Hip Pain – Michigan Spine & Pain

5 Common Causes of Hip Pain in Women

As with other types of chronic pain, women tend to experience hip pain more often than men. Yet, hip pain can have a number of different causes and determining the correct one is the key to getting the best treatment.

Getting a Hip Pain Diagnosis

When you tell your doctor your hip hurts, the first thing he should do is confirm that your hip is actually the problem. Women might say they have hip pain, but what they may mean is they’re having pain in the side of the upper thigh or upper buttock, or they may be experiencing lower back pain. Hip pain is often felt in the groin or on the outside of the hip, directly over where the hip joint (a ball-and-socket joint) is located.

Hip Pain Causes in Women

When a female patient comes to Michigan Spine and Pain complaining of hip pain, our clinicians and physiatrists consider the patient’s age, build and activity level. Depending on the patient’s weight, general physical fitness and health as well as age and other factors, the possibilities will be different.

Some of the most common causes of hip pain in women include:

Arthritis.

The most common cause of chronic hip pain in women is arthritis, particularly osteoarthritis — the wear-and-tear kind that affects many people as they age. The ball-and-socket joint starts to wear out. Arthritis pain is often felt in the front of your thigh or in the groin, due to stiffness or swelling in the joint.

Hip fractures.

Hip fractures are common in older women, especially those with osteoporosis (decreased bone density). Symptoms of a hip fracture include pain when you straighten, lift or stand on your leg. Also, the toes on your injured side will appear to turn out, a sign that can aid our preliminary diagnosis.

Tendinitis and Bursitis.

Many tendons around the hip connect the muscles to the joint. These tendons can easily become inflamed if you overuse them or participate in strenuous activities. One of the most common causes of tendinitis at the hip joint, especially in runners, is iliotibial band syndrome — the iliotibial band is the thick span of tissue that runs from the outer rim of your pelvis to the outside of your knee.

Hernia.

In the groin area, femoral and inguinal hernias — sometimes referred to as sports hernias — can cause anterior (frontal) hip pain in women. Pregnant women can be susceptible to inguinal hernias because of the added pressure on the wall of their abdomen.

Gynecological and Back Issues.

Hip pain in women can have gynecological causes and it’s important not to just assume the pain is caused by arthritis, bursitis or tendinitis. Depending on one’s age and other health issues, the pain in your hip could be coming from some other system.”

Treatment for hip pain depends on the diagnosis, but pain caused by overuse or sports injury is often treated with heat, rest and over-the-counter anti-inflammatory medication. To prevent injuries, it’s important to stretch before exercising and wear appropriate clothing, especially good shoes when running. Some causes of hip pain, such as fractures or hernias, may need surgical repairs. If your hip pain persists, come in and let’s discuss the possible causes and treatment options.

Take Me Out to the Ball Game…Without Pain

The snow is a distant memory (we hope!) and sports fields and ballparks are buzzing. If you are heading to see the Tigers or your own child or grandchild play, you can be in for a great treat: time outside, camaraderie and hopefully, adding to the win column.

But, if you suffer from back, neck or hip pain, the ballpark can be a somewhat uncomfortable experience. A few tips to lessen the aches and pains and avoid having a Bleacher Bum. (Bleacher Bums are the fans in the cheap seats, but it’s also the way your tush feels after sitting on the cold metal bleachers.)

Bring a comfortable seat with you to children’s games. You can purchase portable seating that comes with a carrying sack. These seats aren’t perfect, offering insufficient neck support, but they are typically warmer than the bleachers and at least they have back support. If you cannot tolerate carrying the chair, see if you can leave one with the coaches’ equipment or drop it off as close as you can to the seating area.
If you must sit on the bleachers, many bleachers have a top row with a back. These are significantly more comfortable than the unsupported lower seats; you just have to make your way to the top.
Bring blankets and padding. Bleachers are hard and cold. Putting a cushion down really helps a lot, in terms of protecting your lower back and hips as well as keeping your temperature up.
Walk around as often as possible. Don’t wait for the 7th inning stretch. Walk as often as you need to. Stand on your tip toes. Stretch your arms above and to the side. Bend at your waist. Do a few slow squats. Turn your ankles in circles.
Dress in layers. If cool temperatures are a trigger to headaches, bring multiple layers to stay warm. If you suffer from heat flashes, by all means, wear clothing that can be taken off without leaving you uncovered.
Don’t be a martyr. If the weather is inclement, take a break inside or in your car. Your family will forgive you. And if it’s a Tigers game, forget about the ticket price. Your health is more important and more valuable.
Stay hydrated. Soda and beer aren’t good sources of hydration. Only good old water does the trick. It’s especially important for those patients who take prescription medication and diabetics to maintain hydration when outdoors.
Don’t forget to wear sunscreen especially early in the season when we’re out of practice in terms of encounters with bright sunlight. Hats and sunglasses are important, especially if it’s team swag!
Plan ahead for trips to Comerica Park. If you have trouble walking or climbing stairs, consider your parking plans and seat assignments long before the trip. You may have to trade tickets through the box office for more appropriate locations. Pay the extra money for parking that is more convenient and involves less walking and less exposure to extreme temperature (if they are present).

