One of the most common problems our patients have is “hip pain”, but what do patients truly mean when they say hip pain? There are multiple conditions which can cause pain in and around the hip, buttock, and thigh and the location of your pain is useful in determining the cause.

Groin pain

Patients describing groin pain are most often suffering from osteoarthritis of the hip joint. This is a condition which occurs when the cartilage covering the ends of your bones becomes worn out in places. Patients with arthritis describe a dull aching pain in the groin which tends to be worse after activity and usually improves with rest. As the arthritis progresses, the pain may become more pronounced at night. Pain in the groin will often lead to a limp and a decreased ability to move the leg and patients will often find it difficult to perform duties which require bending at the hip such as putting on their shoes and socks.

If you find that you are experiencing similar symptoms, your doctor will probably want to do some tests. These include a physical exam to check your range of motion, which is diminished or lost as arthritis progresses. They will also take x-rays of your hip joint which may show things such as narrowing of the joint space between the socket of your pelvis and the ball of your femur, or bone spurs also called “osteophytes” which are formed in arthritis and can be a cause of your pain.

If your doctor determines that you have arthritis in your hip there are non-invasive treatments they will suggest. A combination of Tylenol and NSAIDs is the best for treating the pain associated with arthritis of the hip. This provides good pain control and decreases the inflammation in the joint which is responsible for most of the pain. Narcotics are not a good choice for this condition. Your doctor may suggest an injection into your hip joint which cannot be done in the office but can be scheduled in the hospital. Assistive devices such as a cane, walking stick, or walker are also helpful to take some of the pressure off the hip or provide balance if you feel unsteady. Your doctor may also give you a prescription for physical therapy or a home exercise program aimed at stretching and strengthening the muscles around your hip. The best types of exercises for patients with arthritis are stationary bikes, elliptical machines, or swimming/walking in a pool as these activities are not impact loading and so are the easiest on your hips. If these conservative treatments fail, your doctor may talk with you about surgical replacement of your hip.

Outer thigh pain

Patients describing outer thigh pain are usually experiencing trochanteric bursitis. This is a condition in which the bursa, which is a fluid filled cushion between the thigh muscle, called the iliotibial band, and the thigh bone, becomes inflamed and painful. The pain associated with this is localized over the side of the upper thigh but can radiate into the buttock or down to the knee, and is very tender to touch. Most patients will say the pain is worst when trying to get up from a sitting position, after walking for a long time, or at night when patients say they cannot lay on their side.

If you are describing this type of pain, your doctor will most likely be able to reproduce it by pushing against the outside of your thigh. They may still want to take an x-ray of your hip to make sure there are no bony problems on the inside which could be causing your pain.

The treatment for this consists largely of controlling the inflammation in the bursa which causes the pain. Taking a short course of NSAIDs and icing the painful spot helps decrease the pain. Your doctor may suggest physical therapy or a home exercise program which stretches the iliotibial band. They may offer an injection of a steroid into the bursa itself which can be done in the office and can be very helpful in relieving symptoms.

Thigh pain which radiates to your buttock or past your knee

When patients describe symptoms such as thigh pain that radiates into their buttock, lower back, or down past the knee there is always a chance that this pain is coming from the patient’s back. This pain can be severe and can be worsened by activity, sitting, coughing, or sneezing, and patients will often say they have a hard time finding a comfortable position to sit in. Patients will say that lying on their back with a pillow under their knees provides some relief. This radiating pain, called sciatica, is usually due to irritation of the nerves in your low back which provide the sensation and muscle function to your legs.

To check your back, your doctor will test how well your spine moves, he will check your reflexes and the strength in your legs, and he will usually get x-rays of your back.

Most sciatica, although it can be incredibly painful, is relatively short lived and will improve with conservative management in about three to four weeks. Your doctor may send you to therapy or give you a program to work on stretching and strengthening your core and back muscles. He may also prescribe a short course of oral steroids such as prednisone or a Medrol dose pack. If these do not improve your pain, your doctor may order an MRI to further investigate the source of your pain.

No matter the location, “hip” pain is a treatable condition that needs to be investigated fully by your doctor and treated conservatively before surgical intervention is considered. Here at Three Rivers Orthopedic Associates, we have many highly qualified physicians who will evaluate you and try to help alleviate your hip pain. Call us at 412-782-3990 to schedule an appointment.

By Julia Grunebach PA-C