Hip pain - causes, symptoms and treatment

Pain on the hip

Hip pain is a relatively widespread complaint that can lead to significant impairment in the daily lives of those affected. Running, walking and standing are becoming increasingly difficult in the face of the pain. These can be due to a variety of causes, of which the hip joint arthrosis is one of the best known.

contents

• Pain on the hip
• definition
• Hip pain as a symptom
• Causes of pain in the hip
• Hip pain due to joint diseases
• Cause hip flu (coxitis fugax)
• Housemaid's knee
• bone diseases
• Neuralgia and other impairments of the nerves
• Other causes of hip pain
• diagnosis
• Treatment for aching hips

definition

Pain on the hip indicates painful discomfort in the area between the upper end of the femur and the upper edge of the pelvis. The pain can occur directly in the hip joint or emanate from the surrounding muscles, tendons, ligaments and nerves. The more general term "hip pain" is to be distinguished from the more specific term "hip joint pain".

Pain on the hip can lead to massive restrictions in everyday life. (Image: twinsterphoto / fotolia.com)

Hip pain as a symptom

The symptoms can be very different depending on their causes. While many sufferers feel particularly in the joint under stress and after sitting for a long time stinging pointy hip pain, in others they show as pulling pain, which reaches into the groin, in the thigh and sometimes even up to the knee. Lower back pain and back pain may also be associated with hip discomfort. Ultimately, the intensity and localization of the pain depends significantly on the underlying diseases.

Causes of pain in the hip

The possible causes range from congenital malocclusion, acute inflammation of the bursa and joints to neuralgia (nerve pain) and chronic muscle and joint diseases. Also, fractures of the pelvis, such as after a serious fall or traffic accident can be the cause of massive hip pain. Since these may be associated with life-threatening internal bleeding, medical help should be called in as quickly as possible or an ambulance should be alerted.

Hip pain due to joint diseases

Various diseases of the hip joints can lead to problems in the hip area. The joint is formed from the upper end of the femur (femur), the so-called femoral head (caput femoris), and the acetabulum of the pelvis (pelvis). Different diseases can result in impaired joint function and pain.

The most common is osteoarthritis of the hip. In the course of the disease, the cartilaginous layer of the acetabulum and the femur head is increasingly damaged. Under stress, there is an increase in low-lying pain in the hip joint, which typically radiates into the groin. Occasionally hip osteoarthrosis is also associated with back pain and pain on the outside of the thigh. Under certain circumstances sufferers also suffer from a movement impairment of the hip joint.

An inflammation of the hip joint or an arthritis (for example, reactive arthritis or chronic polyarthritis) may also trigger the painful hip. These are usually associated with sharp, stress-independent pain in the joint. Usually swelling, warming and redness of the joints is recognizable, which is externally imperceptible in arthritis of the hip joint.

The inflammation can in the worst case lead to irreversible damage to the joint. The disease is usually the result of mechanical stress, metabolic diseases (gouty arthritis) or bacterial infection. The latter urgently need a timely elimination, otherwise at worst a blood poisoning threatens.

Another joint disease that can cause significant hip pain is femoral head necrosis. In the course of the disease, parts of the femur head die due to insufficient blood flow. This so-called aseptic bone necrosis leads in addition to the pain to a significantly reduced mobility in the hip joint. If the death of the bone progresses, a complete destruction of the joint threatens.

In a disease of Perthes disease, which occurs as aseptic bone necrosis in children, hip pain that can radiate to the knee, a typical symptom. In the course of the disease, the joint here also takes considerable damage, which not only leads to movement impairments but also to a significantly increased risk of osteoarthritis in the further life course. In adolescents, there is also the risk of a young hip-joint solution, in which the upper end of the femur separates from the remaining bone. If left untreated, often a femoral head necrosis is the result.

Hip pain can indicate serious impairment of the hip joint. (Image: WavebreakMediaMicro / fotolia.com)

Cause of the discomfort may be a collision of the femur with the acetabulum. For example, in Femoro-Acetabular Impingement, the thighbone and the edge of the acetabulum converge when the individuals bend forward. Stinging pain in the groin are the result. These can also occur after a long sitting or under stress, such as when cycling.

Cause hip flu (coxitis fugax)

The so-called Hüftschnupfen usually affects children under the age of ten years and describes an acute inflammation of the hip joint. The affected children suffer from sudden onset of joint pain and begin to limp in the face of pain or deny any movement. In addition, her hip rotation is clearly limited. The hip fever bears its name because it is often observed following a viral infection of the respiratory tract. Some signs of coughing, runny nose and hoarseness suddenly show significant pain in the hip joint.

