Front hip pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Hip-related pain is not always felt directly over the hip. Instead, you may feel it in the middle of your thigh. You may feel it in the front of the hip or the front of the thigh. Similarly, pain you feel in the hip may actually reflect a problem in your back, rather than your hip itself.

Hip pain may be associated with the following:

• Pain along the lateral (outside) of the hip
• Pain when ascending stairs and/or getting up from a seated position
• Pain associated with standing for long periods or for sitting for extended periods
• May have trouble sleeping
• May have limited range of motion of the hip


A common cause of pain in the front of the hip is hip flexor strain . This is characterized by:

• Overload or overuse of the muscle in front of thigh and hip such as climbing stairs, marching or uphill running
• There may be a limp and shortened stride
• Mechanical imbalance in lower extremity


Hip pain can be brought about by excessive pronation

• Pronation (a flattening of the arch) is a normal movement of the foot that helps the body to absorb shock and to adapt to different ground surfaces
• In analyzing ones gait, first contact is on the heel and outside of the foot; followed by a shift of body weight continuing forward, toward the arch and toes.
• If the foot is weak or tired and/or the footwear is not supportive, then the arch can flatten more than normal, which is excessive pronation.
• If the pronation becomes excessive, there is increased rotation of the leg, knee, thigh and hip, causing added stresses to the joint.
Flattening of the arch too much (excessive pronation) places pressure on the arch, and on up the chain including the ankle, knee and hip.

Contributing factors to the development of hip pain are:

• Poor flexibility
• Muscle imbalances
• Leg length discrepancies
• Tightness of IT Band/Tensor Fascia Latae
• Flattened pronated feet
• Poor support of shoes you wear and /or the support inside the shoes can add to the stress on the foot and lower extremity
• Biomechanical changes in the foot can allow increases in pronation
• Many foot injuries are caused by overpronation

Two common and concerning causes of front hip pain are fractures and insufficient blood flow to the hip (aseptic necrosis).

A hip fracture can change the quality of your life significantly. Fewer than 50% of those with a hip fracture return to their former level of activity. In addition, while recovering from a hip fracture, several possible complications can be life-threatening. These include pneumonia and a blood clot in the leg, which can dislodge and cause a clot in the lungs. Both are due to immobility following a hip fracture and hip surgery.

Hip fractures become more common as people age because falls are more likely and bones become less dense. People with osteoporosis can get a fracture from simple, everyday activities, not just a dramatic fall or injury.

Aseptic necrosis can happen if you have been on steroids for a long time or you have sickle cell anemia. Regular use of alcohol and injury also increase your risk.

Legg-Calve-Perthes disease is a type of aseptic necrosis that happens in children.

Other possible causes of hip pain include:

• Arthritis -- often felt in the front part of your thigh or hip.
• Trochanteric bursitis -- inflammation of the bursa that sits on the outside of your hip joint. This hurts when you get up from a chair, walk, climb stairs, and drive.
• Tendinitis from repetitive or strenuous activity.
• Strain or sprain.
• Low back pain such as sciatica.
• Infection.

Tips on how to deal with the pain

• Try to avoid activities that aggravate the pain.
• Take over-the-counter pain medication, like ibuprofen or acetaminophen.
• Sleep on your non-painful side with a pillow between your legs.

A hip fracture is considered a medical emergency. Therefore, if suspected, you should be seen right away.

As the pain improves, gradually begin to exercise. It is best to work with a physical therapist to learn proper exercises and how to advance your activity. Swimming may be a good option because it stretches the muscles and builds good muscle tone without straining your hip joint. However, swimming does not build bone mass. When you are ready (a physical therapist can help determine that), slowly and carefully resume walking or another activity against the resistance of gravity.

Go to a hospital or call 911 if:

• Your hip pain is caused by a fall or other injury.
• Your hip is misshapen, badly bruised, or bleeding.
• You are unable to move your hip or bear any weight.

Call your doctor if:

• Your hip is still painful after 1 week of home treatment.
• You also have a fever or rash.
• You have sudden hip pain, plus sickle cell anemia or long-term steroid use.
• You have pain in both hips or other joints.


Your doctor will perform a physical examination, with careful attention to your hips, thighs, back, and gait.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Do you have pain in one or both hips?
• Do you have pain elsewhere like your lower back or thigh?
• Do you have pain in other joints?
• Did your pain begin suddenly, or slowly and mildly?
• Did the pain begin after an injury, fall, or accident?
• Does any particular activity make the pain worse?
• Have you done anything to try to relieve the pain? If so, what helps?
• Are you able to walk and bear weight?
• What other medical problems do you have? Osteoporosis or other signs of bone loss? Sickle cell anemia?
• Do you take any medications? If so, which ones? If on steroids, for how long have you been on them?


X-rays of the hip may be necessary.

Your doctor may tell you to take a higher dose of over-the-counter medication, or give you a prescription anti-inflammatory medication.

Surgical repair or hip replacement may be recommended for aseptic necrosis. Hip replacement is necessary for hip fracture and severe arthritis. With current technology, an artificial hip should last at least 10 to 15 years. Expect recovery from surgery to take at least 6 weeks.

Complications can occur from surgery. A blood clot in the leg is the most common complication, which can lead to a blood clot in the lungs.


Prevention

• Avoid activities that raise one of your hips above the other for extended periods of time, like running on an uneven surface. Running on a treadmill can keep your hips level.
• Warm up before exercising and cool down afterward. Stretch your hips, low back, and thighs.
• Avoid falls.
• Wear hip pads for contact sports like football and hockey. For those at high risk for a hip fracture, pads with a streamline design can be worn in undergarments.
• Learn how to prevent osteoporosis.


TREATMENT

The 3 S's - Stretching, Strengthening, and Supporting, along with ICE and REST, have been found to be the simplest and most effective treatment for these injuries

• Stretching of the IT Band, Hamstring, Quad and Psoas Major can help to decrease and eliminate many of the problems.
• Strengthening of the muscles of the abdomen, quad and hip can assist in avoiding problems.
• Supporting the foot with proper shoes and insoles, can prevent or eliminate the vast majority of stresses on the lower extremity.

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