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Hip Pain - Causes, Symptoms, and Treatment

Hip pain

Hip pain is a relatively widespread symptom that can lead to significant impairments in the everyday life of those affected. Running, walking and standing are becoming increasingly difficult in view of the pain. These can be due to a wide variety of causes, of which hip joint arthrosis is one of the best known.

definition

Hip pain is painful discomfort in the area between the top of the thighbone and the top of the pelvis. The pain can occur directly in the hip joint or originate from the surrounding muscles, tendons, ligaments and nerves. The more general term “hip pain” must be distinguished from the more specific term “hip joint pain”.

Hip pain as a symptom

The symptoms can appear in very different forms depending on their causes. While many sufferers feel sharp, punctiform hip pain in the joint, especially when they are under strain and after sitting for a long time, others experience it as pulling pain that extends to the groin, thigh and sometimes even to the knee. Lower back pain and back pain may also occur in connection with the hip problems. Ultimately, the intensity and localization of the pain depends largely on the underlying disease.

Causes of Hip Pain

The possible causes range from congenital deformities to acute inflammation of the bursa and joints to neuralgia (nerve pain) and chronic muscle and joint diseases. Pelvic fractures, such as those following a serious fall or a traffic accident, can also trigger massive hip pain. Since this can be associated with life-threatening internal bleeding, medical help should be sought as soon as possible or an ambulance should be alerted.

Hip pain from joint disease

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

The most common is osteoarthritis of the hip joint. In the course of the disease, the cartilage layer of the acetabulum and the head of the femur is increasingly damaged. Under load, there is more and more deep-seated pain in the hip joint, which typically radiates into the groin area. Sometimes hip osteoarthritis is also associated with lower back pain and pain on the outside of the thigh. Under certain circumstances, those affected also suffer from impaired movement of the hip joint.

Inflammation of the hip joint or arthritis (for example reactive arthritis or rheumatoid arthritis) can also trigger the painful hip. These are usually associated with sharp, stress-independent pain in the joint. Usually swelling, warming and reddening of the joints are also noticeable, but this is not noticeable externally in arthritis of the hip joint.

In the worst case, the inflammation can 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 require prompt elimination, otherwise in the worst case there is a risk of blood poisoning.

Another joint disease that can lead to significant pain in the hip area is femoral head necrosis. In the course of the disease, parts of the head of the femur die off due to insufficient blood flow. This so-called aseptic bone necrosis leads not only to pain but also to significantly reduced mobility in the hip joint. If the bone continues to die, the joint is threatened with complete destruction.

When suffering from Perthes disease, which occurs as aseptic bone necrosis in children, hip pain that can extend to the knee is a typical symptom. In the course of the disease, the joint also takes considerable damage, which not only leads to impaired movement but also to a significantly increased risk of osteoarthritis in the further course of life. Adolescents are also at risk of adolescent femoral head solution, in which the top of the thigh bone becomes detached from the rest of the bone. If this is left untreated, femoral head necrosis is often the result.

The cause of the discomfort can be a collision of the thighbone with the acetabulum. In femoro-acetabular impingement, for example, the thighbones and the edge of the acetabulum clash when the person concerned bends forward. Shooting pain in the groin area is the result. These can also occur after long periods of sitting or during exertion such as cycling.

Cause of hip runny nose (Coxitis fugax)

The so-called hip runny nose usually affects children under the age of ten and describes an acute inflammation of the hip joint. The affected children suffer from sudden onset of joint pain and begin to hobble or refuse to move in the face of the pain. In addition, their hip rotation is significantly restricted. The runny nose gets its name because it is often seen following a viral infection of the respiratory tract. Some show after the cough, runny nose and hoarseness subsided, the children suddenly suffer from significant pain in the hip joint.

The relationship between the occurrence of coxitis fugax and the previous infectious diseases has not yet been conclusively clarified. However, it is known that the cold of the hip can also occur after an inflammation of the tonsils, 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.

Bursitis

If the surrounding bursa of the hip joint is inflamed, this also causes massive pain in the hip area. These begin here primarily during stress, but can move into a chronic stage, so that those affected suffer from them even when they are at rest.

The bursa in the area of ​​the greater trochanter (large rolling hillock; outer protrusion of the thigh bone) is usually affected. Here the tendons rub regularly over the protruding bone, which leads to what is known as trochanteric bursitis (inflammation of the hip bursitis). In addition to hip pain, buttock pain may also be noticed, as the tendon cords of the gluteal muscle also run over the great rolling mound. Bursitis can not only be caused mechanically, but in rare cases can also be due to a bacterial infection.

Irritation and overloading of the ligaments or tendons in the hip joint are also to be mentioned as triggers of the complaints. Often these are based on an anatomical deviation. For example, with the so-called “snapping hip” (medical coxa saltans), the muscle fascia of the thigh slides too close over the greater trochanter, which means that the fascia occasionally gets stuck and then jerks on. This leads to a clearly noticeable hip snap and in the long run can be associated with considerable pain in the hip.

Bone diseases

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

Furthermore, osteoporosis, as a bone disease, can cause pain, especially in older people. The decrease in bone density in 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) also usually affects older patients and causes them to develop uncontrolled new bone tissue. This bone remodeling is accompanied by inflammatory processes that manifest themselves as bone pain. The deformities of the bones can also press on the surrounding tissue and cause pain.

