Hip problems

• Why do I have Hip pain?
   
• How can I help myself?
   
• I have just injured myself …
   
• I have had a problem for over 3 months that is not getting better …
   
• When should I seek medical attention?
   
• What treatments are available?
   
• How do I get help?
   
• Helpful Links
   
• Videos
   

The hip joint is a ball-and-socket joint formed between the pelvic bone (acetabulum) and the top of the thigh bone (head of the femur). The joint is designed to be strong and stable to withstand the weight of the body, which it does with the help of many tough ligaments and a joint capsule. Surrounding this is a powerful set of muscles which assist with movement. There are many muscle involved with movement around the hip, but some of the main groups include the gluteals (maximus, medius and minimus), hamstrings, adductors, Iliopsoas, and rectus femoris to name but a few.

Hyaline cartilage lines both the acetabulum and the head of the femur, providing a smooth surface for the moving bones to glide past each other. Surrounding the socket is another type of cartilage called the labrum. The role of the labrum is to deepen the socket and provide a seal around the ball and socket joint allowing the joint fluid to act as a shock absorber.

 

►	Why do I have Hip pain?

Hip pain can be caused by a number of structures around the hip. An understanding of the location of pain, the aggravating movements and the time of onset of the symptoms can help make a diagnosis. Pain can be present as the result of trauma leading to damage to one of the numerous structures around the hip; however this is not always the case. Pain can be present in the absence of structural damage and can be termed persistent pain.

As there are a number of possible causes of hip pain, a thorough examination by a healthcare professional may be required to make an accurate diagnosis.

 

►	How can I help myself?

There are a number of things that you can do to help manage your pain before seeking help from a medical professional. Below are some ways that you may wish to try to help manage your knee pain.

 

I have just injured myself …

If you have suffered an acute hip injury you may be suffering with pain, swelling and bruising. In this instance the advice of choice used to be R.I.C.E. (Rest, Ice, Compression, and Elevate)

More recently, the R-part (rest) has been debated, as completely resting an injury can actually make things worse – often the best plan is to rest immediately, but then to re-start gradual movement again. A newer acronym has been designed to better advise you … P.O.L.I.C.E:

• Protection makes us think differently about the injured area – it makes us think that we need to avoid damaging it anymore, but it doesn’t make us think that it has to be wrapped up and immobilised indefinitely. Avoiding or limiting painful activities such as standing, walking (commuting/ shopping/gardening/house work), driving and stairs initially with a gradual return to…
  
   
• Optimal Loading means working out what you can do, without injuring yourself any more – certain types of movements are often ok – so long as you don’t twist, for example. These non-damaging movements are known as optimal loading. Keeping tissues moving allows proteins and hormones to be released which actually promote faster healing.
  
   
• Ice – Using a cold pack around the area of pain and swelling can help manage your symptoms.
  
   
• Compression – Using a Neoprene sports bandage can help manage the swelling.
  
   
• Elevation – when resting, keeping the leg supported but elevated so the foot is above the groin level can help manage the swelling.
  
   

It may be appropriate to manage your symptoms with appropriate pain relief. You can discuss what medication is most appropriate for you with a pharmacist at your local pharmacy. If these medications do not provide adequate relief then you may need to see a GP to discuss prescription pain medications.

 

I have had a problem for over 3 months that is not getting better …

If symptoms persist for more than 3 months this still does not mean that there is damage to the structures in the hip. We know that there are a number of reasons as to why pain can persist for longer than three months without structural damage. If this is the case then there are ways to manage the symptoms:

• Commence gentle exercise – this could be specific for the leg or general cardiovascular exercise. The NHS recommends 150 minutes of moderate aerobic exercise and 2 to 3 days of strengthening exercise per week for people between the ages of 19 and 64 years of age. Muscles and joints need regular movement to remain healthy.
  
   
• Pain medication – Pharmacists at a local pharmacy will be able to advise you on over the counter pain medications that will be most appropriate to you. If these do not provide adequate relief then you may need to speak with a GP to discuss prescription medications.
  
   

 

►	When should I seek medical attention?

If you have sustained a trauma to the hip which is accompanied by inability to put your body weight through the hip in standing, high levels of pain and a reduced ability to move the hip then the injury may warrant further investigations and a trip to the local walk-in-centre or A & E may be required.

If hip pain and restriction of activities of daily living continue to be problematic then a review with your local general practitioner may be required to discuss future management options.

 

►	What treatments are available?

Often the first line of treatment is through self-help – (see section How can I help myself? For more details)

Medical treatment will vary depending on your symptoms and likely diagnosis. Often your general practitioner will refer you directly to physiotherapy where exercise therapy, manual therapy and advice may be of benefit.

Occasionally a review with an Extended Scope Practitioner or Orthopaedic Consultant is required which may lead to further treatment options such as Injections or surgery.

 

►	How do I get help?

If you wish to seek further advice and help in the diagnosis and management of your hip pain then you will need to make an appointment to see your GP. Your GP can then make a decision with you about what would be the next steps going forward in managing your pain. At this time your GP may consider sending you for investigations including x-ray, or they may wish to refer you to the Surrey Integrated Musculoskeletal service at Ashford & St Peter’s Hospitals, or to a physiotherapist.

 

►	Helpful Links

There are a number of websites that you may find useful regarding taking care of your hips:

 

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Videos

Patient Decision Aid: Hip Replacement

• View the Decision Aid