Hip Pain

WHEN TO SEE YOUR DOCTOR

* After an injury, even a minor one, your hip pain persists or grows worse.

* The pain is interrupting your sleep or interfering with your work or home activities.

* You also have open sores on your feet, or leg pain.

What Your Symptom Is Telling You

When you say hip and your doctor says hip, you may be talking about two different places. To most people, hip pain can refer to pain in the side of the upper thigh or the side of the upper buttock—the area right around the curvy part in women. But to a doctor, hip pain means pain felt in the groin—where the hip joint itself lies.

Hip pain can be tricky to decipher for other reasons. You can feel pain deep in the hip joint itself. You can feel pain in the tissues around the joint—in a bursa, for example. (The bursae are fluid-filled sacs that cushion the bony part of the hip close to the surface. If a hip's bursae become inflamed, you have bursitis.) There are tendons around the hip, too, tying it to the legs and the back. And these can also become inflamed (often after an injury), a condition called tendinitis. And the pain in your hip doesn't have to start there. You might have "referred" pain—you feel it in your hip, but the source is somewhere else, like your back. The cause of hip pain can even be outside your body: a too-soft mattress or ill-fitting shoes.

Arthritis is a common cause of hip pain. Usually, it's osteoarthritis—the "wear-and-tear" kind that affects almost everyone to some degree as they get older. Osteoarthritis in your hip is particularly likely to be a problem if you've ever suffered a fractured hip or pelvis. It's possible, too (though less common), that rheumatoid arthritis is making its presence known in your hip. This is the potentially disabling type that usually strikes when you're young.

Occasionally, a structural defect is at the root of hip pain. A curved spine or one leg that is slightly shorter than the other can cause your hip to hurt.

While carrying extra weight is not exactly a structural defect, your hip doesn't know that. Extra pounds can contribute to hip pain no matter what the cause.

Symptom Relief

Hip pain is a hindrance and a hassle—no doubt about it. Fortunately, there are many ways to relieve it.

Use heat to soothe. Moist heat is your first ally against hip pain, because moisture helps the heat penetrate further, says William Loomis, D.O., a Spokane, Washington, osteopathic physician and president of the American Association of Orthopedic Medicine. Soak a towel in hot water, wring it out and place it over your hip for 20 minutes three or four times a day, he suggests. You might want to place a dry towel on top of the wet one to help hold in the heat. Or you can use a moist heating pad.

Take it easy. You should cut back on exercise (but not totally eliminate it) for a few weeks when the pain is at its worst, says Robin Dore, M.D., a rheumatologist in private practice in Anaheim, California. Give yourself a chance to heal. Perform only stretching, not weight-bearing exercises.

Smooth on a deep-heating ointment. Both the ointment itself and the soothing rub will ease tight hip muscles. Try Ben-Gay, Flex-all 454 or Eucalyptamint, available at most pharmacies. Never use menthol-containing ointments with a heating pad, however, as serious burns may result.

Make that a massage. Whether it's your own hands or a spouse's, massage is a masterful healer for hip pain, says Dr. Loomis. "Massage focuses on surrounding tissues, where so much of the pain originates, rather than the joint," he says. "Since there are so many kinds out there, from Swedish to Shiatsu, you should experiment to find out which gives you the most relief."

Ask about medicines. If over-the-counter standards like aspirin and acetaminophen haven't eased your pain, your doctor may prescribe stronger medicines. Your doctor may also recommend cortisone injections or tablets, Dr. Loomis says. "It's great for quick reduction of inflammation within the first few days after an injury."

Sleep in comfort. Avoid lying on the painful hip, suggests Dr. Dore. And for softer support, use a foam egg crate mattress over your regular mattress.

Walk in the right shoes. Buy running shoes for walking—not walking or aerobic or cross-training shoes. Running shoes are extra light and specially designed to increase stability of the foot, says Bill Arnold, M.D., rheumatologist and chairman of the Department of Medicine at Lutheran General Hospital in Park Ridge, Illinois.

Customize your cane. If you need a cane or walker for extra steadiness, be sure it's the right size, suggests Earl Marmar, M.D., an orthopedic surgeon at Einstein Medical Center, director of the Einstein/Moss Joint Replacement Center and assistant clinical professor of orthopedic surgery at Temple University in Philadelphia. "If Grandpa's cane from Ireland is the wrong size for you, it will increase your hip pain," he says. Ask your doctor to refer you to a medical supply store where you can be properly measured.

Lose some weight. It's easy to overlook as a cause, but excess body weight can greatly increase hip pain, says Dr. Marmar. "Every time you take a step, two to three times your body weight goes through the hip in terms of the pressure exerted on the joint," he explains. "Each pound lost represents two to three pounds less pressure on your hip."

Pinpoint your pain. If you do go to your doctor for hip pain, be prepared to talk about exactly where it hurts and when. Tell your doctor what kind of pain you're experiencing—whether it's dull or sharp, whether it comes or goes, whether it hurts more when you're moving or still, and what kinds of movements seem to make it worse.

Don't get testy. If your doctor suspects arthritis, you may need to undergo several diagnostic tests, as there are over 100 types of arthritis, says Dr. Marmar. Be prepared for a bone scan or perhaps MRI (magnetic resonance imaging). Your doctor may also prescribe anti-inflammatory medicines and refer you to a physical therapist for exercises and heat and ultrasound treatments.

Examine your architecture. If a curved spine or slightly shorter leg has altered your gait, you may be unaware of it. Here's a home test from Sidney Block, M.D., a rheumatologist in private practice in Bangor, Maine: Stand undressed with your back to a mirror and a hand mirror angled over your shoulder so you can see yourself from the rear. Or ask a family member to look at you from the rear. If the height of your knees seems unequal, if your pelvis seems titled downward in one direction or if your back looks curved, you may have discovered the problem.

Fortunately, your gait is correctable—usually quite easily. You may need a prescription shoe lift or just an over-the-counter lift inside one shoe, Dr. Block says. If the difficulty is severe, your doctor will refer you to an orthopedist or othotist (a physical therapist who specializes in braces, special shoes and other appliances).

Go for repairs. Usually, a hip fracture will require surgical repair, says Dr. Marmar. One procedure preserves your natural bone and implants a pin in the hip to strengthen it. For a more serious fracture, or even severe arthritis, a surgeon may remove the affected joint and replace the hip entirely with a prosthesis.

An infection in the hip may require surgery as well as intravenous antibiotics, Dr. Marmar says.

And in the unlikely event that a tumor has caused your hip pain, after the biopsy you will be treated with some combination of radiation, chemotherapy and surgery.

See also Joint Inflammation; Joint Pain