By James P. Jamison, M.D.
When a patient asks about why his or her hip hurts, I often ask the patient to point to where the pain is.
If the patient points to the groin, the front of the thigh or to the buttock, then the source of the pain may well be the hip joint. If they point to the side, it might be bursitis. If they point to the low back or back side of the pelvis, more often the problem is with the low back/lumbar spine.
Signs of Osteoarthritis
The most common hip problem I see is osteoarthritis, which presents itself with pain and stiffness. Patients may note decreasing ability to move the hip, which may be painful.
It may be hard to get up from a chair after sitting for a little while, or it may be increasingly harder to walk any distance. Taking the stairs may become more of a problem, gradually requiring the patient to do steps one at a time (like a child).
Osteoarthritis may make it harder to put on your shoes and socks without help, and you may start to walk with your foot rotated outward if the condition is becoming more advanced.
Signs of Bursitis
Bursitis usually causes pain out to the side of the hip, actually over the top end of the thigh bone, or femur, called the greater trochanter. Therefore, this is greater trochanteric bursitis.
It can cause pain at rest, especially sitting in a car with bucket seats. It can also cause pain with walking and stairs. One of the most specific signs of bursitis is pain with sleeping on that side, such that you have to roll off of it to make the pain stop.
Low back pain
Low back pain is very common, but it is just that – low back pain. That is not hip pain. Pain in the back part of the pelvis is often from arthritis at the sacro-iliac joint (yes, that not only sounds funny, it really exists).
This problem can be especially noticeable when getting up and down from a chair, and with walking.
Conservative Treatment is the Best Place to Start
Treatment for hip arthritis, greater trochanteric bursitis and sacroiliac joint arthritis usually begins with over-the-counter anti-inflammatory medications, like Aleve or Advil, if you can take them. Stretching and strengthening exercises are a good idea.
An injection with cortisone can be helpful, too, though used less often for hip arthritis. The hip joint is more difficult to inject because it is a much deeper joint (than is the knee or shoulder, by comparison), it usually requires fluoroscopy (x-ray), and is less predictable in how long the injection may last.
Bursitis and sacroiliac joint arthritis rarely require surgery. When conservative treatment for hip arthritis no longer helps, when pain and limited motion become enough of a problem, that is when it may be time to consider hip replacement surgery.
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Dr. James P. Jamison, M.D., is an orthopedic specialist with a focus on hip and knee joint replacement and reconstruction surgery. Referrals to Dr. Jamison by your primary care physician can be made by calling (330) 758-0577, Ext. 1102.