How to Manage Hip Pain
If you find yourself with pain in the hip joint, it’s important to consult an orthopedic surgeon. An examination will help determine what’s causing the pain. Hip pain can actually come from locations other than the hip, such as the spine, pelvis or leg. While waiting to see an orthopedic surgeon, there are some modifications and exercises that may provide some relief. Doctors may often refer you to physical therapy first to see if strengthening will help with the pain.
Anti-inflammatories, commonly known as non-steroidal anti-inflammatory drugs (NSAIDs) are used primarily to treat mild to moderate pain associated with inflammation. This inflammation may be the result of muscular tears, bursitis, tendonitis, arthritis, labral tears or synovitis. Anti-inflammatories are also used as a first-line treatment option in conjunction with a strengthening program.
Physical therapy is an integral component to the multi-faceted team approach of examining and treating hip pain. The importance of physical therapy is to gain an understanding of the underlying causes of hip pain.
The hip joint is a deep joint surrounded by almost 30 muscles. Physical therapy aims to strengthen these muscles, increase flexibility, maintain range of motion of the joint and decrease the associated inflammation. In the case of a labral tear, physical therapy will not heal the tear. With the appropriate muscular training and activity modification, however, the condition may become asymptomatic and therefore require no surgery.
If operative treatment is inevitable, a pre-operative physical therapy program will provide the ability to address nearly all underlying joint problems or muscle imbalance, which ultimately leads to a better outcome. Additionally, post-operative physical therapy is essential in educating the patient regarding daily activities and providing an appropriate recovery course.
Injections are commonly prescribed to help relieve a patient’s pain as well as to diagnose the direct cause of the pain.
Following an injection of a numbing drug into the joint, immediate relief from pain will help confirm that the joint is the source of pain. If complete pain relief is achieved while the hip joint is numb, the joint is likely to be the source of pain. If not, further consideration of a possible cause is needed.
- Intra-articular Injections
An ultrasound-guided cortisone injection made directly into the hip joint can provide relief. Ultrasound-guided cortisone injections using dedicated high-resolution ultrasound equipment are very precise and allow a radiologist to target the injections directly into an area, maximizing therapeutic outcomes. Following the injection, pain relief varies from patient to patient. Some may feel relief from pain within two to five days. If a patient feels no relief within ten days following the injection, the patient is unlikely to gain any additional improvement and further diagnostic testing may be needed to identify other options for relief.
- Psoas Injection
Psoas injections, which are performed under ultrasound, are often prescribed when the diagnosis is thought to be a symptomatic psoas tendon, which runs outside of the hip joint. In some cases, this diagnosis is difficult to make, as a painful psoas tendon often results in compression and tears of the labrum. As a result, pain relief following a psoas injection will only occur outside of the hip joint. If there is involvement of the labrum, which is inside the joint, additional evaluation is recommended.
- Trochanteric Bursa Injection
A trochanteric bursal injection is prescribed for patients who present clinically with bursitis on the outside of their hip, and for whom physical therapy and an anti-inflammatory regimen has not provided relief.