When you swing your leg over the side of a bicycle or get in or out of a car, the incredible power and range of motion of your hips are at work. The intricate design of these ball-and-socket joints gives them both the flexibility to let you sit, stand, run, and climb stairs and the stability to support the weight of your body in any movement you’re currently undertaking.
These major weight-bearing joints are equipped with a variety of anatomic features that help us maintain stability and mobility. Though naturally sturdy, your hips can fall prey to overuse, injury, or disease. If something goes wrong with them, your ability to perform daily activities may be significantly diminished. Because of the central location of the hips, hip dysfunction can affect your lower back and legs—and lower back and knee dysfunction can affect your hips. What’s more, hip pain that causes you to limp can place stress on other joints. Below are some common conditions that affect the hips.
Osteoarthritis is the most common cause of hip pain in individuals after age 55. It’s the result of gradual wear and tear on the cartilage that lines the joint. Inflammatory forms of arthritis such as rheumatoid arthritis, ankylosing spondylitis, and lupus can also affect the hip. The cause of inflammatory arthritis is unknown.
What it feels like: Pain in the groin or outer thigh that starts slowly but gradually worsens. The pain typically increases when you move and eases up when you’re at rest. As joint damage progresses, the hip will hurt even when you don’t move it. Other signs are morning stiffness and reduced movement in the affected joint.
Bursitis is inflammation of the bursae, fluid-filled sacs that reduce friction between bones, skin, and soft tissues to ensure smooth movement. Hip bursitis often affects the greater trochanteric bursa, which covers the bony protrusion jutting out from the upper part of the thighbone or the iliopsoas bursa in the front of the hip. One cause of bursitis is an abnormal gait, which can be a result of stiffness in the lower back, knee arthritis, an ankle sprain, or different leg lengths. An abnormal gait can put enough pressure and friction on the area to cause bursitis.
What it feels like: Pain on the outside or front of your hip, tenderness, or a catching sensation when you move it. You might not be able to sleep on the affected side.
Several major muscles work in tandem to move the hip. Tendons attach these muscles to bones. Overuse or injury can stretch or tear muscles, resulting in a strain. Tendons that are overused or injured can lead to tendinitis.
What it feels like: Hip pain that worsens when you move your leg in one direction or with continued activity. Tendinitis can produce a snapping or clunking sound.
A hip fracture is a break in the upper thighbone. Bones can gradually become weak from a disease like osteoporosis (fragile, brittle bones) or break on impact from a fall or other injury. Fractures aren’t always obvious: An occult hip fracture is one that’s “hidden,” meaning that it doesn’t appear on routine X-rays. As a result, it can be easy to miss and hard to diagnose.
What it feels like: Sudden, severe pain along the front and side of your hip or groin after a traumatic injury. The pain may worsen with activity and when you try to put weight on or rotate the affected hip.
The lateral femoral cutaneous nerve travels from your spine through your pelvis and upper thigh and supplies feeling to your thigh’s skin. Meralgia paresthetica occurs when there’s increased pressure on the nerve. Compression can be caused by obesity, tight clothes around the area, or scar tissue, such as from past surgery. It’s also more common in people with diabetes.
What it feels like: Numbness, tingling, or burning pain over the upper outer thigh.
“Necrosis” refers to the death of tissues. In osteonecrosis, poor blood flow causes the affected part of the bone to die if left untreated, resulting in joint destruction. It can develop in people who use corticosteroid drugs or overuse alcohol, for example. It’s less commonly associated with a fracture that cuts off blood supply.
What it feels like: Pain in the groin, thigh, or buttocks, depending on the bones involved. Pain may intensify when you put weight on the hip or move it.
Pain felt in a part of the body from which the cause doesn’t originate is called referred pain. Sometimes hip pain doesn’t stem from the hip joint and instead originates in the knee or lower back. For example, a herniated disk, a slipped vertebra (spondylolisthesis), or a narrowing in the spine can compress a nerve and cause pain in the hip. Hip and spine problems often coexist. In a 2018 study in the journal Archives of Physical Medicine and Rehabilitation, nearly 54 percent of older people with chronic low back pain had at least one hip symptom.
What it feels like: Hip pain accompanied by a pins-and-needles sensation or pain in the back, buttocks, or legs.
How to protect your hips
You can reduce the likelihood of developing hip problems with these strategies to help strengthen muscles, maintain flexibility, prevent falls, slow bone loss, and reduce osteoarthritis risk:
- Get an adequate amount of physical activity. Get at least 150 minutes a week of moderate-intensity aerobic activity (brisk walking, dancing, or housework) or 75 minutes a week of vigorous-intensity activity (running, tennis, or high-intensity fitness classes). Combine moderate and vigorous activities during the week to mix it up. For example, walk briskly for 35 minutes twice a week and jog at higher intensity for 20 minutes twice a week.
- Incorporate weight training. Do muscle-strengthening exercises at least twice a week. The exercises should involve all major muscle groups—arms, shoulders, chest, back, abdomen, hips, and legs. If one muscle group is much stronger than the opposing group, it can disrupt the joint’s natural range of motion and lead to injury. For example, tight hip flexors inhibit the opposing buttock muscles, which can lead to a destabilization of the lower back.
- Stay balanced. Take up activities that will improve your balance, such as tai chi or yoga, to reduce your risk of falls and associated injuries. Other balance exercises include walking backward, standing on one leg, and using a wobble board.
- Fall-proof your environment. Eliminate clutter and remove tripping hazards such as loose wires and throw rugs. Wear sensible shoes or slippers with nonslip soles. Use a walking aid such as a cane if you feel unsteady on your feet.
- Get your bone density tested. The U.S. Preventive Services Task Force recommends that women be screened for low bone density with dual-energy X-ray absorptiometry (DXA) at age 65. It also advises DXA for younger women whose risk factors for fracture put them on par with a 65-year-old woman who has no additional risk factors. Because of insufficient evidence, the Task Force has no screening recommendation for men who have had no previous fracture. But several other medical groups recommend that men be screened with DXA at age 70, or earlier if they are at elevated risk for fractures.
- Check your meds. Ask your doctor to review your medications to see whether they may be taking a toll on your bone density or potentially causing dizziness or sedation, putting you at risk for falls.
- Eat for healthy bones. Consume foods rich in calcium and vitamin D—sardines, broccoli, and low-fat milk and yogurt are good options.
- Maintain a healthy weight. Excess weight can take a toll on joints.
- Limit alcohol use and don’t smoke. Heavy drinking and cigarettes can reduce bone density.
This article first appeared in UC Berkeley Health After 50.
Published September 17, 2019