Chronic hip pain is a common condition we see in the clinic. In general, this condition can be managed with manual therapy, stretching and strengthening exercises and lifestyle modifications.
However, when ignored or left unattended, chronic hip pain can result in significant pain and disability.
In cases of chronic hip pain due to osteoarthritis of the hip joint, with further deterioration of the joint and cartilage over time, the hip muscles become weaker and hip mobility becomes more limited.
A study reported more than 220,000 total hip replacement surgeries for osteoarthritis were performed in hospitals from 2003 to 2013 in Australia.
While surgery is the only option in some of those cases, what you do not hear is the other side of the story: For most parts chronic hip pain can be managed WITHOUT the need for surgery.
Chronic hip pain is generally developed over a long period of time. However, with appropriate interventions, we can treat, prevent or minimise the negative effects of chronic hip pain.
Before we talk about how we can achieve that, let us talk about what is the hip joint.
The Hip Joint
As the joint connecting our legs to our pelvis and spine, the hip has many important functions.
The hip joint is formed between the femur and the pelvis. This mobile ball-and-socket joint gives our legs the ability to move in all planes of movement.
Being one of the most flexible joints in the body, the hip depends on ligaments, tendons, muscles and connective tissue to form the joint capsule and give it stability and strength throughout its range of motion.
In some cases these structures can extend up to the lumbar spine (the hip flexors/iliopsoas) and to the knee joint (via the iliotibial band)!
This amazing joint is what allows us to do activities such as:
Despite all these remarkable capabilities, we physiotherapists still see those plagued by chronic hip pain.
What causes our hips to give us so much grief?
Types of Chronic Hip Pain
While osteoarthritis is one of the most common types of chronic hip pain, there are other reasons why our hips can hurt!
Some other potential diagnoses of chronic hip pain include:
Barring actual trauma or injuries to the hip, most of those conditions above generally share one common causal factor: Faulty movement patterns and excessive loading of the joint.
This means that those who have chronic hip pain from one of the conditions above will tend to avoid those movements or limit their physical activity.
But what happens when you stop using certain parts of your body?
You guessed it!
They may become weaker and subsequently more painful!
What happens when your muscles are spasming due to pain?
You guessed it again: Your hips feel stiffer and your mobility becomes more limited!
Debunking Misconceptions About Chronic Hip Pain
Other than movement mechanics, there are other potential factors that can result in chronic hip pain. These include:
- Body Weight
- Hip Muscular Strength
- Physical Activity Levels and Type
- Sleep Quality
- Mood and Psychological Health
However, these factors often result in misconceptions that are not only wrong but potentially negative in managing chronic hip pain. Let us take a look at some of them briefly.
1. Debunked: Imaging Results Explain Chronic Hip Pain
Getting an x-ray or MRI of the hip has become a common practice for those seeking help from chronic hip pain.
While medical imaging is helpful for confirming diagnosis from clinical assessments, a pure x-ray or MRI alone is insufficient in giving the whole picture.
That is because in many pain-free hips, you can still find signs of labral tears, reduced cartilage thickness and arthritis!
Furthermore, most of the time chronic hip pain is caused by how you move: Something a stationary image cannot properly demonstrate.
2. Debunked: Chronic Hip Pain Is Due to Aging
This is a common misconception and understandably so. After all, one in five persons over 60 years old are affected by chronic hip pain.
With age generally comes decrease in physical activity levels, strength, recovery and healing rates.
While this does not directly cause hip pain, this means our bodies are less capable of coping with incorrect movement mechanics.
The silver lining is if you learn how to move well, your hips will remain happy and pain-free longer!
3. Debunked: Physical Activity Causes Chronic Hip Pain
Oftentimes, people with chronic hip pain are told to avoid painful physical activity and exercise as that makes their pain worse and damages their joints.
This cannot be further from the truth.
Countless research studies have demonstrated the effectiveness of exercise in treating chronic hip pain. Of course, the exercise intensity must be within your physical capacity and with proper technique.
