Specialist Hip Pain Management
Specialist Hip Pain Management
Expert diagnosis and comprehensive treatment for hip pain from Dr. Mona Mubarak, Consultant in Chronic Pain Management. We provide targeted interventions for osteoarthritis, bursitis, labral tears, and complex hip pain syndromes.
Understanding Hip Anatomy & Function
The hip is a ball-and-socket joint that connects the femur (thigh bone) to the pelvis. It’s one of the body’s largest weight-bearing joints, designed for both stability and a wide range of motion, making it essential for walking, running, and daily activities.
Hip Joint Structure
Simplified representation of the hip joint structure
Key Anatomical Structures
- Acetabulum: Socket in the pelvis where the femur head sits
- Femoral head: Ball-shaped top of the femur bone
- Articular cartilage: Smooth tissue covering bone ends
- Labrum: Fibrocartilage rim deepening the socket
- Synovial membrane: Lining that produces joint fluid
- Ligaments: Strong bands stabilizing the joint
- Bursae: Fluid-filled sacs reduce friction
- Muscles: Gluteals, hip flexors, rotators supporting movement
Why Hip Pain is Complex
Hip pain can originate from multiple structures and is often challenging to diagnose because:
- Referred pain: The hip can refer pain to the groin, thigh, knee, or buttock
- Multiple pain generators: Several structures can cause similar pain patterns
- Biomechanical interdependence: Problems in the back, knee, or foot can affect the hip
- Age-related changes: Different conditions predominate at different life stages
- Overlap of symptoms: Many conditions present with similar groin or lateral hip pain
Common Causes of Hip Pain
Hip pain can result from various conditions affecting the joint itself or surrounding structures. Accurate diagnosis is crucial, as treatment varies significantly depending on the underlying cause.
Primary Hip Conditions by Location
Anterior Hip Pain
Front of hip/groin
- Osteoarthritis
- Hip impingement
- Hip flexor tendinitis
Lateral Hip Pain
Outside of hip
- Trochanteric bursitis
- Gluteal tendinopathy
- IT band syndrome
Posterior Hip Pain
Buttock/back of hip
- Piriformis syndrome
- Hamstring tendinitis
- SI joint dysfunction
Referred Pain
Hip area from elsewhere
- Lumbar spine issues
- Pelvic conditions
- Knee problems
Most Common Hip Conditions Compared
| Condition | Primary Location | Main Causes | Key Characteristics |
|---|---|---|---|
| Osteoarthritis | Hip joint, groin area | Cartilage wear, aging, previous injury, genetics | Pain with movement, stiffness, reduced range of motion, crepitus |
| Trochanteric Bursitis | Outside of the hip (greater trochanter) | Overuse, trauma, biomechanical issues, leg length discrepancy | Lateral hip pain, worse when lying on the affected side, tenderness to pressure |
| Femoroacetabular Impingement (FAI) | Front of hip/groin | Bone abnormalities, labral tears, repetitive motion | Deep groin pain, stiffness, clicking/catching, pain with flexion |
| Labral Tears | Hip joint, groin area | FAI, trauma, dysplasia, degenerative changes | Deep ache, catching/locking sensation, instability, limited motion |
| Piriformis Syndrome | Buttocks may radiate down the leg | Muscle tightness/spasm, prolonged sitting, biomechanics | Buttock pain, sciatica-like symptoms, worse when sitting |
| Hip Fractures | Hip/groin may radiate to the knee | Trauma, osteoporosis, falls, stress fractures | Severe pain, inability to bear weight, leg shortening/rotation |
Hip Pain Across Different Age Groups
Hip pain causes vary significantly by age, requiring different diagnostic approaches:
- Femoroacetabular impingement
- Labral tears
- Sports injuries
- Early arthritis (if predisposed)
- Early/moderate osteoarthritis
- Tendinopathies
- Bursitis
- Referred pain from the back
- Advanced osteoarthritis
- Fracture risk (osteoporosis)
- Polymyalgia rheumatica
- Avascular necrosis
Recognizing Hip Pain Symptoms & Patterns
Hip pain symptoms vary depending on the underlying condition. Recognizing symptom patterns helps guide accurate diagnosis and appropriate treatment selection.
Symptom Patterns by Condition
Osteoarthritis Symptoms
- Gradual onset of groin pain
- Morning stiffness lasting <30 minutes
- Pain worsens with activity, better with rest
- Reduced range of motion (difficulty putting on shoes)
- Crepitus (grinding sensation)
- Pain may refer to the thigh, knee, or buttocks
Bursitis Symptoms
- Sharp, burning lateral hip pain
- Pain worse when lying on the affected side
- Tenderness over a bony prominence
- Pain climbing stairs or rising from a chair
- Pain may radiate down the thigh
- May have visible swelling in acute cases
Referred Pain Symptoms
- Hip pain without hip joint pathology
- Pain patterns don’t follow typical hip patterns
- May have associated back pain or stiffness
- Neurological symptoms (numbness, tingling)
- Pain changes with spinal movements
- Normal hip examination despite pain
Red Flags: When to Seek Immediate Medical Attention
Certain hip pain symptoms require urgent evaluation:
- Severe pain after trauma or a fall
- Inability to bear weight on the affected leg
- Suddenly, severe swelling with redness/warmth
- Fever with hip pain (possible infection)
- Cold foot or loss of pulse in the leg (vascular emergency)
- Loss of bowel/bladder control with hip/leg pain
- Unintended weight loss with hip pain (possible systemic illness)
Functional Limitations Assessment
Understanding how hip pain affects daily activities helps determine treatment priorities:
| Activity Level | Functional Limitations | Treatment Priority |
|---|---|---|
| Mild Limitations | Pain with prolonged walking, occasional stiffness, and normal daily activities | Education, exercise, and pain management |
| Moderate Limitations | Difficulty with stairs, limited walking distance, and sleep disturbance | Physical therapy, injections, and medication |
| Severe Limitations | Constant pain, difficulty with basic activities (dressing, bathing), and work limitations | Comprehensive pain management, advanced interventions, and surgical evaluation |
Comprehensive Hip Pain Treatments
Effective hip pain management requires a multimodal approach tailored to the specific diagnosis, pain severity, functional limitations, and patient goals.
