What does Benphysio have to say about Hip Pain?

What Causes Your Hip Pain?

The trend of hip pain has increased following the well-known global pandemic, with studies conducted by leading institutions such as the World Health Organization (WHO) and the Global Burden of Disease (GBD) suggesting that around 15–25% of people worldwide experience hip pain at some point in their lives, with higher rates observed in older populations. Women are more likely to be affected than men, particularly after menopause, possibly due to hormonal changes and anatomical differences.

For younger patients who have achieved skeletal maturity, hip pain often results from tendon muscle strain, ligament sprains, bruising, or bursitis. For older adults, degenerative osteoarthritis (OA) and fractures should be considered as primary causes (Fan Z. et al., 2023).

Hip pain is complex, and several factors can influence its causes and severity. The history of pain must be considered when diagnosing an injury. A personal history of developmental hip dysplasia, slipped capital femoral epiphysis, sports activities, and injuries; a family history of hip problems; as well as the location and quality of pain, aggravating and relieving factors, and mechanical symptoms should be taken into account (Murphy, N. J., Eyles, J. P., & Hunter, D. J. (2016)). The examination of hip pain is guided by observation, physical examination, hip range of motion, neurovascular assessment, and physical examination tests (Ahuja V. et al., 2020).

Contrary to popular belief, the way you walk provides significant clues. For example, a Trendelenburg gait, characterized by excessive lowering of the pelvis on the opposite side while walking due to weakness of the gluteus medius and minimus muscles, is commonly seen in patients with hip OA and slipped capital femoral epiphysis (Dick AG et al., 2018). A waddling gait occurs as a result of congenital hip disorders, spinal muscular dystrophy, or myopathy (Ro DH et al., 2019). An antalgic gait is a limp adapted to avoid pain caused by leg injuries. In a spastic gait, patients walk with a scissoring motion, seen in cases of intoxication, brain injury, stroke, and polyneuropathy. In a steppage gait, the foot drops with the toes pointing downward and scraping the ground while walking, seen in patients with multiple sclerosis, peripheral neuropathy, and spinal cord injuries (Lloyd DG et al., 2023).

The normal range of hip motion is 100° flexion, 30° extension, 40° abduction, and 20° adduction. With the hip in a flexed position, internal and external rotation of the hip joint is 45°. The range of motion is also restricted in various hip joint pathologies (Palermi S. et al., 2021).

Certain occupations involving heavy manual labor and high-impact sports activities are associated with hip OA and other joint conditions in older age. Repetitive stress and biomechanical loads, especially in the presence of pre-existing anatomical abnormalities of the hip joint, are likely causes. Personal history of developmental hip dysplasia, slipped capital femoral epiphysis, sports activities, injuries, family history of hip issues, as well as the location and quality of pain, aggravating and relieving factors, and mechanical symptoms should be considered during diagnosis (Lespasio M., 2018). Farmers, in particular, are at risk of hip OA (Aresti, N., et al., 2016). However, there is no reliable evidence suggesting that exercise and physical activity are directly linked to hip OA in the general population.

Prolonged sitting can irritate the hip joint and contribute to hip pain, particularly if posture is suboptimal. Certain occupations involving heavy manual labor and high-impact sports activities are associated with hip OA and other joint conditions in older age (Wilke, B. Et al., 2023). Repetitive stress and biomechanical loads, especially in the presence of pre-existing anatomical abnormalities of the hip joint, are likely causes (He Y. et al., 2020). Farmers, in particular, are at risk of hip OA (Harris EC, Coggon D, 2015). However, there is no reliable evidence suggesting that exercise and physical activity are directly linked to hip OA in the general population.

Reference

1. Palermi, S., Massa, B., Vecchiato, M., Mazza, F., De Blasiis, P., Romano, A. M., ... & Sirico, F. (2021). Indirect structural muscle injuries of lower limb: Rehabilitation and therapeutic exercise. Journal of Functional Morphology and Kinesiology, 6(3), 75
2. Lespasio, M. J., Sultan, A. A., Piuzzi, N. S., Khlopas, A., Husni, M. E., Muschler, G. F., & Mont, M. A. (2018). Hip osteoarthritis: a primer. The Permanente Journal, 22.
3. Aresti, N., Kassam, J., Nicholas, N., & Achan, P. (2016). Hip osteoarthritis. BMj, 354
4. He, Y., Li, Z., Alexander, P. G., Ocasio-Nieves, B. D., Yocum, L., Lin, H., & Tuan, R. S. (2020). Pathogenesis of osteoarthritis: risk factors, regulatory pathways in chondrocytes, and experimental models. Biology, 9(8), 194.
5. Murphy, N. J., Eyles, J. P., & Hunter, D. J. (2016). Hip osteoarthritis: etiopathogenesis and implications for management. Advances in therapy, 33, 1921-1946.
6. Fan, Z., Yan, L., Liu, H. et al. The prevalence of hip osteoarthritis: a systematic review and meta-analysis. Arthritis Res Ther 25, 51 (2023). https://doi.org/10.1186/s13075-023-03033
7. Ahuja V, Thapa D, Patial S, Chander A, Ahuja A. Chronic hip pain in adults: Current knowledge and future prospective. J Anaesthesiol Clin Pharmacol. 2020 Oct-Dec;36(4):450-457. doi: 10.4103/joacp.JOACP_170_19. Epub 2020 Sep 26. PMID: 33840922; PMCID: PMC8022067.
8. - Dick, A. G., Houghton, J. M., & Bankes, M. J. (2018). An approach to hip pain in a young adult. bmj, 361.
9. Ro, D. H., Lee, J., Lee, J., Park, J. Y., Han, H. S., & Lee, M. C. (2019). Effects of knee osteoarthritis on hip and ankle gait mechanics. Advances in orthopedics, 2019(1), 9757369.
10. Veerkamp, K., Carty, C. P., Waterval, N. F., Geijtenbeek, T., Buizer, A. I., Lloyd, D. G., ... & van der Krogt, M. M. (2023). Predicting gait patterns of children with spasticity by simulating hyperreflexia. Journal of applied biomechanics, 1(aop), 1-13.
11. Harris, E. C., & Coggon, D. (2015). HIP osteoarthritis and work. Best practice & research Clinical rheumatology, 29(3), 462-482.
12. Wilke, B. K., Guier, C., Applewhite, A., Garner, H. W., Stanborough, R. O., Spaulding, A., & Sebro, R. A. (2023). Is Heterotopic Ossification Associated With Surgical Approach in Total Hip Arthroplasty?. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 31(7), e385-e393.

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