Exercise is also effective at managing a major contributor to hip osteoarthritis: Being overweight or obese!
4. Debunked: Surgery and Injections Are The Only Options For Chronic Hip Pain
If that was true, then we physiotherapists would be out of jobs!
Surgical management has its benefits. For example, if you have a debilitating hip labral tear, a keyhole surgery can give you much relief.
Similarly, cortisone injections can be effective at temporarily reducing pain from inflammation in the joint or tendons.
However, if your chronic hip pain is also caused by how you move, you can get benefits with appropriate manual therapy and exercise rehabilitation.
In fact, we physiotherapists often work hand-in-hand with doctors and surgeons to improve the hip mobility and strength of our patients with or without surgery!
Our Tips for Managing Chronic Hip Pain
Tip 1: Have A Balanced Diet
This one sounds straightforward but there is more to it than just ‘not over-eating’.
A balanced diet can help manage weight gain, which has been listed as a major contributor to chronic hip pain and osteoarthritis.
However, there are other benefits to your hip joints from having a balanced diet.
For example, sufficient calcium intake helps ensure proper bone health while monitoring your sugar consumption can prevent excessive inflammation.
Your body also requires adequate protein levels from food to repair and rebuild muscles, tendons and ligaments after you exercise.
Besides, having a balanced diet also keeps you physically and mentally healthier so it benefits more than just your hips!
Tip 2: Get Good Quality Sleep
Sleep is an important part of tissue healing and recovery.
However, for those with chronic hip pain, getting into a comfortable sleeping position can be tricky!
For side-sleepers, a pillow (or two) between your knees when you sleep is especially helpful if you have wider hips.
As for back sleepers, you can place a pillow under your knees while tummy sleepers can put a pillow under their belly!
Getting good quality sleep is more than just for the body: It improves your mood and mental energy levels.
This is important as negative mood and fatigue are proven to increase pain in the body, including the hips!
Tip 3: Avoid Sitting All Day
Right now, I am sitting in a chair while I type this blog.
However, every 30 minutes or so, I stand up to pace about, do a few squats or practice my Tai Chi form before sitting down to write again.
This is important for preventing chronic hip pain. When we sit, our hips are compressed, preventing joint fluids from accessing the joint spaces to provide nourishment and lubrication to the cartilage and bone.
Also, limiting sitting duration is not only beneficial for hip health, it reduces the risk of chronic diseases too!
So why not stand up now and get on with a few squats before reading the final tip?
Tip 4: Exercise is Medicine For the Hips
Of course, what is a physiotherapy blog article without talking about exercise?
The key to exercising with chronic hip pain is moderation. For our hips to function properly, we need appropriate strengthening, mobility and flexibility.
You can start off with walking up and down your living room or doing a few sit-to-stand exercises each day. The body takes time to adapt to exercise and it is harder when your hips are sore.
As your hips get stronger and your capacity to exercise increases, you can have a nice stroll outdoors and even consider joining an exercise group or class!
Exercise is not only great for your hips; it improves physical and mental health and reduces body weight!
Check out our Restore, Rebuild and Refine classes run in the clinic – all involve progressive strength and conditioning of the hip muscles.
de Oliveira, B. I., Smith, A. J., O’Sullivan, P. P., Haebich, S., Fick, D., Khan, R., & Bunzli, S. (2020). ‘My hip is damaged’: a qualitative investigation of people seeking care for persistent hip pain. British Journal of Sports Medicine, 54(14), 858-865.
Ackerman, I. N., Bohensky, M. A., Zomer, E., Tacey, M., Gorelik, A., Brand, C. A., & De Steiger, R. (2019). The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC musculoskeletal disorders, 20(1), 1-10.
Dunstan, D. W., Howard, B., Healy, G. N., & Owen, N. (2012). Too much sitting–a health hazard. Diabetes research and clinical practice, 97(3), 368-376.