What is the Cause of My Hip Pain?

By: Kathleen A. Hogan, MD

Your hip is hurting. Walking, sleeping, everything seems to cause your hip to hurt. The pain must be coming from your hip joint, correct? Perhaps. Sometimes it can be surprisingly difficult to determine what joint is the primary source of pain.  Hip arthritis can cause back, hip, and knee pain. Arthritis of the spine can cause back, hip, and leg pain. If X-rays show arthritis in multiple areas, how can your physician determine the primary source of pain?

The first step is to pay attention to your symptoms so that you can describe them accurately to your doctor. When do you hurt? All the time or just when you are walking?  Where do you feel pain? Is it down the leg, in the groin, or on the outside of the hip? Do you have numbness or pins and needles in your legs?   Is the pain better when you walk with a shopping cart in the grocery store? Does the pain start after you walk a specific distance? These are some questions that your doctor may ask to help to determine where your pain is originating from.

Causes of Hip Pain

What are some causes of hip pain? Pain from hip arthritis is typically located in the groin and may radiate down to the knee.  Some patients have limited motion of the hips with difficulty putting on shoes and socks, and pain that is predominately in the back or in the knee.   Bursitis around the hip can cause pain on the outside of the hip.  It can be very painful to sleep on ones side.  Sometimes the hip may feel like it is going to give out.  Disc herniations in the back can cause pain that radiates down the leg. Depending on the location of the disc herniation, the pain may go into the groin. Spinal stenosis is caused by the narrowing of the space for the nerves in the back due to arthritic changes.  This can cause pain that radiates down both legs. Pain from spinal stenosis is often improved when you lean forward (on a shopping cart, for example).  Back and hip pain can often be caused by muscle weakness or tightness as well.

Diagnosing Hip Pain

In order to help determine the cause of your pain, your doctor may choose to order X-rays of your hip and/or back.  X-rays are very good at showing bony abnormalities and for the diagnosis of arthritis.  Sometimes an MRI can also give helpful information.  MRI’s will show disc herniations, tendon injuries, and bony abnormalities such as avascular necrosis.  However, an abnormal finding on an X-ray or MRI may or may not be the source of your pain.  Cortisone injections can provide pain relief and also help determine if the abnormalities on the imaging studies are causing your pain. Physical therapy is often helpful if muscle imbalance or weakness is contributing to the pain.  Not all pain is arthritis and not all patients with arthritis require surgery.  If you are having hip pain that keeps you from doing things you enjoy, talk to your doctor and get evaluated to find out where the pain is really coming from and what can be done to get you back to doing the activities you enjoy.