Hip Problems, Age 12 and Older

Overview

Hip pain can make it hard to walk, go up and down stairs, squat, or sleep on the side that hurts. A clicking or snapping feeling or sound around your hip joint (snapping hip) may bother you or cause you to worry. But if your hip isn't painful, in many cases the click or snap is nothing to worry about. Home treatment may be all that's needed for minor hip symptoms.

To better understand hip problems, it may be helpful to know how the hip works. It's the largest ball-and-socket joint in the body. The thigh bone (femur) fits tightly into a cup-shaped socket (acetabulum) in the pelvis. The hip joint is tighter and more stable than the shoulder joint, but it doesn't move as freely. The hip joint is held together by muscles in the buttock, groin, and spine; tendons; ligaments; and a joint capsule. Several fluid-filled sacs (bursae) cushion and lubricate the hip joint and let the tendons and muscles glide and move smoothly. The largest nerve in the body (sciatic nerve) passes through the pelvis into the leg.

Hip problems

Hip problems may develop from overuse, bone changes with age, tumours, infection, changes in the blood supply, or a problem that was present from birth (congenital). Oddly enough, a person who has a hip problem often feels pain in the knee or thigh instead of the hip. The type of hip pain you have may help your doctor find the cause of your pain.

• Pain when resting doesn't get worse with motion or standing. This type of pain is usually caused by a less severe problem, unless the pain doesn't go away or it awakens you from sleep.
• Pain with movement gets worse when you move the hip or leg, but not when you stand or bear weight. This type of pain is most often caused by a muscle injury, inflammation, or infection.
• Pain with weight-bearing gets worse when you stand or walk. It may cause you to limp. This type of pain usually means that you have a problem with the hip joint itself. Pain that's severe enough to prevent any weight-bearing is more likely to mean a serious bone or joint problem.

You may have pelvic, groin, thigh, or knee pain (referred pain) along with a sore, painful, or tender hip. Hip pain can have many causes.

• Snapping pain on the outside of the hip and sometimes the knee may be caused by iliotibial band syndrome. The iliotibial band is a band of fibrous tissue that runs down the outside of the thigh. The band may overdevelop, tighten, and rub across the hip bone or the outer part of the knee.
• Pain in the hip, thigh, or knee of an older child or teen may be caused by conditions such as slipped capital femoral epiphysis, in which the upper end of the thigh bone (femur) slips at the growth plate (epiphysis), or Legg-Calve-Perthes disease.
• Pain that's worse in the morning and improves during the day may be caused by bones rubbing together. This can happen with osteoarthritis, rheumatoid arthritis, and lupus.
• Pain may be a sign of inflammation of the large sac that separates the hip bones from the muscles and tendons of the thighs and buttocks (trochanteric bursitis).
• Pain can occur with signs of infection in a joint (septic arthritis), bursa (septic bursitis), or bone (osteomyelitis).
• Pain and stiffness in the hip may be caused by lack of blood flow to the hip joint (avascular necrosis). You may also have pain in the knee.
• Pain that shoots down the leg from the hip or lower back may be caused by an irritated or pinched nerve (sciatica).
• Pain with weight-bearing that gets worse over several months may be caused by transient osteoporosis. This is more common in middle-aged men. But it also can affect women in the later part of pregnancy (third trimester). Osteoporosis related to pregnancy usually goes away on its own within a year after the baby is born.
• Some types of bone cancer (osteosarcomas) and the spread of cancer to the bone (metastatic disease) can cause bone pain.

Treatment may include first aid and using a brace, cast, harness, or traction. It may also include physiotherapy and medicines. In some cases, surgery is needed. Treatment for a hip problem depends on:

• The location and type of injury, and how bad it is.
• Your age, general health, and activities (such as work, sports, hobbies).

Self-Care

Try the following tips to help relieve hip pain, swelling, and stiffness.

• Rest.

  Try to rest and protect the affected area. Stop, change, or take a break from any activity that may be causing your pain or soreness.

• Sleep on the side that doesn't have the problem.

  Put a pillow between your knees. Or sleep on your back with pillows under your knees.

• Avoid things that might increase swelling.

  For 48 hours, avoid things that might increase swelling. These things include hot showers, hot tubs, hot packs, and drinks that contain alcohol.

• Apply heat.
  • After 2 or 3 days, you can try applying heat to the area that hurts. Types of heat therapy include microwavable packs and disposable heating patches.
  • Apply heat for 10 to 20 minutes at a time.
  • You might also try switching between cold and heat.
• Start normal activities and gentle stretching.

  After 48 to 72 hours, if swelling is gone, you can carefully start doing normal activities and gentle stretching, such as:

  • Prone buttocks squeeze. This strengthens the buttocks muscles. It supports your back and helps you lift with your legs.
  • Pelvic tilts. These stretch the lower back.
  • Hamstring stretch. It stretches the muscles in the back of the thigh.
  • Hip flexor stretch. It stretches the muscles in the hip that help the hip glide and work smoothly.
• Rub the area.

  Gently massage or rub your hip to relieve pain and encourage blood flow. Don't massage the affected area if it causes pain.

• Don't smoke or use other tobacco products.

  Smoking slows healing because it decreases blood supply and delays tissue repair.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• New pain or swelling.
• New signs of infection, such as redness, warmth, or a fever.
• New numbness, tingling, or weakness.
• New pale, white, blue, or cold skin.
• Trouble bearing weight on the hip.
• Symptoms occur more often or are more severe.

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