The connection between the occurrence of coxitis fugax and the previous infectious diseases has not yet been conclusively clarified. However, it is known that the hip flu can also occur following an tonsillitis, otitis media or an infection of the gastrointestinal tract. As a rule, the inflammatory disease is over after a maximum of two weeks. Until then, the children should take care of themselves and their hips.

Housemaid's knee

If the surrounding bursa of the hip joint is inflamed, it also causes massive pain in the hip area. These are primarily used during exercise, but can go into a chronic state, so that sufferers suffer from them even when at rest.

The bursa is usually infested in the region of the greater trochanter (large hillock, outer protrusion of the thighbone). Here, the tendons rub regularly over the bone protrusion, which leads to a so-called bursitis trochanterica (bursitis of the hip). In addition to the hip pain, buttocks pain may also be noted, as the tendon cords of the large buttock muscle also run over the large rolling hill. Bursitis can be caused not only mechanically, but in rare cases also due to a bacterial infection.

Irritation and overloading of the ligaments or tendons in the hip joint are also to be named as triggers of the complaints. Often these are based on an anatomical deviation. For example, in the so-called "snapping hips" (medical Coxa saltans), the muscle fascia of the thigh glides too close to the greater trochanter, which causes the fascia to hang occasionally and then to jerk away. This results in a noticeable hip snap and can be associated with significant pain in the hip over time.

bone diseases

A disease of the bone system that may be associated with hip pain is osteomalacia. The insufficient mineralization leads to a softening of the bones, which brings lasting damage to the skeletal system and sometimes severe bone pain. The pain can also occur in the area of ​​the hip. The most common cause of the disease is a vitamin D deficiency, but hereditary diseases of the bone metabolism are known to be the cause of bone softening. In children, the clinical picture of osteomalacia is called rickets.

Furthermore, osteoporosis as a bone disease, especially in the elderly may trigger the pain. The decreasing bone density during the course of the disease also results in an increased susceptibility to fractures in the hip area. As a disease of the skeletal system, Paget's disease (Osteodystrophia deformans) usually also affects elderly patients and causes uncontrolled neoplasm of bone tissue. This bone remodeling is accompanied by inflammatory processes that manifest as bone pain. Also, the deformations of the bones can press on the surrounding tissue and cause pain.

In osteoporosis, bones lose their strength and break more easily. (Image: crevis / fotolia.com)

The so-called intraosseous ganglion is also to be mentioned as a possible cause of hip discomfort. Benign cysts form in the bone. If these arise, for example, in the pelvic area, severe pain in the hip can be felt. However, the intraosseous ganglion may be completely painless.

Neuralgia and other impairments of the nerves

Cause can be diseases, bruises or entrapment of the nerves. The occurring nerve pain (neuralgia) vary depending on the nerve tracts affected. If, for example, the lateral cutaneous nerve, which arises from the plexus of the lumbar plexus in the region of the lumbar and cerebral spinal column, is clamped at the level of the inguinal ligament, stinging, burning pains appear on the outside of the thigh - the supply area of ​​the nerve.

Corresponding complaints are referred to as Meralgia paraesthetica. The causative nerve compression is in many cases due to mechanical causes. For example, tight jeans can cause a high pressure on the tissue, which causes a constriction of the nerve. Seat belts here is attributed a comparable effect. After exiting the pelvis, the lateral cutaneous nerve in the area of ​​the inguinal ligament is increasingly pinched by an extreme increase in weight on the abdomen. A pregnancy can have the same effect. Excessive strength training, especially of the leg or thigh muscles and abdominal muscles, is also considered a potential trigger of the Meralgia paraesthetica.

In addition to these mechanical causes occasionally metabolic diseases such as diabetes lead to a Meralgia parästhetica. The pain on the outside of the thigh is often accompanied by other sensory disturbances such as tingling or numbness in the disease. The symptoms show up especially when the hip joint remains stretched for a long time, such as standing or lying down.

Piriformis syndrome also describes nerve compression, which may be associated with hip pain. Here, the sciatic nerve (sciatic nerve) is narrowed at the level of the passage between the pelvic bone and the piriformis muscle. This is usually associated with strong buttocks pain that can drag to the hip. The main causes here are also mechanical impairments, for example, by carrying the purse in the back pocket, sitting for a long time and overloading when lifting heavy objects.

