Lower left back and hip pain female

When trying to analyse the cause of hip pain in women, it is important to think about any systems that could potentially be contributing to that pain. For example, the pain felt over the front of the hip, in the groin area, could be attributed to a gynaecological cause (a problem with the womb or ovaries), an abdominal cause (like a hernia) or a joint problem. Pain over the side of the hip and in the buttock area is more likely to be caused by a problem within the hip joint. However, all of these may also be caused by referred pain from a problem in the knee or lower back.

This article will focus more on the direct causes of hip pain caused by problems in and around the hip joint itself, and offer ‘5 top tips’ to help relieve hip pain caused by common joint problems. If you have any concerns that your hip pain may be caused by something other than the joint directly, you should seek advice from your GP.

Musculoskeletal (MSK) pain is a significant contributor to ill health in the UK, with 25% of all GP consultations relating to joint and muscle pain. Of this, hip pain is a major contributor, appearing in the top three most commonly reported MSK problems.

Causes of hip pain

Hip pain can be caused by many different elements in and around the joint:

Arthritis

The hip joint itself refers to the ball and socket joint between the top of the thigh bone (femur) and the socket within the pelvis, as shown in the image. The leading cause of long-term hip pain in the UK is osteoarthritis of this ball and socket joint. This is common arthritis caused by general wear and tear that happens within the joints during the ageing process and can be exacerbated by factors such as previous joint injury or excess weight. In osteoarthritis, there is mild inflammation within the joint, damage to the protective cartilage that covers the ball and socket, and formation of bony spurs known as ‘osteophytes’. This can cause pain and stiffness, particularly on movement. The hip joint is the second most commonly affected joint by osteoarthritis (the knee joint being the most common), with 2.46 million people affected in England and women twice as likely to suffer with it than men.

Rheumatoid (or inflammatory) arthritis (RA) is another cause of joint pain and is up to four times more common in women. Whilst RA classically affects the smaller joints in the hands, it can also affect larger joints such as the knee or hip. Unlike osteoarthritis, RA can affect people of any age and often presents in younger adults, although it is much less common.

Whilst osteoarthritis remains the leading cause of chronic hip pain in the UK, there are a few other causes, which are more common in younger adults, that can lead to pain around the hip joint:

Dysplasia/impingement

Dysplasia refers to the bony parts of the joint not forming in the correct shapes needed for the hip to function normally. Whilst this is more commonly seen in infants, it can sometimes present in adulthood. The most common symptom is hip pain, which is caused by walking on a misshapen joint for a long time. In some cases, there is only a very small amount of irregularity between the ball (top of the femur/thigh bone) and socket (in the pelvis); not enough to inadequately support the joint, but enough to cause some of the bones in the hip joint to rub together causing pain. This is known as impingement, and again, is seen more in younger adults presenting with hip pain. It can also occur in a normal hip if commonly using the extremes of normal joint motion (e.g. in gymnasts or dancers). In older adults, impingement often occurs alongside osteoarthritis.

Iliotibial band syndrome

The ‘iliotibial band’ is a ligament that runs across the front of the hip joint itself. If over-exercising (classically with long-distance running), this ligament can become inflamed and result in pain on movement.

Bursitis/tendonitis

Special fluid-filled sacs are surrounding many of the joints in the body called a bursa. Their job is to provide some cushioning and protection to the joints. There are several present in the large hip joint, and inflammation or swelling of these bursae can cause pain and stiffness on movement. This inflammation can be caused by infection or be secondary to other inflammatory diseases like rheumatoid arthritis or gout.

A similar kind of inflammation can also occur in the tendons (the fibrous bands that join muscles to bones) and can cause pain and swelling over the joint known as tendonitis. Tendonitis shouldn’t last longer than a few weeks with appropriate rest.

5 top tips for relief of hip pain

1. Talk to your pharmacist/GP about pain relief

If your pain is having a significant impact on your day-to-day life, then it is important to get your pain under control. Conventional over-the-counter (OTC) medications like paracetamol and ibuprofen can be extremely effective for joint pain when taken correctly. For further advice on how best to take these, you can always ask your local pharmacist who will be able to tailor advice to your situation. If you are finding that these medications are not giving you sufficient pain relief, then it would be appropriate to seek further advice from your GP, who may be able to prescribe an alternative.

Using ice to ease hot, swollen joints (frozen peas work well) or heat for sore, stiff joints can also be extremely effective forms of pain relief.

2.Exercise modification

With long-term hip pain, it is vitally important that you keep the joint moving as much as you can. Particularly in the case of osteoarthritis, although movement can be painful, keeping your joints moving can provide a great array of benefits. It is important to focus on gentler, lower-impact exercise that will help to maintain mobility without putting too much stress or strain through the weight-bearing joints (hips and knees).

If you have a type of hip pain relating to excessive exercise (particularly long-distance running), a period of rest is appropriate followed by gradually building back up to your normal exercise regime.

3.Weight loss

Weight loss has been shown to dramatically improve symptoms in people who are overweight and experiencing joint pain from osteoarthritis. Particularly, weight loss in combination with exercise has been shown as a highly effective method for treating hip osteoarthritis and can be good options to avoid or delay the need for joint replacement.

   4.Physiotherapy/targeted exercise

As well as modifying general exercise and keeping moving, there are some specific, more targeted exercises that you can do to help strengthen the muscles around your hip and take some of the pressure of the joint to relieve pain. Whilst it is recommended to seek the advice of a physiotherapist for more complex problems, here are some simple exercises to get started with at home:

LYING EXERCISES:

Start all of these exercises lying flat on your back with a cushion under your head.

• Knee-to-tummy: one leg at a time, bring your knee up to your tummy/chest, hold for approx. 20 seconds and replace. Repeat on the other side and a further 5 times
• Knee bends: keeping your foot on the bed, bend one knee, then straighten your leg. Repeat 20 times, each side at a time
• Straight leg raises: keeping your leg straight, raise your ankle (aim for about a 20cm rise), hold for approx. 5 seconds and slowly lower. Repeat on the other side and up to 10 times

STANDING EXERCISES:

These exercises start with standing and require minimal equipment. Try to ensure there is something stable nearby, if you feel unsteady, to hold onto.

• Leg swing: stand sideways on a small step, allowing your outside leg to hang freely over the step. Let the leg swing back and forth gently. Repeat on the other side
• Stand-sits: Stand in front of a chair, slowly lower to sit on the chair, then slowly stand up straight again. Try to do this without using your hands to help if you can
• Side stretch: Stand up straight holding onto something for support. Keeping your torso straight and upright, lift the outside leg and lift it sideways (keeping the leg straight), then return to a standing position. Repeat on the other side

    5.What to do next

If your pain is not resolving with the appropriate rest/mobility and OTC painkillers after a few weeks it would be advisable to see your GP for further assessment.

You should also go to see your GP if you are having hip pain and experiencing any of the following:

• A new fever or rash
• Sudden onset hip pain and you have sickle cell anaemia
• There is a pain in both hips and other joints

There are also a few situations where it is appropriate to go straight to A&E or seek immediate medical attention in case there is a more serious problem:

• Hip pain caused by a serious fall or accident
• You are worried about a fracture or dislocation of the hip joint
• There is significant bruising or bleeding
• You are not able to put any weight through the hip at all
• You are not able to move the hip at all
• You have a high temperature and are feeling very unwell

Date: 22/02/2019
By: gpittson

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