Exercising (Exorcising?) Your Pain Away

photo by Rudolph A. Furtado

Exercise is good for everybody, even people who struggle with pain. Exercise helps build strength, improves balance, contributes to feelings of well-being through the creation of endorphins and is a significant factor in maintaining appropriate body weight.

Researchers in pain management are circling around three exercises that show promise in contributing to a healthy lifestyle: Pilates, Yoga and Tai Chi.

All three exercise groups are beneficial because:

They include slow, controlled movements.
They don’t involve any sudden movements or jolts, meaning they are low-impact.
They encourage strengthening core muscles, including the trunk as well as limbs.
They help patients focus on breathing.
They often include quiet meditation.

Before you embark on any exercise program, check with your health care team. They will recommend the best practitioners and will also tell you what exercises and positions to avoid, like flexing your back or neck or certain positions that might put too much pressure on hip or knee joints.

Go visit a class or watch a video if you are going to exercise from home. See if the motions look doable to you. Meet with the instructor prior to attending and discuss your exact needs.

During any class or demonstration, follow your doctor’s orders. There is no longer any support for “no pain no gain” exercise regimens. If you are in pain, stop the movement; ask the teacher for some sort of modification or just sit quietly until the group moves on to the next task. On the other hand, do not shy away from a little exertion or a bit of a stretch. It is okay to break a sweat (less likely in Tai Chi, however.)

If you were an exercise lover before your pain episodes, these three exercise types may or may not be a perfect fit for you. For some, Yoga, Pilates and Tai Chi feel slow or contemplative. The music is quiet, but not peppy, and the pace can feel cumbersome. But taking a slow route back to health and wellness is a reasonable detour, before making your way fully back into more vigorous cardiovascular workouts or even weight-bearing strength routines, both of which are crucial components to a lifetime of physical fitness.

Hip Pain Sufferers Should Hit the Water for Relief

New research on arthritis in hips indicates that exercise really can be beneficial and an effective component of a pain management strategy.

Many Americans suffer from osteoarthritis. The major body areas where osteoarthritis is prevalent are in hips, knees and in the back, as well as in the joints of the hands and feet.

People who are at risk for arthritis include older patients, those who have suffered previous injuries to joints, as well as obese patients who experience arthritis at a higher rate in knees and hips.

Recent research on hip pain from osteoarthritis was conducted at La Trobe University in Bundoora, Australia. The researchers, led by Kay M. Crossley, compared the pain relief of patients with hip osteoarthritis following water exercise as well as land exercise.

The water-based exercise appeared to give patients the greatest pain relief in the short-term and long term. The land-based exercise also gave some short-term benefit but did not appear to result in long-lasting pain relief. Both types of exercises were deemed far more effective than manual manipulation without exercise.

The best exercise program appeared to be at least twelve weeks in length, incorporating water aerobics and gentle swimming routines that are designed specifically for hip pain sufferers. The exercises targeted strengthening as well as increased range of motion. The participants participated in the program at least three times per week.

Although these research results would not appear at first glance to be ground-breaking, they are instructive. Many physicians are reluctant to encourage exercises to hip pain sufferers, urging them to rely on pain relief medications and manipulation first. Doctors are aware that not all hip pain sufferers will be willing to exercise. In addition, hip pain sufferers need to exercise with the guidance and supervision of pain management physicians, as well as physical therapists. The best scenario is coaching on specific exercises that can reduce the effects of osteoarthritis.

In general, the studies confirm that bedrest and inactivity are the wrong approaches to joint pain, which improves with regular physical activity and movement.

Avoiding Overuse Injuries

Sometimes our body aches because of the presence of disease, like arthritis or fibromyalgia or various headaches, like migraines. Sometimes, we are in pain because of injuries to the bones or muscles.

