

Your doctor may also recommend physical therapy.

“Having someone on your team guiding you and identifying areas you can focus on—and making sure you’re performing exercises in a safe way—is very beneficial,” Dr. Palmer says.

In addition, you can try a walker or a cane, pain creams like topical lidocaine or Voltaren Gel®, acupuncture, supplements like glucosamine or anti-inflammatory medications.

Depending on the severity of your pain, your doctor may suggest a cortisone injection or a biologic treatment like a platelet-rich plasma (PRP) injection to help reduce acute pain and inflammation.

Finally, your doctor may talk to you about prioritizing an anti-inflammatory diet and the impacts a mental health condition like depression can have on pain levels when left untreated.

Surgical treatments for hip pain

The most common surgical option for osteoarthritis in the hip is a hip replacement.

“Hip replacement surgery is 100 years old,” Dr. Palmer says. “It’s gone through a lot of evolution and was once called the operation of the century. It’s very successful, in general, for allowing patients to return to a good quality of life with minimal pain.”

Success with hip replacement surgery looks like reduced pain, improved function and a better quality of life.

Still, as with any surgery, there are risks with hip replacement surgery such as fracture, infection and blood clots.

“The philosophy is, if it’s the right thing to do, if you can give somebody a good quality of life for the foreseeable future, it certainly makes sense,” Dr. Palmer says.

Roughly 90 percent of people go home the same day after hip replacement surgery. “It’s turned into an outpatient surgery in recent years,” Dr. Palmer adds, noting that a small number of people need to stay in the hospital for a few days afterward.

Like recovery, rehabilitation from hip replacement surgery is individualized. “It’s a process and a gradual return to normal activity,” Dr. Palmer says. “It’s not mandated by a certain amount of time. It’s mandated by when you’re ready to move on to the next phase of activity.”

Improve your hip mobility with The Christ Hospital Health Network

If you’d like to discuss your specific needs with us and take steps toward less hip pain and more mobility, schedule an appointment online with Dr. Palmer or one of our other hip specialists, or call us at 513-557-4900.