The hip is a ball and socket joint that attaches the thigh to the pelvis. While many causes of hip pain can arise from the joint itself, pain can also be referred from other areas such as your low back, hip or pelvic muscles. 

Hip issues may cause pain in your hip, buttock, thigh, groin or sometimes even your knee. Finding the source and exact cause of pain requires a skilled assessment from a trained physiotherapist.

Common causes of hip pain

Bursitis (Inflammation of the Bursa) – Bursae are sacs of liquid decreasing friction between tendons and bones.  The trochanteric bursa for instance, is a fat-pad on the outside part of your hip that serves to protect muscles and tendons as they cross the outside bony prominence of your hip. When this bursa is exposed to excessive stress (like a fall) or repetitive strain (for instance from a weak muscle) it can get inflamed causing pain.

Osteo-Arthritis – Osteoarthritis affects 1 in 9 Canadians to varying degree and is a common cause of hip pain and stiffness. Osteo-arthritis of the hip is associated with inflammation of the hip joint, leading to breakdown of the cartilage, stiffness and pain.  Generally there is a progressive sensation of pain, stiffness and in some cases a grating sensation from the hip.

Sacroiliac joint disorders (SI-Joint) – The SI-Joint is part of the bony structures that give stability and load transfer ability to the pelvis. It is provides a transition of forces between the mobile hip joints and the stable lumbar joints. 

The SI-Joint can be a common pain-source before, during and after pregnancy and can be injured in serious traumatic events.  SI-Joint problems are relatively rare and pain in its area does not always imply a problem with the SI-Joint.

Tendinitis/Overuse Injuries – Hip pain can also arise from injuries where muscles, tendons or ligaments become inflamed.   Tendinitis is an inflammation of the tendons usually caused by repetitive or excessive stress without enough recovery time.

Hamstring/groin strains – Hamstring and groin strains (pulled groin) are commonly seen in athletes (hockey, soccer, baseball, gymnastics etc). 

Symptoms can include pain in the groin area, the inside or back of your thigh and buttock. Symptoms generally are a sharp pain, aggravated by pushing off of the affected leg with running or skating.

Depending on the severity of the injury, these muscles can be strained or torn and can limit a player’s ability to return to their sport for weeks or months if not treated properly.

Muscle imbalances – The pelvis and hip joint can commonly suffer from problems related to imbalances of strength, flexibility or muscle weakness syndromes originating from your spine, pelvis, hip knee or even ankle areas.

Finding the source of pain is important to alleviate your symptoms initially, but finding the cause of why pain started and continued is essential in making sure your problem doesn’t re-occur in the future. 

Hip Fractures – A fall is the most common reason that people fracture a hip.  A hip fracture refers to a fracture of the upper part of the femur (thigh bone).  Fractures will need to be followed by a medical Dr (E.R. or G.P.) as to ensure they are stable, safe or require surgery for optimal recovery.  Once your Medical Physician has deemed the fracture “stable”, referral for a physiotherapy evaluation and treatment plan may be recommended.

Labral Tear – This is a tear in the ring of cartilage (labrum) located on the outside rim of the socket of your hip joint.  This labrum acts like a rubber seal to help hold the ball of the femur securely within your hip socket.

Athletes/people who perform repetitive twisting movements are at higher risk of developing tears in this structure. Pain is typically felt in the groin area and can be accompanied by the sensation of the joint ‘catching’ or ‘locking’.

Prenatal/Postpartum Pain – Many pregnant women or those who have just given birth can experience hip or pelvic pain.  Generally this is caused by laxity as a result of the natural hormone “RELAXIN” being released.  The pressure of the baby on your back and pelvis as well as the strain on the pelvic joints and muscles can lead to pelvic pain, difficulty with physical activity and/or incontinence.

Inguinal Hernia (Sport hernia) – A hernia (a small protruding tear) of the abdominal wall may cause pain in the front of your hip and groin.  Inguinal (groin) hernias are most common while femoral hernias arising from a canal near the hip joint are possible but less common.

Physiotherapy treatment

Physiotherapy management of the above conditions has scientifically been proven to be helpful to improve pain, help in recovery with acute or chronic hip-pelvic symptoms.

Treatment administered by a registered physiotherapist can include hands-on treatment, education, self-care management, exercise therapy or modalities is effective in managing hip and pelvic pain. Other treatments such as acupuncture, soft tissue release and massage therapy may also help.

A registered physiotherapist can conduct a skilled assessment and examination of the hip and pelvis; initiate appropriate treatment or suggest the need for further follow-up.