There are several common injuries that are typically the result of overuse, either from athletic pursuits, work routines or regular daily life activities. Overuse kind of sneaks up on you. It may start off as a twinge that goes away and over time develops into more constant or consistent pain associated with specific activities.

Frequently occurring overuse injuries are:

Shin Splints (Leg pain which worsens with running or walking)
Tennis Elbow/Golfer’s Elbow (weakness and/or pain inside or outside the elbow)
Runner’s Knee (pain behind the kneecap, made worse with running, walking, jumping, cycling and ascending or descending steps)
Rotator cuff tendinitis (shoulder pain felt when lifting the arms straight up or in a circular motion like a swimming stroke)
Plantar Fascitis (usually felt in the feet and ankles upon first waking up)
Achilles Tendinitis (typically presents as ankle pain)

Overuse injuries are the result of too much exertion, combined with muscle weakness. The major ways to prevent the above injuries include babying yourself a little bit by not hitting the same muscles day after day. When you work out, be sure to warm up before true exertion. Most importantly, after exercising or after a long period of working, take time to stretch and cool down. Be sure you are moving appropriately. Contact a coach or trainer to check your form or consult with a physical therapist to demonstrate what hurts and learn compensating exercising to increase strength, flexibility and reduce pain.

If you are trying to increase exertion or activity, do so gradually, not all in one spurt of activity. If you’ve led a sedentary life, you can’t go from sitting on the couch to running a marathon. Start by adding 15 minutes of exertion and add a maximum of 10 minutes per day.

Being more active is a great goal. Being safe and avoiding overuse injuries should also be a concurrent objective.

Too Hip for Your Own Good? Preventing Hip Pain

Your hip joint is one of the world’s greatest engineering feats: a ball and socket joint that allows for fluid movement. This joint also is surrounded by ligaments and is cushioned by cartilage. Most people’s hips can handle a lot of motion throughout their lives and a significant amount of wear and tear.

But lots of people suffer intermittent or chronic hip pain.

Hips can “wear out”. The cartilage that provides cushioning can erode. Muscles can be overused. And of course, the hip bone can be broken, a common occurrence in elderly patients, whose balance may be compromised and whose bones may be weaker due to osteoporosis.

Not all hip pain can be prevented, especially if the cause is injury or a disease process. But hip pain can be mitigated and hip injuries can also be avoided.

Whenever you use the hip (for example, by going for a run), a cushion of cartilage helps prevent friction as the hip bone moves in its socket.

When you experience pain in the hip or related areas (groin, thigh, buttocks), be aware of what makes the pain feel worse or what makes it feel better. Do you experience relief when you cut back on activity or is your hip pain worse after lying down? Try to be tuned into your body so you can do more of whatever provides relief and less of whatever increases your hip pain.

Some of these suggestions may help:

Maintain an ideal body weight.
Exercise regularly, but always stretch and warm up prior to exercise and stretch and cool down afterwards.
If your pain flares up after exercise, particularly running, ease up a bit.
You can take a non-steroid anti-inflammatory drug when you experience pain or even before it comes on, if you know you are going to be using that hip joint a lot (like before shopping errands, travel, football game days, etc.)
When you sleep, choose a firmer mattress and sleep on the unaffected side with a pillow between your legs. Some people find side sleeping uncomfortable and enjoy more restorative sleep sleeping on their back or on their stomach.
Hip pain is often caused by inflammation of the joint. For this reason, applying ice for 15 minutes as many times a day as you can tolerate is often quite effective, as ice reduces swelling.
Elevate your hip when you lie down to recuperate, using pillows.
Low-impact exercises can aid in flexibility and provide relief. Some of the best choices are yoga, swimming (leisurely or vigorously) and water aerobics.
Resistance training, especially with body bands, can also help to strengthen weaker muscles surrounding the hips.
Wear good-fitting shoes all the time, but especially when exercising.
Runners with hip problems are advised to avoid running on hard surfaces such as concrete and asphalt.

Try to take care of your hips and do your part to maintaining this crucial body part. Obviously, if your pain does not abate or is severe or debilitating, contact your health care team immediately.

Are You Too Hip for Your Own Good?

If your hips are causing you pain and decreasing your mobility, it’s time to give your hips some attention.

Anatomically, your hips are the key to moving and walking around. Your hips are the site where your thigh bones join with your pelvis. The actual hip is a ball and socket joint. The ball (the top of your thigh or femur) is called the femoral head. The femoral head lies within the acetabulum, which is the socket in your pelvis. Ligaments connect the femoral head to the socket.