The so-called intraosseous ganglion is also to be mentioned as a possible trigger of the hip discomfort. Benign cysts form in the bone. If these develop in the area of ​​the pelvic socket, for example, severe pain can be felt in the hip joint. Under certain circumstances, however, the intraosseous ganglion is completely painless.

Neuralgia and other nerve impairments

The cause can be illnesses, bruises or pinching of the nerves. The resulting nerve pain (neuralgia) varies depending on the nerve tracts that are affected. If, for example, the lateral femoral cutaneous nerve, which arises from the lumbar plexus plexus in the lumbar and sacral spine, is pinched off at the level of the inguinal ligament, stabbing, burning pains will appear on the outside of the thigh - the area where the nerve is supplied.

Corresponding complaints are called meralgia paraesthetica. The causal nerve compression can be traced back to mechanical causes in many cases. For example, tight jeans can put a lot of pressure on the tissue, which constricts the nerve. A comparable effect is ascribed to seat belts here. After exiting the pelvis, the lateral femoral cutaneous nerve in the area of ​​the inguinal ligament is also increasingly pinched by an extreme increase in weight on the abdomen. Pregnancy can have the same effect. Excessive strength training, especially of the leg or thigh muscles and the abdominal muscles, is also a potential trigger of meralgia paraesthetica.

In addition to these mechanical causes, metabolic diseases such as diabetes occasionally lead to meralgia paresthetica. The pain on the outside of the thigh is often accompanied by other sensory disorders such as tingling or numbness. The symptoms are particularly evident when the hip joint remains stretched for a long time, such as when standing or lying down.

Piriformis syndrome also describes nerve compression that may be associated with hip pain. 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 severe pain in the buttocks that can reach the hips. Here, too, the main causes are mechanical impairments, for example from carrying the money bag in the back pocket, sitting for long periods of time and overloading when lifting heavy objects.

If the sciatic nerve is pinched in the area of ​​the spine, as is often the case with a herniated disc or so-called vertebral slipping (spondylitis), the pain from the back area can also radiate into the hips and legs.

Other causes of hip pain

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

Muscle diseases such as polymyalgia rheumatica should also be mentioned as potential causes. So-called muscle rheumatism is triggered by inflammatory processes in the vessels of the affected muscles and can be associated with considerable pain. The muscles of the shoulder are also often affected, so that in addition to hip problems, 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. Often the affected muscle groups are sensitive to pressure and as the disease progresses, which is still incurable, other general complaints such as chronic fatigue, dizziness, breathing difficulties or the regular feeling of a lump in the throat increase. Ringing in the ears can also be associated with fibromyalgia. In addition to muscle pain, those affected usually suffer from a variety of physical but also sometimes psychological complaints.

In addition to diseases of the muscles, bones, joints, ligaments and bursae, diseases of the cardiovascular system may also be responsible for hip pain. Above all, the so-called peripheral arterial occlusive disease (PAOD) should be mentioned here. Mostly this is due to hardening of the arteries, in the course of which narrowing and occlusions of the arteries can form. If the arteries supplying the legs are affected, this can lead to severe hip and leg pain.

Hip pain may also be a symptom of Bechterew's disease (ankylosing spondylitis). The chronic rheumatic disease mostly affects the joints of the lumbar and thoracic spine. They stiffen and start to hurt. Usually, after the onset of ankylosing spondylitis, the pain is initially temporary in the loin and buttock area. Then they go into a chronic stage and those affected suffer more 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 the patient is asked not only about the duration, intensity and localization of the hip pain, but also about hereditary diseases such as ankylosing spondylitis or Paget's disease. Palpation and movement tests provide additional information for making a diagnosis.

Symptoms in the hip joint can usually be diagnosed relatively clearly with the help of sonography (ultrasound). Other imaging methods, such as x-rays, computed tomography and magnetic resonance tomography, serve to secure the diagnosis in case of doubt. A blood test can also be used to determine whether there is inflammation and what may be causing it. In the case of nervous disorders, however, the interplay of the various complaints and the situations in which they occur are often the only clues for making a diagnosis.

Treatment for a sore hip

As different as the causes of the complaints are, in most cases the treatment is fundamentally similar. Pain relieving herbs form the basis. Physiotherapy, massages and possibly acupuncture follow. If no relief can be achieved with the help of this procedure, the only option in case of doubt is an operation. For example, destroyed hip joints can be replaced with a hip joint prosthesis. Benign and malignant tumors can be surgically removed, and surgery can also help with bursitis.

For the treatment of a painful hip or its cause, naturopathy primarily relies on manual therapies, such as from the field of osteopathy, Rolfing or chiropractic. In addition, traditional Chinese medicine (e.g. acupuncture) is of particular importance here.

Herbal medicinal ingredients, which are supposed to have an anti-inflammatory and pain-relieving effect, are also used. Schüssler salts and homeopathic remedies are also used against the pain. Naturopathic procedures are not a substitute for operations that may be necessary, but they can make a significant contribution to alleviating the symptoms of severe hip arthrosis, for example.

Which naturopathic treatment approaches are to be selected depends heavily on the respective symptoms or the cause. The selection should therefore only be made by experienced therapists. (fp)

Author and source information

This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.

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Important NOTE:
This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.