Conservative & Non-Surgical Treatments
| Treatment Approach | Mechanism of Action | Best For | Expected Outcomes |
|---|---|---|---|
| Physical Therapy | Strengthens supporting muscles, improves biomechanics, and increases flexibility | Most hip conditions, post-injury rehab, and pre-surgical optimization | Improved strength, function, gait normalization, and pain reduction |
| Activity Modification | Reduces aggravating activities, allows healing | Overuse injuries, acute flare-ups, and early osteoarthritis | Pain reduction, prevention of worsening, and functional maintenance |
| Weight Management | Reduces joint loading (3-6x body weight through the hip during walking) | Osteoarthritis, overload conditions, and biomechanical pain | Significant pain reduction, slowed disease progression |
| Assistive Devices | Reduces joint forces, improves stability | Moderate-severe arthritis, post-injury, balance issues | Pain reduction during activities, increased mobility, fall prevention |
| Medications | Reduces inflammation, modulates pain | Acute flare-ups, inflammatory conditions, pain control | Symptom relief, improved mobility, better sleep |
Interventional Pain Procedures for Hip Pain
For patients with persistent pain despite conservative treatment, we offer targeted interventions:
Image-Guided Injections
Precise delivery of medication to specific structures using ultrasound or fluoroscopic guidance.
- Intra-articular hip injection: For osteoarthritis, synovitis
- Trochanteric bursa injection: For bursitis
- Lumbar sympathetic block: For complex regional pain syndrome
- Piriformis injection: For piriformis syndrome
- Benefits: Diagnostic and therapeutic, rapid pain relief
Regenerative Medicine
Using biological materials to stimulate healing and tissue regeneration.
- Platelet-Rich Plasma (PRP): For tendinopathies, mild osteoarthritis
- Prolotherapy: For ligamentous laxity, instability
- Stem cell therapy: For cartilage defects, advanced research
- Mechanism: Stimulates natural healing processes
- Considerations: Requires appropriate patient selection, multiple treatments
Advanced Interventions
Specialized procedures for complex or refractory hip pain.
- Radiofrequency ablation: For osteoarthritis pain (genicular nerves)
- Spinal cord stimulation: For refractory neuropathic pain
- Pulsed radiofrequency: For nerve-mediated pain
- Benefits: Longer-lasting relief (months to years)
- Procedure: Minimally invasive, often outpatient
Surgical Options & Referrals
For conditions requiring surgical intervention, we collaborate with leading orthopedic surgeons and provide comprehensive pain management throughout the surgical journey:
Integrated Surgical Pathway
- Pre-operative optimization: Pain control, physical conditioning, education
- Surgical options: Arthroscopy (labral repair, FAI correction), osteotomy, hip resurfacing, total hip replacement
- Post-operative pain management: Multimodal analgesia, nerve blocks, rehabilitation support
- Chronic post-surgical pain management: For persistent pain after surgery
Treatment Progression Framework
Our evidence-based approach follows a stepwise progression:
- Phase 1 (Diagnosis & Education): Accurate diagnosis, patient education, activity modification, basic exercises
- Phase 2 (Active Treatment): Physical therapy, medications, injections as needed, weight optimization
- Phase 3 (Advanced Interventions): Regenerative treatments, advanced injections, interventional procedures
- Phase 4 (Surgical Consideration): Surgical evaluation if conservative measures fail, comprehensive pre-op planning
- Phase 5 (Maintenance & Prevention): Long-term management, flare-up prevention, functional optimization
Specialist Hip Pain Consultation
Hip pain can significantly impact mobility, independence, and quality of life. Early specialist intervention often leads to better outcomes, preserved function, and avoidance of unnecessary surgery.
When to Seek Specialist Hip Pain Evaluation
- Hip pain persisting >6 weeks despite rest and simple measures
- Pain that limits walking distance or daily activities
- Night pain affects sleep quality
- Difficulty with stairs, rising from chairs, or putting on shoes
- Pain accompanied by stiffness, locking, or catching sensations
- Previous treatments haven’t provided adequate or lasting relief
- Considering hip surgery and seeking a second opinion
We offer comprehensive hip assessments including diagnostic injections, gait analysis, and collaborative care with physiotherapists and orthopedic surgeons.