If the sciatic nerve is pinched in the area of ​​the spine, as is the case more frequently in a herniated disc or so-called spondylitis, the pain from the back area can also radiate to the hips and legs.

If the sciatic nerve is caught in a herniated disc, the pain often radiates to the hip. (Image: Robert Kneschke / fotolia.com)

Other causes of hip pain

In addition to the causes already described, benign and malignant tumors in the hip area are generally considered triggers. Above all, abscesses, cysts and cancers are to be considered. For example, Paget's disease can rarely turn into bone cancer (osteosarcoma). But even with bladder cancer and cervical cancer, the affected may feel a kind of hip pain.

Furthermore, muscle diseases such as polymyalgia rheumatica are to be mentioned as potential causes. The so-called muscle rheumatism is triggered by inflammatory processes in the vessels of the affected muscles and can be associated with considerable pain. Frequently, the muscles of the shoulder are affected, so that in addition to the hip symptoms many patients also suffer from shoulder pain.

The so-called fibromyalgia also affects the muscles. It is associated with spontaneous muscle pain that can occur in different parts of the body. Frequently, the affected muscle groups react sensitively to pressure, and with the progress of the disease, which is still incurable, more and more general complaints, such as chronic fatigue, dizziness, respiratory problems or the regular feeling of a lump in the throat, are increasingly being added. Otolaryngology can also be associated with fibromyalgia. In addition to the muscle pain, sufferers usually suffer from a large number of physical but also psychological symptoms.

In addition to the diseases of the muscles, bones, joints, ligaments and bursae may also be diseases of the cardiovascular system responsible for the hip pain. First and foremost here is the so-called peripheral arterial disease (PAD). This usually goes back to an arteriosclerosis, in the course of which can form constrictions and occlusions of the arteries. If the supplying arteries of the legs are affected, this can lead to considerable hip and leg pain.

Hip pain may also be a symptom of ankylosing spondylitis syndrome (ankylosing spondylitis). The chronic rheumatic disease usually affects the joints of the lumbar and thoracic spine. They stiffen and begin to hurt. Normally, the pain after the onset of ankylosing spondylitis is initially limited in time to the lumbar and buttocks. Subsequently, they go into a chronic stage and sufferers increasingly suffer from painful inflammation of the joints and tendon attachments. In addition, there is an increasing loss of mobility in the lumbar and thoracic spine.

diagnosis

At the beginning of the diagnosis, a detailed anamnesis is required, in which patients are asked not only about the duration, intensity and localization of hip pain, but also about hereditary diseases such as ankylosing spondylitis or Paget's disease. Through palpation and movement tests, further indications for the diagnosis can be obtained.

Complaints in the hip joint can usually be diagnosed relatively clearly with the help of sonography (ultrasound). Other imaging procedures, such as X-rays, computed tomography and magnetic resonance imaging are used in case of doubt to secure the diagnosis. A blood test can also determine if any inflammation is present and what causes it. In the case of nervous disorders, however, the interplay of the various complaints and the situations in which these occurrences are the only clues for the diagnosis often provide.

In the treatment of hip problems, massages and physiotherapy are often used. (Image: WavebreakmediaMicro / fotolia.com)

Treatment for aching hips

As different as the causes of the symptoms may be, treatment is basically similar in most cases. Pain-relieving remedies form the basis. This is followed by physiotherapy, massages and possibly acupuncture. If no relief can be achieved with the help of this procedure, there is only the possibility of surgery in case of doubt. For example, destroyed hip joints can be replaced by a hip joint prosthesis. Benign and malignant tumors can be surgically removed and surgery can also be helpful in bursitis.

In the treatment of a sore hip or its cause, naturopathy relies above all on manual therapies, for example in the field of osteopathy, Rolfing or chiropractic. In addition, traditional Chinese medicine (eg acupuncture) has a special significance here.

Herbal medicines, which are said to have an anti-inflammatory and analgesic effect, are used concomitantly. Also Schüssler salts and homeopathic remedies are used against the pain. Although naturopathic procedures are not a substitute for surgery that may be required, they can significantly help alleviate the symptoms of severe hip arthrosis, for example.

Which naturopathic treatment approaches are to be selected depends strongly on the respective symptoms or the cause. The selection should therefore be made exclusively by experienced therapists. (fp, last updated on 22.2.2018)