Hip Pain: Symptoms, Causes and Treatment

Hip pain is a common complaint that can affect people of all ages, from athletes to older adults. The hip joint plays a crucial role in mobility and stability, and when pain arises, it can have a significant impact on daily life. Understanding the symptoms, identifying the causes, and knowing the latest treatment options are essential for effective management and recovery. In this article, we’ll guide you through these key areas with evidence-based information and practical insights.

Symptoms of Hip Pain

Hip pain presents in various ways, depending on the underlying cause and the structures involved. Recognizing the type and location of pain, as well as associated symptoms, is the first step toward diagnosis and appropriate treatment.

Feature	Description	Typical Location	Source(s)
Pain	Aching, sharp, or burning discomfort	Groin, thigh, buttock, or lateral hip	1, 4
Stiffness	Decreased range of motion	Hip joint or surrounding area	4
Swelling	Inflammation or visible swelling	Around hip joint	7
Clicking/Locking	Sensation of hip catching or popping	Deep in hip, sometimes audible	1

Table 1: Key Symptoms of Hip Pain

Types of Hip Pain

Hip pain can be acute or chronic, and its nature often hints at its origin:

• Acute Pain: Typically due to injuries, strains, or fractures. The onset is sudden and may be linked to trauma or overuse.
• Chronic Pain: More commonly associated with degenerative conditions like osteoarthritis or repetitive stress injuries. The pain develops gradually and persists over time.

Location Matters

The exact location of pain gives important clues:

• Groin Pain: Often points to intra-articular issues such as labral tears or osteoarthritis.
• Lateral Hip Pain: More likely linked to extra-articular problems—e.g., trochanteric bursitis or gluteal tendon injuries.
• Buttock Pain: May signal problems with the sacroiliac joint, piriformis syndrome, or referred pain from the lower spine.

Associated Symptoms

Beyond pain, people may experience:

• Stiffness and Restricted Movement: Difficulty bending, walking, or rotating the hip joint is common, especially in arthritis or after injury 4.
• Swelling and Warmth: Suggests inflammation, which can result from surgery, trauma, or infection 7.
• Clicking, Locking, or Snapping Sensations: These mechanical symptoms may accompany labral tears, loose bodies, or specific tendon issues such as snapping hip syndrome 1.

When to Seek Medical Attention

Red flags include severe pain after trauma, inability to bear weight, visible deformity, fever, or sudden loss of hip function. These may indicate fractures, infections, or other urgent conditions.

Causes of Hip Pain

Hip pain has a broad differential diagnosis, encompassing both local joint problems and conditions that mimic hip disease. Understanding the underlying cause is essential for targeted treatment.

Cause	Mechanism / Description	Typical Age Group	Source(s)
Osteoarthritis	Degenerative cartilage loss	Middle-aged/elderly	2, 7
Labral Tears	Damage to the hip’s cartilage rim	Young adults	1
Femoroacetabular Impingement (FAI)	Abnormal bone shapes causing joint collision	Young/middle-aged	2
Bursitis	Inflammation of hip bursae	Adults	1
Tendonitis/Tendon Injury	Overuse or acute injury to hip tendons	Active adults	1

Table 2: Common Causes of Hip Pain

Intra-articular Causes

These originate within the hip joint:

• Osteoarthritis: The most prevalent cause, especially in older adults. It involves progressive cartilage wear, joint deformity, pain, and loss of function 2, 7.
• Labral Tears: The labrum is a cartilage rim that helps stabilize the hip. Tears may result from trauma, repetitive motion, or underlying morphologic abnormalities 1.
• Femoroacetabular Impingement (FAI): Characterized by abnormal contact between the femoral head and acetabulum. This repetitive impingement can cause soft tissue damage and increase the risk for osteoarthritis. Common in active young adults and athletes 2.
• Loose Bodies and Chondral Damage: Fragments within the joint or cartilage injuries can cause catching, locking, or mechanical symptoms 1.

Extra-articular Causes

These occur outside the joint itself, often involving soft tissues:

• Bursitis: Inflammation of the bursae (fluid-filled sacs) such as the greater trochanteric bursa, leading to lateral hip pain 1.
• Tendonitis and Gluteal Tendon Injury: Overuse, strain, or degeneration of tendons (e.g., iliopsoas or gluteal muscles) produces pain, especially with activity 1.
• Snapping Hip Syndrome: “Internal” (iliopsoas tendon) or “external” (iliotibial band) snapping can cause discomfort and audible hip noises 1.

Non-Articular and Mimicking Conditions

Sometimes, hip pain isn’t from the hip at all:

• Referred Pain from the Spine: Lumbar spine disorders like herniated discs can present as hip pain 4.
• Sacroiliac Joint Dysfunction: Causes buttock or posterior hip pain, often confused with hip joint pathology 1.
• Sports Hernias and Groin Injuries: Athletic pubalgia, adductor strains, and osteitis pubis can mimic hip pain but arise from the pelvic region 1.

