My hip hurts — What do I do?
11/28/2022 by Denise Dupras, M.D., Ph.D.
Hip pain is a common complaint. It can be caused by problems involving the hip joint, the soft tissues around the joint, the pelvic joints or the back.
Two common causes of pain are arthritis of the hip joint and bursitis, or inflammation of the jellylike cushion between the bones and the soft tissues of the hip. This is known as trochanteric bursitis.
But how do you know what is causing your hip pain? Do you need to be seen by a health care professional? What can you do to treat the pain?
The first step in finding the cause is to pay attention to your symptoms. Where do you feel the pain? What makes it worse — or better?
The main symptom of trochanteric bursitis is pain over the point of the hip, on the outside of the leg, which can extend down the outside of the thigh. At first, it may involve only a small area of the hip, be sharp and intense, but with time may spread and feel achier. Another thing you might notice is that lying on the hip at night makes it worse, causing you to roll over to ease the pain. Other things that can make it worse are squatting, stair-climbing and prolonged walking.
It is more common in women, especially as they get older. Risk factors for developing bursitis include spine problems, injuries to the hip, differences in leg lengths, history of hip surgery and repeated stress to the hip joint that is related to activities.
A physical examination often is sufficient for the diagnosis, although in certain situations, additional testing may be recommended.
So if you think you have bursitis, what do you do?
Avoid activities that cause or aggravate the pain. Application of a cold pack to the area can provide pain relief. Nonsteroidal anti-inflammatory drugs, commonly referred to as NSAIDs, can help with pain. Be sure to check with your clinician to see if it's safe for you to take these, especially if you have chronic medical conditions or take prescription medications. Try walking with a cane for a week or two on the side where you don't have pain. Exercise by focusing on stretching, strengthening and improving the flexibility of the hip muscles. If these things don't help, cortisone shots may be recommended. Surgery is rarely needed to treat this cause of hip pain.
Other pain that comes from the hip joint is most commonly related to arthritis. This occurs as a result of the loss of the cartilage that protects the space between the bone surfaces. These changes develop slowly. The pain comes on gradually and worsens with time. Unlike bursitis, stiffness is a common complaint along with the pain and loss of the ability to put on a sock, tie a shoe or do other activities that require bending at the hip joint. The stiffness may be worse in the morning or after sitting or resting. The pain differs because it often is felt in the groin rather than over the point of the hip and radiates to the knee or buttock. Occasionally, the hip may seem to lock or stick with a normal activity. The pain worsens with activity but is not affected by lying on the side of the painful hip.
Risk factors for pain from arthritis include age, history of hip injury, excessive weight, a family history of hip arthritis and changes in the formation of the hip joint at birth.
Like bursitis, a physical examination can be helpful in determining that arthritis is the cause of hip pain. An X-ray is often helpful to determine the extent of the arthritis.
Treatment of hip pain due to arthritis is remarkably similar to bursitis and involves avoiding activities that aggravate the pain, exercises, using a cane and nonprescription medications, such as NSAIDs. Additional recommended treatments include the use of acetaminophen and weight loss, when appropriate. Cortisone injections into the hip joint can provide temporary relief. When hip arthritis results in uncontrolled pain or interferes with the ability to do normal activities, it is appropriate to consider hip replacement.
Denise Dupras, M.D., Ph.D., is a general internist in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients.