Long-term hip pain usually develops due to overuse with repetitive and demanding movements or any past trauma to the joint. If you have tight hip flexors or weak glutes, they are common precursors to chronic hip pain.
There are typically 2 reasons why your muscles may be tight. They may be compensating for weakness elsewhere or they are held in a shortened position for a long period of time. If your job requires you to sit for most of the day, your hip flexors, located in the front of your leg, are in a constant shortened position. Additionally, your glutes are not activated while your are sitting and may not know how to “turn on” when needed.
Your gait can also affect your hip flexors. Many of us over rely on our knees and quads to walk or run and we don’t engage our glutes. For runners who are more quad and hamstring dominant, rather than glute dominant, your body compensates for this imbalance with tightening your hip flexors. Weak glutes causes your hip and pelvis to be off, leading to wear and tear of the hip joint.
If some of these chronic conditions are left untreated, osteoarthritis can develop over time with continuous repeat damage to the cartilage and tendons surrounding the hip joint.
A sudden pain in the hip is usually the result of a direct physical injury to the hip. Falling or abnormal twisting the hip, among other injuries, can cause intense pain, bruising, or swelling. More severe symptoms of hip pain include:
• Inability to put weight on the hip
• Inability to move the hip in a normal manner
• Any acute injuries could result in fractures, inflammation, or injury to the tissues surrounding the hip.
During your physical therapy evaluation, your physical therapist will review your medical history and gather specific details around your hip condition such as the location of the pain – can touch or deep within the joint – and when the pain started to occur. Based on your review, your physical therapist will use their hands to pinpoint the painful area. For example, if the pain is related to a muscular issue such as piriformis or snapping hips, they will look for tenderness in the internal hip flexor or external IT band, respectively.
Both manual therapy and guided exercises should be used together for the best treatment outcome. Due to the location of the hip, it is very difficult to do the self-mobilization techniques needed to give your hips full range-of-motion. With the help of your physical therapist, your treatment will begin with passive motions performed by your physical therapist to move your leg and hip and will progress to active exercises you can do at home.
Hip surgery depends on the severity and type of the condition. For sudden injuries (i.e. torn cartilage or ligaments), surgery may be a better option to repair mechanical instability in the hip. In other cases, the injury may be inflammatory in which case surgery is less helpful. Those with chronic hip pain that severely impacts their day-to-day life can also consider hip replacement, which replaces the joint with an artificial joint. About 97% of hip replacements are due to hip fractures because of osteoarthritis. Depending on how far your osteoarthritis has progressed, surgery might be a better option in some cases. Other times, physical therapy for chronic hip pain can be just as effective at restoring movement and decreasing pain.
Whether undergoing surgery or not, managing the symptoms of hip pain with rest, pain relievers, and physical therapy is necessary. For most people, physical therapy is a good place to start their treatment course, especially if symptoms aren’t severe. Your physical therapist can refer you to an orthopedic surgeon if surgery is necessary for your condition.
If your hip pain affects your general mobility, gait or sleep, you should seek treatment as soon as possible to prevent potential inflammation from getting worse. When it comes to hip pain, it’s important to always consider that there are a wide range of symptoms. Determining whether or not you have acute or chronic pain and how impaired your range of motion is will help improve and optimize your treatment program. With or without a surgical procedure, incorporating physical therapy into the treatment of hip pain will result in quicker healing, less hip pain, and a reduced risk of future hip pain. The goal of treatment is to allow you to resume your everyday activities unrestricted by your hip pain.