Patient information: Hip pain

HIP PAIN OVERVIEW

The most common causes of hip pain are arthritis, bursitis, muscle strain, and nerve irritation.

Arthritis — The hip is a "ball and socket" joint formed by the pelvic bones (the socket) and the end of the femur bone (the ball). Both bones are covered with a smooth layer of protective cartilage; loss of this cartilage from wear and tear, inflammation, or injury causes arthritis. (See "Patient information: Arthritis".)

Bursitis — The hip joint and the large muscles that cover it are lubricated by five large bursa sacs and the fluid contained in the hip joint. Each sac produces lubricating fluid and functions to reduce pressure and friction around the joint. These bursa sacs can become irritated from injury, excessive pressure, and overuse. Inflammation of a bursa is called bursitis. (See "Patient information: Bursitis".)

Muscle strain — Three major muscle groups help to move the hip through a wide range of movements. Overuse and irritation of these muscles can lead to muscle strain.

Nerve irritation — The major nerves controlling lower leg function cross the hip. Irritation of these nerves can cause pain through the hip and/or down the leg. Injury to the sciatic nerve frequently causes pain along the outer thigh or down the back of the leg; this is called sciatica. This is discussed separately. (See "Patient information: Low back pain in adults".)

LIMIT ACTIVITIES

Hip arthritis — If you have hip arthritis, you should avoid the extremes of hip motion and should minimize jarring and high impact activities:

• Contact sports such as football, rugby, and wrestling, and stop-and-go sports such as basketball, tennis, and racquetball should be limited or avoided, at least temporarily. These activities can cause flares of arthritis and worsen arthritic damage.
• Avoid running and jumping
• Avoid activities that require you to spread your legs widely.

Hip bursitis — Avoid repeated bending of the hip and direct pressure over the hip.

• Do not sleep on the affected side; sleeping on the back or stomach is preferable.
• Stair climbing, stair stepper, step aerobics, rowing machine, bicycling, squatting, and stop-and-go sports (eg, tennis and racquetball) create too much friction and irritation and should be avoided until the pain has subsided.
• Avoid prolonged sitting.
• Minimize working in a stooped position.
• Limit repetitive bending at the hip.
• Do not bend over to touch the toes during the recovery period.

HIP PAIN RELIEF

If pain is bothersome, you can take a pain medication such as acetaminophen (Tylenol®). A nonsteroidal antiinflammatory drug (NSAID), such as ibuprofen (eg, Advil®, Motrin®) or naproxen (eg, Aleve®) can also be used for pain. The dose of these medications is available in table 1 (table 1). (See "Patient information: Nonsteroidal antiinflammatory drugs (NSAIDs)".)

STRETCHING FOR HIP PAIN

Heat — Heat helps prepare the tissues for stretching and is recommended before beginning each exercise session. The preferable method of heating is in a warm shower or bath for 10 to 15 minutes. Local heat (eg, with a heating pad or a towel warmed in a microwave) is an alternative, but may not be as effective.

Hip arthritis — Stretching exercises are recommended once per day, after heating the area.

Knee chest pulls — Lie on the back on a bed or on a towel on the floor. Bring knees up to chest. Place the hands behind the knees and pull toward the chest until you feel a stretch in the lower back and buttocks. Hold for a count of 5. Rest and repeat 15 to 20 times. (picture 1).

Figure of four stretch — Stand next to stable piece of furniture (eg, couch). Stand on the unaffected leg and place the opposite foot along the inside of the knee (imagine a number 4). Gently rock the knee outward. The higher the foot is raised the greater the stretch. Hold for a count of five. Rest and repeat 15 to 20 times.

Sitting stretch — Sit on the floor and place the feet together and the knees apart. Pull the feet up towards the groin. Lean forward gently to increase the stretch, but do not bounce. Hold for a count of five. Rest and repeat 15 to 20 times.

Hip bursitis — Cross leg pulls and outer thigh stretches are often recommended for people with hip bursitis.

Cross-leg pulls — To perform cross leg pulls, cross the affected leg over the other while in a sitting position either in a chair or on the floor. Grasp the knee and pull the leg to the opposite side. Keep the buttocks flat; do not roll the pelvis. A gentle pulling sensation should be felt in the outer buttocks or hip area. Rest and repeat 15 to 20 times.

Outer thigh stretches — Stand at arms length away from a wall with the affected leg near the wall (picture 2). Cross the affected leg behind the other leg. Carrying all the weight on the good side, bend the elbow and lean into the wall. You should feel a stretch through the hip and side of the body. Rest and repeat 15 to 20 times.

MUSCLE TONING EXERCISES FOR HIP PAIN

Muscle toning exercises may be recommended if you require prolonged bedrest, have been in a cast, or have been inactive. Toning exercises should always be done after stretching exercises.

Straight leg raises — These exercises are performed while sitting on the edge of a chair or while lying down. Keep the affected leg straight and bend the knee of the other leg (figure 1). Lift the affected leg three to four inches off the ground. Hold for 5 seconds. Rest. Repeat 15 to 20 times.

With improved strength, these exercises can be performed with a five to 10 pound weight placed at the ankle.

Leg extensions — These exercises strengthen the muscles in the buttocks. Perform these exercises while lying on the stomach or while on all fours (picture 3). Extend one leg backwards, hold straight, and raise it 3 to 4 inches off the ground. Hold for five seconds. Repeat 15 to 20 times for each leg.

After three to four weeks, you can increase the difficulty of the exercise by adding a five to 10 pound weight to the ankle. Perform this exercise while lying flat if you have knee cap irritation or arthritis.

GOOD BODY MECHANICS TO PREVENT HIP PAIN

The following positions and activities are recommended to reduce the possibility of reinjury to the hip joint and the surrounding bursal sacs:

• Sit in a partially reclined position
• Sit up straight with your legs slightly turned out
• Stand with the weight equally distributed between your right and left legs
• Lift and carry weight close to the body
• Sleep on your back with the legs spread apart
• Sleep on the unaffected side of the body with a pillow between the knees
• Keep your weight under control
• Swim with the crawl kick (legs kept straight)

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two people are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our Web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Some of the most pertinent include:

Patient Level Information:
Patient information: Arthritis
Patient information: Bursitis
Patient information: Low back pain in adults
Patient information: Nonsteroidal antiinflammatory drugs (NSAIDs)

Professional Level Information:
Clinical manifestations of osteoarthritis
Evaluation of the adult with hip pain
Patient guidelines for weight-resistance training in osteoarthritis
Rehabilitation program for the lower limb
Risk factors for and possible causes of osteoarthritis
Weight-resistance training in patients with osteoarthritis

A number of Web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.

• National Library of Medicine

      (www.nlm.nih.gov/medlineplus/healthtopics.html)

• American Academy of Orthopaedic Surgeons

      (http://orthoinfo.aaos.org/)

• National Institute of Arthritis and Musculoskeletal and Skin Disease

      (www.niams.nih.gov)

• American Physical Therapy Association

      (www.apta.org)

• Arthritis Foundation

      (www.arthritis.org)