Hip Pain Treatment

Ask someone where their hip hurts and most people put a hand on the bony point at the side. That spot is the one place the hip joint almost never refers to, which is why this is the first thing we sort out.

Groin and front of the thigh is the hip joint itself. It can travel down toward the knee, and a surprising number of people arrive convinced they have a knee problem. A characteristic gesture goes with it: a hand cupped around the side and front of the hip, thumb behind, fingers in the groin.

The outside, over the bony point, is usually the tendons and the tissue that passes over them rather than the joint. It is tender to press, it is worse lying on that side at night, and it is worse after standing on one leg — getting out of a car, going up stairs.

The buttock is most often referred from the low back or from the joint where the spine meets the pelvis, not from the hip. If it travels down the back of the leg, that belongs with sciatica. If it sits across the belt line as well, see lower back pain.

Osteoarthritis of the hip. The commonest reason for true groin pain in adults past middle age. It builds over years, it is stiff first thing and after sitting, and the first movement to go is usually rotation — noticed as trouble putting on socks and shoes, or getting in and out of a car.

Gluteal tendon problems and bursitis. The commonest cause of pain on the outside. More frequent in women, and often in people who have recently changed how much they walk or stand. This is a tendon that has been overloaded relative to what it is conditioned for, and it responds to loading it properly rather than resting it.

Impingement and labral problems. In younger, active people, where the shapes of the ball and socket catch at the end of range. Deep groin pain with pivoting, deep squatting or prolonged sitting, sometimes with clicking or catching.

Referred pain from the lumbar spine. Common enough that we examine the back on every hip patient. A back that refers to the buttock and outer thigh can look exactly like a hip problem from the outside.

Muscle and tendon strains around the hip, and in runners, stress reactions in the bone.

Hip joint pain has a recognizable rhythm. It is stiff and reluctant for the first few minutes after you get up or after you have been sitting, it eases as you move, and it aches again when you have been on it too long. That start-up stiffness is one of the more useful things you can report.

The sock test is the practical one. Difficulty reaching your own foot to put on a sock or tie a shoe, on one side only, points strongly at the hip joint rather than the back — because it is rotation that is limited, and rotation is the hip's job.

Clicking on its own is not a problem. Catching that stops the movement is worth reporting, and so is a hip that gives way. Night pain that stops you lying on that side belongs to the outside of the hip rather than the joint, and it changes the plan.

Pain that is unrelated to position — the same lying, sitting and walking — is the description that earns a closer look, because mechanical hip problems almost always vary with what you are doing.

The thing that turns a manageable hip into a difficult one is rarely a dramatic change on a scan. It is adaptation. Rotation goes first and nobody notices, so the low back starts taking the twisting. The muscles on the outside of the hip weaken, so the pelvis drops slightly on each step and the other side works harder. Stride shortens. The knee on the same side starts complaining.

By the time people come in, a substantial part of what hurts is often the adaptation rather than the original problem — and that part is treatable in its own right, which is the more encouraging half of the sentence.

It also explains why hip strength work changes how a hip feels more reliably than almost anything else, and why a plan that only addresses the joint tends to stall.

We start with where you point and what provokes it, then watch you walk, because a hip tells you a great deal in about ten steps. The examination measures range in every direction — rotation in particular, since it is the first to go and the easiest to track — then tests the positions that reproduce your specific pain, and measures strength through the muscles on the outside of the hip rather than eyeballing it.

The low back and the joint where the spine meets the pelvis are examined on every hip patient, because referred pain from either is a frequent and expensive thing to miss.

Imaging is used when it would change the plan. Age-related change shows on hip films in plenty of people with no symptoms at all, so a scan is read next to the examination rather than instead of it. What imaging genuinely settles is a suspected fracture, a stress reaction, or a question that the examination cannot answer on its own.

Physical Therapy is the centerpiece for almost every hip, and the evidence for strengthening the muscles around the joint is better than for anything else available. Expect a short, specific program rather than a long generic list, progressed as it gets easier.

Chiropractic addresses the mechanics above and below — the low back, the pelvis and how the two move together — using Diversified, drop-table and Activator techniques, with spinal decompression and dry needling available as modalities.

Acupuncture is offered at every clinic and is an option alongside the rest, particularly where pain is limiting what you can do in therapy.

Pain Management steps in when conservative care is not enough. An image-guided joint injection into the hip can reduce pain enough to make the strengthening possible, which is the point of it — the injection buys a window, and what you do with the window decides whether the relief holds.

Where a hip has reached the stage that these options are not enough, the honest next step is an orthopedic opinion about joint replacement, and we will say so and help you get there rather than keep treating around it.

A hip you cannot bear weight on after a fall needs urgent assessment for a fracture — and in an older adult, or anyone with osteoporosis, that applies after even a minor fall. A leg that looks shortened or turned out after a fall is a fracture presentation and needs emergency care.

A hip that becomes hot, red, markedly swollen and severely painful over hours, especially with a fever, needs urgent medical assessment; an infected joint is treated as an emergency.

Seek prompt evaluation for hip or groin pain alongside unexplained weight loss, night sweats, or a history of cancer; for new severe groin pain in a child or adolescent, which is assessed differently; and for numbness, pins and needles or progressive weakness in the leg rather than pain alone.

None of this describes ordinary hip pain, which is the reassuring part of the list.

No referral is needed for Chiropractic, Physical Therapy, Acupuncture or Pain Management, and our goal is to get you in within the same week.

Expect to walk, and to be asked to point with one finger. The examination covers range and rotation, the provocation tests that reproduce your particular pain, strength through the hip muscles, and a screen of the low back. It is worth wearing something you can move in, and worth bringing the shoes you wear most for walking — wear patterns are informative.

Bring a photo ID and your insurance card, any previous imaging or reports, and a list of what you are taking. If an image-guided injection turns out to be the right next step, it is performed in office at Northglenn, north Colorado Springs, Mesa and Glendale, and every other clinic coordinates it to one of those.

The aim is that you leave with a diagnosis you understand and a plan you have agreed to.

Keep loading the hip within a range that does not leave it sore the following morning. That next-morning check is a better guide than how it feels during the activity, and it lets you build up steadily without guessing.

Strength through the muscles on the outside of the hip and through the glutes changes how a hip feels more than anything else you can do at home. Sit-to-stand from a chair, step-ups at a height you control, and side-lying leg raises are unglamorous and effective.

For pain on the outside, avoid sleeping directly on that side and put a pillow between your knees if you sleep on the other one. Avoid standing with your weight hanging on one hip, and avoid crossing your legs for long stretches — both load exactly the tissue that is sore.

Low soft chairs and long drives set a hip back more often than anything else. Raising the seat and getting up periodically does more than any stretch.

Hip pain is treated at every Mountain View Pain Center clinic in Colorado and Arizona. The care is the same wherever you start; what changes is where an interventional step would be performed if you need one.

By metro: pain management in Denver, pain management in Colorado Springs, or pain management in Phoenix. Each page names the clinics in that metro and what the first visit involves.

Image-guided injections are performed in office at Northglenn, Interquest in north Colorado Springs, Mesa and Westgate in Glendale, and every other clinic coordinates to one of those.

Pain that travels down the back of the leg: sciatica. Pain across the low back as well as the buttock: lower back pain. Joint pain in more than one place, with morning stiffness: arthritis and joint pain. The injection itself: joint injections.