Hip pain shows up in the chiropractic office on a regular basis. Sometimes it is the main problem. But often it is secondary, mentioned while talking about some other issue.
Usually, as a chiropractor, I have them point to the pain to make sure we are all on the same page.
Many people don’t remember high school anatomy. Often they point to their low back or sacroiliac joint for what they are calling hip pain.
What the patient thought was a hip problem is a straight forward back problem. The pain may be traveling to the hip, but this is because there is a pinched nerve in the back. Or a muscle problem in the back.
Knowledge of the pelvis can help with understanding the hip.
The pelvis consists of several bones:
- The sacrum
- The coccyx
- The ilium
- The ischium
- The pubis.
They are all fused together making up one bone.
The bottom of the pelvis is the pelvic basin or girdle. It provides support and protects the abdominal organs.
The pelvis also transmits forces downward from the head, the arms, and the torso to the legs.
It does this by forming special joints. These joints often can be a source of pain that feels like hip pain.
The joints involved in the pelvis are:
- The lumbosacral joint in the low back at the L5S1 level
- Two sacroiliac joints on either side of the pelvis
- The sacrococcygeal joint
- The symphysis pubis
- Two hip joints on either side called acetabulofemoral joints
The hip joints are the most stable joints in the body.
They consist of a ball, the femoral head, and socket, the acetabulum.
The joint is also surrounded by a tough, fibrous sleeve or capsule which helps hold it together. The capsules lined with the synovium. This tissue produces synovial fluid. The fluid nourishes the cartilage and lubrication of the joint.
The hip joints are also the most mobile single joints in the body.
The hips are capable of six ranges of motion. This is a lot. Compare the elbow that has only two. The ranges of motion are:
- Rotating inwards and outwards
- Abduction and adduction (like the ways the legs move during a jumping jack)
This allows the hips to perform important functions such as:
- Transfer the large forces between the trunk of the body and the ground
- They help in the movement of the body when walking
- Both hips take part in elevating and lowering the body, for example rising from a chair
- The hip brings the foot upward toward the body, for example, when putting on a shoe.
With each step, the muscles surrounding the hip must do a balancing act. They must create a force to balance over 80 percent of the body’s weight (the head, the torso, the arms, and the opposite leg).
When this occurs the hip joint sustains over twice the body’s weight with each step.
So What Causes Hip Pain?
Different types of arthritis
Arthritic changes in the hip joint can be a source of pain in some circumstances. The most common forms of arthritis that affect the hips are:
Osteoarthritis or degenerative joint disease
This type of arthritis is the most common. It occurs when the cartilage that is at the end of the bones begins to wear down.
This type of arthritis is due to an infection in the joint from a bacteria, virus, or fungus. It usually starts very quick and is very painful. Bacteria are the most common cause and often travel through the bloodstream to the hip. They often come from another infection site (like a urinary tract infection). It can also occur if the hip experiences some type of puncture wound. Because there is an infection, there can also be other infection signs. Signs like fever, redness around the joint, swelling and the hip can feel warm.
Immune system arthritis
Like septic arthritis, this is again a reaction as if there were an infection. But instead of an infection, the body is attacking its own tissues as if they were a germ. The most common causes are rheumatoid, psoriatic, lupus, and ankylosing.
There can also be injury to the hip
The most common injuries to the hip:
This is a rare hip injury because the hip is so stable. But if forced the ball of the hip joint can move outside of the cup of the hip joint, causing immediate hip pain.
The hip can fracture with the trauma of a fall. As we grow older or with certain medications, the risk of fracture can increase.
The cartilage ring around the hip socket, called the labral, can tear. When torn it is painful.
Strain or sprain
The tissues of the hip joint are muscle, tendon, fascia, and cartilage. They can become strained or sprained if placed under too much stress.
There are fluid-filled sacs around the hip joint. They are bursae and help cushion tendons lying against the bone. When inflamed through trauma, overuse, or incorrect use, they become painful.
This can come from an injury or overuse. The tendons, which are chords that attach muscle to bone become inflamed. This inflammation causes hip pain.
Pinched nerves and other conditions not related to the hip
This type of problem can irritate the nerve roots that leave the low back and service the hip joint and leg. This can create pain traveling to the hip. When the disc ruptures it can place pressure on the nerves traveling down the leg. When this occurs it usually involves the sciatic nerve.
The sciatic nerve when irritated can cause pain in the back, buttocks, hips, even the leg. Hip pain is a commons symptom of sciatica.
This again relates to a pinched nerve causing hip type pain. It also involves the sciatic nerve. It is usually caused by degenerative changes in the lower spine. This narrows the holes where the nerves come out to travel down to the hips and legs.