Hip pain causes discomfort, making practically everything you do--sitting, standing, even sleeping uncomfortable. When your hip hurts, there is often a good reason. It is the largest joint in your body and is responsible for supporting your entire weight when you stand or sit, as well as allowing you to move freely from side to side, rotate and bend at this joint. The hip also allows for movement of the upper leg and lower leg together in order for you to walk or run. This joint has a lot of responsibility.
Because the hip is a very complex joint with many different functions, there are many different ways it can be injured. Muscles can become tight, ligaments and tendons can become injured or inflamed, or arthritis can form in the joint, causing pain and restricted range of motion. The difficult part is figuring out the correct diagnosis due to overlapping symptoms.
So what might be going on with the hip, and what are some options for relieving your pain? Let's start with the most common soft tissue conditions and move on to more complex reasons.
Piriformis syndrome
This is one of the most common soft tissue conditions massage therapists encounter when dealing with complaints of hip pain. Piriformis syndrome is caused by a muscle in your buttocks that's pressing on the sciatic nerve. The piriformis muscle acts as a bridge between the lower back and outer thighs. It helps you rotate your leg outward (external rotation) when you walk or run, but it can become tight and cause pain if you sit for long periods, like slouching at a desk or driving for hours on end. The resulting pressure on nearby nerves can cause symptoms such as numbness or tingling in your lower back, hips, leg(s), foot, and/or toes; pain when walking; difficulty bending forward at the waist; weakness in one or both legs; and shooting pains into the thighs/knees are all symptoms of sciatic nerve impingement by the piriformis muscle.
You can perform a simple self-diagnostic test called the“figure four” to rule the piriformis in or out as the culprit. While seated, try to take the leg of the affected hip and cross the ankle over the knee of the opposite leg. If you find this difficult or painful, chances are your hip pain could be coming from a tight piriformis.
Gluteus Medius
If you have pain in the side of your hip, it's likely you have a problem with your gluteus medius. This literal pain in the butt can be caused by trigger points in the muscle belly or inflammation of the tendon that attaches to the hip (GM tendinopathy), or both. This painful condition occurs when there is stress on the tendons that attach to this muscle. The most common reason for stress on the gluteus medius tendon is weakness in the gluteal muscles from prolonged sitting or standing.
The symptoms of gluteus medius tendinopathy include pain on the side of your hip when standing on one leg and pain when sitting down or getting up from a chair.
Physical activities such as running, jumping, and walking uphill can also cause pain in the hip. If you have pain in one leg but not both legs, it could be due to an imbalance between the two sides of your body.
Psoas tendonitis (IPT)
Psoas tendonitis (IPT) is a common cause of groin pain and hip pain. The psoas muscle connects your spine to the inside of your thighbone at the head of the femur, and it can become irritated when you sit for long periods, walk with an unusual gait or have significant anterior pelvic tilt. These cause inflammation in the tendon that attaches to your hip joint. If you have psoas tendonitis, you may feel pain in the:
Groin area
Lower back (the lower part of your spine)
Side of your abdomen
Buttocks area
Thighs
Similar to piriformis syndrome, IPT can cause trigger points to develop in your quadriceps (front of the thigh). In many cases, the piriformis, gluteus medius, AND psoas are affected as a group, and you can develop trigger points in all three muscles.
Now that we've covered some of the less complex reasons for hip pain, let's move on to some of the more complex ones.
Femoral acetabular impingement (FAI)
Another common cause of hip pain is a condition called femoroacetabular impingement (FAI). This is when the ball-and-socket joint becomes too shallow or misshapen due to repetitive use over time. This causes the hip to rub against the bone when you move, which leads to pain and inflammation. Walking on hard surfaces such as tile or concrete floors, running on pavement, and standing in one place for long periods of time at a job (such as a retail cashier) can be contributors to FAI.
You may notice one or both of your hips feel stiff or painful when walking or running. You might also experience hip pain at night when lying down flat on your back for more than 30 minutes at a time.
If you think that you may have FAI, it's best to talk to an orthopedic surgeon about getting tested. But don't worry; just because you may have FAI doesn't mean you're automatically headed for a hip replacement. The surgeon may recommend less invasive treatment, such as NSAIDs for pain management and physical therapy to strengthen muscles around the hip for support.
Labral tear
A labral tear occurs when the labrum, a piece of cartilage that helps hold your hip joint together, is torn. and because cartilage has little to no blood supply, it is extremely slow to heal. Even more so when you're using the joint to move. Labral tears have different grades of severity, and depending on the grade, your hip pain may be more or less intense.
Labral tears can be caused by trauma, overuse, or degeneration. Symptoms include pain and clicking in the hip joint. Your doctor might also notice that you have limited range of motion when they examine your hip. Your hip, like your shoulder, moves in several directions or planes of motion because it is not affixed to the hip socket. It free-floats with the help of cartilage that holds it in place, like a hammock.
Due to its location inside the hip socket, there is very little that can be done to repair this type of injury short of surgical intervention. If left untreated, this injury could result in other problems, such as osteoarthritis or arthritis within the joint itself. But similar to FAI, a good surgeon isn't going to rush immediately to a surgical solution. Depending on factors such as age, weight, and activity level, they may suggest you try more conservative treatments like physical therapy.
Bursitis
Bursitis is a painful condition that causes inflammation in the bursa, a fluid-filled sac that cushions the bones, tendons, and muscles around the joints. The most common form of bursitis is tendinosis - inflammation of tendons that connect muscle to bone.
Side note: There is a difference between tendonitis and tendinosis. One key difference is how long the condition has been a problem. If you're experiencing tendon inflammation for more than 6 months, that tendonitis becomes tendinosis. In other words, tendonitis is acute while tendinosis is chronic.
The pillowy cushion your bursa provides prevents the head of the femur from rubbing against the hip socket. Overuse, injury, or infection, which causes inflammation, creates less space for the joint to move comfortably due to excess fluid in the bursa sac.
Should I see a doctor?
The hip is a complex structure, and determining the cause of hip pain can be difficult. Your doctor may suggest imaging, such as x-ray or MRI, to help identify the exact cause of your pain and the best strategy treat it. Massage therapists aren’t licensed to diagnose any injury or illness, so any diagnosis would have to come from a practitioner who is licensed to diagnose (such as a physician with an MD after their name).
Can massage help my hip pain?
Massage therapy can be very effective in helping manage hip pain and discomfort due to muscle dysfunction. Massage has been shown to offer numerous benefits, such as loosening tight muscles and increasing blood flow, which can help reduce inflammation and improve range of motion. Additionally, massage can help manage chronic pain, improve sleep quality, and reduce stress from thinking about hip pain. All that is great; however, massage has limited effect on conditions like labral tears, bursitis, or nerve impingement from the joint.
For those who suffer from hip pain, the above information can be a helpful first step in understanding what is going on with your body and how to treat it. After reading this post, if you want to explore how massage might be able to give you relief from your hip pain, reach out to me or schedule an appointment. I'm here to help!