Hip and leg pain is a common ailment that can be caused by a wide variety of problems. The hip joint is a large, weight-bearing joint on each side of the pelvis that attaches the large leg bone (femur) to the pelvis. The top of the femur is shaped like a round ball that fits into a socket (acetabulum) formed by the pelvic bone. This ball and socket joint allows fluid movement (walking, running, and sitting) as the ball glides and rotates within the socket.
As the largest weight-bearing joint in the human body, the hip provides stability by bearing the weight of the body while also withstanding repeated motion. Despite its durability, however, the hip joint can wear down or become damaged due to age, use, or trauma. Sports-related injuries, accidents, and falls in the elderly can injure or even break hip bones; and, arthritis can cause severe hip pain.
Affect the entire hip or leg, or a localized area.
Be stabbing, sharp, dull, aching, or tingling.
Some hip and leg pain may be merely annoying; however, more severe pain can affect a patient’s ability to walk or bear weight on the leg or hip.
The precise location of hip pain provides the doctor with valuable clues about the underlying cause. Problems within the hip joint itself tend to result in pain on the inside of the hip or groin. Hip pain on the outside of the hip, upper thigh, or outer buttock is usually caused by problems with muscles, ligaments, tendons, and other soft tissues that surround the hip joint.
What Causes Hip and Leg Pain?
Hip and leg pain can be the result of several factors. Abnormalities of the skin, nerves, bones, joints, blood vessels, and soft tissues around the hip can all result in pain. The most common causes of hip pain are wear and tear, overuse, and injuries. Sometimes, diseases that affect other joints in the body, such as the inflammation resulting from arthritis, can be the cause of hip pain. And, different types of hip and leg pain can be traced to problems in the lower spine.
Some of the conditions that commonly cause hip and leg pain include:
Arthritis is the most common cause of hip pain, especially in older adults. Arthritis leads to inflammation of the hip joint and the breakdown of the cartilage that cushions the hip bones. Patients with arthritis feel gradually worsening pain and stiffness that reduces the range of motion in the hip. Three types of arthritis that commonly affect the hip include the following:
Osteoarthritis is a “wear and tear” type of arthritis involving cartilage that cushions the bones of the hip. The bones rubbing together is the source of the pain and stiffness.
Rheumatoid arthritis is a disease in which, for unknown reasons, the connective tissue that lines the hip joint (synovial membrane) becomes irritated and produces too much fluid. The excess fluid damages the cartilage, resulting in pain and stiffness.
Traumatic arthritis is often the result of an injury or fracture of the hip. Each year, more than 300,000 people suffer a hip fracture in the United States.
Avascular necrosis (also called osteonecrosis) is a condition that occurs when there is loss of blood to the bone, causing bone tissue to die and leads to the breakdown of the hip joint. The condition can be the result of a hip fracture or dislocation, or from the long-term use of high-dose steroids (such as prednisone), as well as other causes. Although it can affect other bones, avascular necrosis most often occurs in the hip.
Bursitis is the inflammation or irritation of the bursa, which is a sac filled with lubricating fluid between bone, muscle, tendons, and skin that decreases friction and irritation. The inflammation is usually from repetitive activities that overwork or irritate the hip joint and therefore cause pain.
Cancer (tumors) that start in, or spread to, the bone can cause pain in the hips or legs.
Hip labral tear. This is a rip in the ring of cartilage (labrum) that follows the outside rim of the socket of the hip joint. Along with cushioning the hip joint, the labrum helps hold the ball at the top of the thighbone in the hip socket. Athletes and people who perform repetitive twisting movements are at higher risk of developing this problem.
Hip pointer. This is a bruise or tear in the muscle that connects to the top of the ilium (the crest of the pelvis, just below the waist). A hip pointer can occur after a blow, fall, or quick twist or turn of the body.
Hip fracture. This is typically a break in the upper quarter of the femur (thigh) bone. With age, bones tend to become weak and brittle; therefore, people over age 65 are most at risk of a hip fracture.
Meralgia paresthetica is characterized by tingling, numbness, and burning pain in the outer part of the thigh. It is a chronic neurological disorder of the lateral femoral cutaneous nerve which supplies sensation to the surface of the outer thigh, and is most common among people who are pregnant or have diabetes.
Muscle or tendon strain. Activities that repeatedly place a strain on the muscles, tendons, and ligaments that support the hips can become inflamed from overuse and cause pain. A strain can prevent the hip from working normally.
Occult hip fracture. This condition is a fine crack in the hip socket that is most common in elderly women and those with osteoporosis. The condition usually occurs in just one hip.
Paget’s disease is a genetic disorder that causes enlarged or deformed bones of the hip. The condition usually causes pain in both hips.
Primary septic arthritis is an infection within the synovial fluid of the hip (reduces friction between the joint and cartilage). The condition is rare in adults, except for those who have a compromised immune system or an artificial hip. Only one side of the pelvis is affected, and the onset of pain is usually rapid.
