Hip pain during exercise is common among young and active people. The most important thing is to determine the cause. An accurate diagnosis is essential to be able to guide treatment.
What causes hip pain?
There are a number of different reasons that can cause hip pain particularly in those under the age of 40. This can be due to biomechanics and overuse type injuries. It can also be due to femoroacetabular impingement (FAI), labral tears or even early osteoarthritis.
Hip pain can be coming from the ball and socket joint itself, but also the soft tissues within the joint or the muscles and tendons around the hip joint. Pain can also be caused from problems coming from the back and the knee.
How do I find out why I have hip pain?
The majority of causes of hip pain can be identified by a person’s symptoms, examination findings and also using X-rays. An MRI scan can then help to confirm the diagnosis and guide treatment. Sometimes an ultrasound scan and an injection can be used to confirm the origin of the pain.
A common reason for patients to see a hip specialist is due to femoroacetabular impingement. This is where either the socket is either too deep which restricts movement or where the ball is too large to fit within the socket. It can also be a combination of both.
Impingement can cause pain but it also can lead to tissue damage within the hip joint such as labral tears and articular cartilage damage which is the start of early hip osteoarthritis.
What is Femoroacetabular Impingement (FAI)?
Femoroacetabular impingement is diagnosed based on the information obtained during about the symptoms, examination findings and the results of X-rays. An MRI scan can be useful to confirm the presence of a labral tear and to ascertain the degree of articular cartilage damage. This helps to predict the outcome of treatment.
FAI tends to affect active young people but can present at any age. There appears to be a genetic component, but is also associated with people who were very active as an adolescent.
People will present with pain, particularly in the front of their hip or groin. It can be made worse when sitting down for a long period of time, certain positions or with activity.
The pain can go into the buttock, lower back or down the leg. It is important to see a specialist if you have had symptoms for more than three months which have not improved with physiotherapy and an exercise-based rehabilitation programme.
An early diagnosis can improve the outcome of treatment and may mean that hip preservation surgery can be offered.
What are the treatment options for FAI?
Treatment options for femoroacetabular impingement include activity modification and an exercise-based rehabilitation programme. Injections can be used, however, these are more helpful in confirming the diagnosis. Repeated steroid injections into the hip would not be a recommended treatment as this can lead to further deterioration of the articular cartilage. Other injections such as PRP (platelet-rich plasma) have been used with varying success and evidence.
If the hip joint is determined to have too much wear, then a hip replacement or resurfacing may be discussed.
Hip preservation surgery, in the form of hip arthroscopy, aims to reduce the patient’s symptoms. There is growing evidence to suggest that it also can delay the wear and tear process within the hip joint.
What is hip arthroscopy?
It is performed through two or three small incisions over the front or outer aspect of the hip. A small camera and instruments are inserted into the hip joint with the aim of repairing any soft tissue damage and removing any areas of bone impingement.
There are now procedures available where articular cartilage can be taken from one area of the hip joint to fill in some defects.
What should I do?
If you have had pain in or around your hip that has not settled with an exercise based rehabilitation programme, then you should seek advice from an experienced hip surgeon. There’s good evidence that shows that the longer you have symptoms for, the more damage that has occurred. There is good evidence to suggest that early surgical intervention provides better outcomes.
It is key that an accurate and early diagnosis is made to guide treatment and ensure the best outcomes.
Mr Mark Webb – MBBS MSc FRCS (Tr & Orth)
Secretary: Jenna Edwards
Email: webbpa@gop.health
Practice Direct Dial: 020 3824 2298
References:
- Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169-1176. Link
- Ng KCG, Kamath AF. An evidence-based review of hip arthroscopy for femoroacetabular impingement. Am J Orthop. 2017;46(3):E160-E167.
- Menge TJ, Briggs KK, Dornan GJ, McNamara SC, Philippon MJ. Preoperative and postoperative factors associated with achieving clinically significant outcomes after hip arthroscopy. Am J Sports Med. 2017;45(3):578-584.
- Carton P, Filan D. The clinical presentation of femoroacetabular impingement. JBJS Rev. 2019;7(7):e6.
- British Hip Society. Patient Information on Hip Preservation Surgery. https://www.britishhipsociety.com/patient-resources/
- Clohisy JC, Dobson MA, Robison JF, et al. Outcomes of labral debridement versus refixation in the treatment of femoroacetabular impingement. J Bone Joint Surg Am. 2012;94(23):2096-2105.
NHS Inform. Hip Pain. https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/hip-pain
