One of the most common causes of hip pain is pain being referred from the lower back. This pain is most commonly felt in the buttock and can feel very specific to that area. The pain can also travel to the anterior thigh, further confusing the clinical picture. A thorough evaluation includes a detailed history to determine the onset of the problem and which activities make it better or worse. Examination helps to bring out the true pain generator to determine the source of the pain and also any underlying pattern of biomechanical dysfunction that may have contributed to its onset. Typically, the actual hip component of the examination is unremarkable, but can also be interrelated with the overall functional problem. Therefore, at times the treatment is focused solely on the lower back, and other times the treatment can involve the lower back and entire lower extremity.
Another common cause of pain in the hip region is Sacroiliitis. This involves irritation and pain with the sacroiliac joint of the pelvis. This large joint has ridge and groove structures within it that can become misaligned. When this occurs it may or may not cause pain, but will surely throw of the normal mechanical functioning of the region. When this joint does become irritated, pain can be felt in the buttock, inguinal region, or down the leg.
Pain can be experienced with standing, walking, sitting, and numerous other activities. Typically an isolated hip examination is unremarkable, but can also be interrelated with the overall functional problem. Pressure and stress applied specifically to the sacroiliac joint create significant pain and commonly the referral pattern can be reproduced. Determining that the sacroiliac joint is the pain generator is just the beginning. Then the clinician must determine what the true cause of that issue is, from poor postural and ergonomic habits, to inherent patterns of biomechanical dysfunction.
You will find a bursa anywhere a muscle, a tendon, or fascia (connective tissue) must cross over a bony prominence. A bursa is a fluid filled sac that counteracts the effects of friction. There are many common bursae throughout your body, but your body can also create one anywhere it deems necessary. These are referred to as adventitious bursae. These little wonders work well at keeping us in pain free motion as long as they don’t experience too much pressure. If a bursa begins to experience too much pressure, it will become inflamed and let you know about it through pain signals. Bursae don’t become inflamed for no reason. Therefore, simply treating the bursitis with medicine or an injection is completely illogical. If your doctor tells you that you have bursitis, you must ask them why.
The most common bursitis experienced in the hip is Greater Trochanteric Bursitis. This pain is noted on the lateral upper thigh at the level of the hip joint. It is typically very tender to direct pressure, therefore, people cannot lay on that side without pain. They also commonly experience pain with walking. However, other structures can create the same pain pattern, most commonly the lower back. As with other conditions, the answer may become clouded by overlapping issues. Consultation and examination will help to sort through the issues and determine the true cause of the problem.
A certain percentage of time, hip pain is actually coming from the hip joint. The most common cause of hip joint pain is from arthritis (Degenerative Joint Disease – DJD), but of course could also be related to an acute injury. Hip DJD can be linked to genetics, trauma, wear and tear, or a combination of these things. Hip joint pain is most commonly found in the buttock and inguinal region (front and back) of the associated hip. However, hip joint pain can also be referred all the way down to the knee, even mimicking knee joint pathology. Thorough consultation and examination should isolate the source of the pain, although other concomitant issues may overlap. Finding muscle imbalances and mechanical dysfunction associated with hip joint pathology is the rule rather than the exception. Correcting those functional issues through the proper forms of treatment can improve symptoms in even very advanced cases.