Radiculopathy is a nerve disorder brought on by pressure or irritation of a nerve at its root (near the spine), often resulting from degeneration of a spinal disc, joint degeneration, or osteoarthritis, among other causes.
Sacroiliac joint dysfunction is an uncommon neurological condition of the sacroiliac joint of the hip, brought on by previous trauma from an accident. The pain is usually on only one side.
Sciatica is a condition most often brought on by damage to the lower lumbar (L4 or L5) nerve roots but sometimes results from inflammation or tension in the piriformis muscle of the pelvis (piriformis syndrome). The pain usually only occurs on one side, but may occur on the other side on various occasions, or (rarely) both sides simultaneously.
Snapping hip is a condition accompanied by an audible “snap” when the hip joint moves while walking or standing from a seated position, which is caused by a muscle or tendon moving over a bony protrusion in the hip. The condition usually occurs in only one hip.
Tendinitis is an inflammation or irritation of a tendon, a thick band of tissue that attaches bone to muscle. It is usually the result of repetitive stress from overuse.
Transient (or acute) synovitis of the hip (also known as “irritable hip”) is the most common cause of hip pain and limping in children (3-10 years old) due to an inflammation of the lining of the hip joint. The cause is unknown but may occur after an injury or fall. The pain is usually only on one side.
What are the Symptoms of Hip and Leg Pain?
The symptoms of hip and leg pain depend on the condition that’s causing the pain. Generally, the pain is a discomfort in the thigh, inside or outside of the hip joint, groin, or in the buttocks. Depending on the cause of hip pain, the pain may occur when walking, running, or engaging in activity. Some people develop a limp from persistent hip pain. Along with pain, there can be a reduced range of motion.
The pain and discomfort may originate from other areas of the body, such as the back, and radiate into the hip. The pain may also become worse over time, especially if the cause is arthritis.
How is Hip and Leg Pain Diagnosed?
The diagnosis of hip and leg pain is often difficult because many of the symptoms are similar to other conditions. The first step in diagnosing the cause of the pain is a comprehensive history and physical exam. Some of the more common questions a doctor will ask include:
Where is the pain located?
How long has the pain been there?
What was the patient doing when the pain was first noticed?
Is there anything that alleviates the pain?
Is the patient currently taking any medications for the pain, and are they effective?
Is there any family history of arthritis or other autoimmune diseases?
After reviewing a patient’s medical history and conducting a physical exam, the doctor may order laboratory tests and radiological imaging. The imaging may help the doctor see if there is damage to the hip joint. Some of the conventional imaging techniques include:
X-rays are a form of electromagnetic radiation used to produce images of internal tissues, and are especially effective producing images of bone. They are commonly used to assess bone fractures, injuries, and joint abnormalities.
CT scan. This diagnostic test combines X-rays with computer technology to produce cross-sectional views of the body, producing detailed images of the body, including the bones, muscles, and organs.
MRI scan. This diagnostic test uses large magnets and a computer to produce detailed images of structures within the body. An MRI displays more detail than a CT scan and X-ray.
Some of the laboratory tests your doctor may order include a complete blood count (CBC), urinalysis, and a white blood cell count (WBC).
And in some cases, the doctor may order an arthrocentesis (joint aspiration) to obtain synovial fluid (joint fluid) for diagnostic lab testing, to alleviate pressure and relieve joint pain, or both.
How is Hip and Leg Pain Treated?
There are many treatment options for severe cases of hip and leg pain. Depending on the cause, treatment usually begins with conservative methods that include having the patient remain active and participate in physical therapy, in addition to taking NSAIDs or acetaminophen (Tylenol).
A good home remedy for hip pain is holding ice to the area for about 15 minutes a few times a day, and allowing the hip or leg to rest as much as possible until it feels better. Sometimes heating the painful area can also help reduce pain.
If the cause of the pain is arthritis, exercising the hip joint with low-impact exercises, stretching, and resistance training can reduce pain and improve joint mobility. Physical therapy can help improve the hip stability in osteoarthritis patients, and help increase the range of motion.
If hip pain is the result of muscle or tendon problems, osteoarthritis, or tendinitis, relief can usually be found with over-the-counter pain medications. Rheumatoid arthritis treatments can also include prescription anti-inflammatory medications, such as corticosteroids and biologics that target the immune system.
A joint injection of corticosteroids is also helpful for patients with symptoms suggesting arthritis. This minimally-invasive procedure can help relieve pain by reducing the inflammation and numbing the joint. The injection has long-acting effects for many patients.
When the pain of osteoarthritis becomes severe enough to deform the hip joint, a total hip replacement (arthroplasty) may be a consideration. And, in cases of a hip fracture, surgery may be necessary to repair the fracture or replace the hip.
There are many more available treatments, dependent on the specific cause of the pain. Because each person suffering from hip or leg pain is unique, an individualized pain plan is necessary for every patient.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating hip and leg pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.