Post-Surgical Causes

• Painful Total Hip Arthroplasty: Even after hip replacement, some patients experience persistent pain. Intrinsic causes (like implant issues) and extrinsic causes (like myofascial pain) need careful evaluation 3.

Treatment of Hip Pain

Managing hip pain requires a tailored approach based on the underlying cause, symptom severity, and individual patient factors. Treatment ranges from conservative measures to advanced interventions.

Treatment	Approach/Method	Key Considerations	Source(s)
Medications	NSAIDs, paracetamol, COX-2 inhibitors	First-line for pain relief	6, 5
Injections	Corticosteroids, PRP, hyaluronic acid	Mixed evidence for efficacy	8
Physical Therapy	Exercise, stretching, strengthening	Essential for most causes	1
Surgery	Arthroscopy, total hip arthroplasty	Reserved for severe cases	7, 3
Regional Analgesia	Nerve blocks, local infiltration	Used perioperatively	6, 5

Table 3: Approaches to Hip Pain Treatment

Conservative Management

Medications

• Non-steroidal Anti-inflammatory Drugs (NSAIDs), paracetamol, and selective COX-2 inhibitors are first-line agents for pain relief and inflammation control 6, 5.
• Opioids should be reserved as rescue medications due to risks of dependency and side effects. Recent protocols emphasize opioid-sparing regimens, which achieve similar pain control with lower opioid use, reducing the risk of adverse outcomes 9.

Intra-articular Injections

• Steroids, Hyaluronic Acid, Platelet-Rich Plasma (PRP): Used for osteoarthritis and some inflammatory conditions, but recent evidence suggests that none consistently outperform placebo (saline injection) for pain or function in hip osteoarthritis 8.
• Saline Injection: Surprisingly, studies show it may provide similar benefits to other injectable options, possibly due to the act of joint lavage or placebo effect 8.

Physical Therapy & Lifestyle Changes

• Exercise and Rehabilitation: Stretching, strengthening, and functional exercises are critical for recovery from most hip conditions. Individualized physical therapy can improve mobility, reduce pain, and prevent recurrence 1.
• Weight Management: Especially important for people with osteoarthritis, as reducing joint load can decrease pain and slow disease progression.

Advanced and Surgical Interventions

Hip Arthroscopy

• Indicated for labral tears, FAI, and some cases of loose bodies or chondral injuries. Minimally invasive, it allows for targeted repair 1.

Total Hip Arthroplasty (THA)

• Reserved for severe osteoarthritis or irreparable joint damage. Postoperative pain control is a key focus, with multi-modal regimens including NSAIDs, paracetamol, and regional analgesia. Newer protocols recommend using local infiltration analgesia, nerve blocks (fascia iliaca block), and limiting opioid use 6, 5, 9.

Adjunctive Therapies

• Photobiomodulation Therapy (PBMt): Low-level laser or light therapy may reduce post-surgical pain and inflammation, offering a novel adjunct to traditional pain management after THA 7.

Pain Management After Surgery

• Regional Techniques: Fascia iliaca block and local infiltration are recommended, especially when NSAIDs are contraindicated. Epidural or femoral nerve blocks are less favored due to side effects 6, 5.
• Opioid-Sparing Protocols: Proven to reduce opioid consumption while maintaining effective pain control and patient satisfaction 9.

Algorithmic and Multidisciplinary Approaches

• Algorithmic Management: Especially after hip arthroplasty, systematic evaluation to differentiate intrinsic from extrinsic causes helps guide therapy. Myofascial pain, for example, may benefit from referral to pain clinics if not resolved with orthopedic care 3.

Conclusion

Hip pain is a multifaceted problem with a wide array of causes, symptoms, and treatments. Understanding its complexities enables timely diagnosis and optimal care. Here’s a quick recap:

• Symptoms: Range from aching and stiffness to mechanical sensations like clicking or locking; location and associated signs offer diagnostic clues 1, 4, 7.
• Causes: Include intra-articular (osteoarthritis, FAI, labral tears), extra-articular (bursitis, tendonitis), and mimicking conditions (spine, pelvic pathologies); post-surgical pain requires careful assessment 1, 2, 3.
• Treatment: Spans medications, injections, physical therapy, and surgery. Evidence supports multi-modal, opioid-sparing regimens, with an individualized approach based on cause and patient needs 5, 6, 8, 9.

Key Takeaways:

• Hip pain can be complex—identify symptoms and location for better diagnosis.
• Causes are diverse, including joint, soft tissue, and referred sources.
• Treatment is tailored; start conservatively and escalate as needed.
• Recent advances favor multi-modal pain management and reduced opioid use.
• Always seek medical evaluation for severe, sudden, or persistent hip pain.

Staying informed empowers you to make the best decisions for your hip health and mobility.