The hip area, in addition to the ligaments, also has a thin membrane (the synovium), which lubricates the joint.

Outside the bone structure, the hip joint is surrounded by large muscles (the largest in the human body) including your “glutes”, your quadriceps, your hamstrings, muscles that connect to the inner thigh and another set of muscles that connect to your lower back.

Servicing all of these muscles and joints are an intricate network of nerves and blood vessels.

In short, your hips are essential: they are truly the core of your body.

But hips are prone to problems, particularly as we age and if we subject the joints to overuse.

Some of the causes and related symptoms of hip pain are:

Osteoarthritis (pain and stiffness, often worse after periods of inactivity)
Rheumatoid arthritis (pain and swelling at the hip joints)
Ankylosing spondylitis (very commonly affects the hip joints)
Lupus (inflammation of the joints as well as organ systems)
Lyme disease (caused by a tick bite)
Sciatica (a sharp, shooting pain down the lower back, hip and leg to the foot, often caused by a compression in the vertebrae)

Hip pain can be addressed in multiple ways:

Physical Therapy to help build strength and endurance in order to maintain the flexibility and stability of your spine
Medication, including anti-inflammatory drugs
Steroids (oral or injected)
Chiropractic adjustment and treatment
Massage therapy
Pain psychology to deal with other issues that can worsen pain like life stressors, anxiety and depression
Transcutaneous Electrical Nerve Stimulation (TENS), which utilizes electrical stimulation of muscle tissue to relieve pain
Acupuncture
Surgical intervention, including total joint replacement (indicated when the joint is severely degraded, typically from arthritis or injury)
Walking aids like a cane or walker.

Hips are a crucial working component of our bodies. It’s important to understand how they function, what can cause pain in the hips as well as some non-surgical and surgical methods of relieving hip pain.

Next week: How to prevent hip pain

Pregnancy and Pelvic Girdle Pain: No Need to Suffer

Pregnant women may not have heard of the term pelvic girdle pain, but many women have experienced this condition.

The pelvic girdle refers to a ring of bones at the base of the spine. Pelvic girdle pain is felt in the front or back of the pelvis. Other symptoms include pain in the lower back, hips, groin, pubic region, pain in the thighs and knees and clicking or grinding sounds made in the pelvis area, which can be exacerbated with certain movements of the legs and hips. Pain can range from mild pain to severe pain.

Pregnancy can put a great deal of stress on the pelvic girdle, which can cause weakness and instability; as a result 20% of pregnant women experience pelvic girdle pain.

The good news: pelvic girdle pain during pregnancy is treatable throughout the pregnancy. Even better news: the treatment is safe for the growing baby. Women do not need to suffer needlessly when they experience pelvic girdle pain.

If you experience pelvic girdle pain, contact your health care provider. In the meantime, you should be aware of some typical treatments:

Avoiding movements that seem to contribute to the pain. For instance if moving your legs apart laterally tends to produce clicking or pain, avoid that position. Adapting to this temporary condition may require consultation with a physical therapist with whom you can discuss your regular activities, including exercise. You may also need to discuss sex and sex positions with your physical therapist.
Exercises can also be prescribed which reduce pain, increase flexibility and strength. Swimming is a great exercise, which is easy on all of your joints. In addition, the water temperature and the feeling of weightlessness can be quite therapeutic.
Chiropractic manual therapy is often quite successful in addressing pelvic girdle pain issues.
Acupuncture is another complementary therapy that can bring immediate as well as long term relief.

Looking ahead: most women with pelvic girdle pain are able to have a vaginal birth. In addition, 90% of pregnant women who experience pelvic girdle pain are “cured” once the baby has been delivered. One caveat: future pregnancies have a higher chance of also including pelvic girdle pain.

Hitting the Road without Hitting the Pain Pills

Our Michigan weather seems to have turned the corner. We’re not quite wearing shorts yet, but maybe we can put the snow shovels towards the back of the garage. Is now the time to plan for a quick weekend getaway to see friends or family or an even longer spring break trip?

Road trips are more economical than airplane rides. But extended car trips do pose a risk for people who experience pain. Extended driving or riding time can exacerbate pain in the back, neck, shoulders, legs, knees and ankles.

Here are some tips to hit the road without exacerbating your current pain issues or creating new ones:

Adjust your seat (and bring along accessories) to ensure that you can maintain proper posture. Remove everything from your back pockets like wallets and cell phones. Bring a pillow or rolled towel and place it in between your lower back and the seat to provide additional support.
Start with good posture when driving. Your arms should be bent at the steering wheel and your knees should be bent too. It is a mistake to sit too far away. This adds extra strain on nearly every part of the body.
Support your head. Adjust your head rest so that it touches the middle of the back of your head. You want to do everything you can to avoid having to lower your neck or lift it up. Ideally, you are looking straight ahead with some neck support.
Wiggle! Staying still is not ideal, believe it or not. Instead, shift your body around, even lift up an arm occasionally and push it on the car roof, doing a little isometric exercise. Roll your neck and shoulders. Shift your hips to the left and to the right and tilt your pelvis back and forth.
Exercise at every stop. When you stop to use the restroom, utilize this extra time to stretch. Walk around for a few minutes (inside or outside, but briskly). You should also stretch out your arms above your head and by crossing the midline of your body. If you can do so, deep squats, done slowly, can also be restorative.
If you are already in pain, stretch cautiously. Although stretching will generally be helpful at rest stops, if you are already experiencing pain, don’t start vigorous exercises the second you get out of the car. You will already be stiff and somewhat inflexible. Give yourself a few moments to slowly “unwind” and only then try small movement stretching exercises (Extending your back, stretching arms to the sky, bending into a half squat are all small movement standing exercises.)
Be a backseat driver. If you are the rider and you begin to experience pain, lie down for a stretch in the back seat so you can change your position and get some relief.
Break up the driving. While lots of people can take on a 10 hour drive, your pain threshold may preclude this. Do not feel guilty about dividing your trip into smaller, bite-size portions.

Help! My Hips Hurt After I Exercise

Hip pain under any circumstance is no fun. Hip pain that occurs as a result of trying to take care of yourself is even more annoying.

But, not all hip pain is the same. There are sources of hip pain that may preclude exercise, like deteriorating hip joints and of course fractures. But many, many people can safely walk, run, play golf or tennis or swim and keep hip pain at bay with simple exercises.

There are several muscles that function within the hips. The muscles that we are focusing on here include:

The gluteus medius, which is the main abductor (which means it is working when you pull your thighs apart) and external rotator of the hip.
The gluteus maximus extends the hip and assists with abduction and external rotation.
The tensor fasciae latae (TFL) is an abductor of the hip, and also helps with internal rotation
The piriformis, which abducts and laterally rotates the femur (the thigh bone)

Consider adding these stretching and calisthenic exercises prior to and after exercising or even on intermediate days if you run or walk on an every other day basis:

Clamshells: Clamshells are not difficult and require no equipment. Lie on your right side with your knees bent in front of you and your legs stacked on top of each other. Bend your right elbow and rest your head on your elbow. Slowly open up the top left leg (like a clamshell) and close that leg again. Repeat this for a total of 10 times. Then turn to the other side, lying on your left side and opening up your right leg. To increase the difficulty, you may wrap an exercise band halfway between your knees and hips to add some resistance. Try to eventually do 30 clamshell repetitions on each side.

Side leg lifts: Lie on your right side with your legs extended in a straight line, with your left leg stacked on top of your right. Bend your right elbow and rest your head on your elbow. Slowly lift up your left leg, keeping the leg straight (do not bend the knee). Count to five and then bring your leg down. Repeat this 15 times. Then turn to the other side, lying on your left side and lifting up your right leg. To increase the difficulty, you may wrap an exercise band halfway between your knees and hips to add some resistance. Try to eventually do 30 side leg lifts on each side by repeating this exercise once more on each side.

One legged Glute lifts; this can also be called the one-legged bridge. Start by lying on your back with your knees bent and your feet firmly on the ground. Slowly do 5 pelvic lifts, counting to 4 each time, lifting your lower back off the ground, using your thighs to support the action. Now lift up your left leg into the air and continue to lift your pelvis for 4 seconds with just your right leg. Repeat for a total of 10 times. Bring your left leg down and do the entire activity from the beginning, but lifting your right leg. Try to eventually do a total of 30 glute lifts on each side, by repeating this exercise two more times per side.

Piriformis stretch: Sit up with your legs in front of you and your hands slightly behind you. Bend your left leg and cross it over your right thigh. Hold onto your left knee with your right hand. Now turn your shoulders towards your bent knee. Count for 10 seconds, breathing slowly. Place your left leg down. Now, bring up your right leg and bend it, and cross it over your left thigh. Hold onto your right knee with left hand. Turn your shoulders towards your bent knee, counting for 10 seconds, breathing slowly.

Hip pain should not be ignored. If your hip pain does not seem to go away, please contact your health care provider.

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