Hip pain

Are you experiencing a pinching pain in the hip when squatting at the gym? Do you feel a throbbing pain at the side of your hip when putting on your pants? What about a sharp pulling pain from the buttock down to the calf? This post will talk about some common causes of hip pain.

Anatomy of the hip

The hip is a ball and socket joint, which means that it is very mobile. There are many different structures, both passive and active, that help to keep the hip stable during movement. An injury to any of these structures can therefore affect the function of the hip and cause pain during movement.

Structures that can cause hip pain include:

  • Labrum: a ring of cartilage around the socket
  • Subchondral bone: a layer of bone below the cartilage
  • Ligamentum teres: a ligament in the inner part of the hip
  • Synovium: a soft tissue lining the joint 
  • Muscles around the hip

Causes of pain at the front of the hip

Among the patients that present with hip pain, a large majority come in for pain at the front of the hip.

Among these patients, most of them fall into these 2 major diagnoses for anterior hip pain: Femoral acetabular impingement (FAI) and osteoarthritis. The table below compares the 2 conditions.

Characteristics

Femoral acetabular impingement

Osteoarthritis

Area of pain 

C shaped area of pain extending from front of the hip to side buttock area 

 

Signs and symptoms

Pain is often described as a deep ache, and is usually associated with a sharp pinch at a certain range of motion.

As a result, the hip joint range of motion is restricted.

In more severe cases, you may experience buckling at the hip when putting weight on that hip while walking.

 

Aggravating activities

  • Activities that bring the hip into flexion – these include squatting and sitting. 
  • Rotating on the hip when you are putting weight on it
  • Lifting the leg out of the car or swinging legs out of bed
 

Who?

Younger, athletic people

Older people 


Although rare, it is possible to experience nerve pain down the anterior hip. This can clearly be differentiated from other sources of pain as it has a distinct burning shooting pain and is commonly associated with numbness or pins and needles.Besides these 2 conditions, another condition that can cause anterior hip pain is acute overwork of muscles. This can happen due to a sudden increase in exercise, lack of muscle recovery or a combination of both. Pain is associated with stressing the muscles during activities such as running or kicking and it goes away during rest.

Causes of lateral hip pain

If you are experiencing pain at the side of the hip especially over the bony bump, it is likely a case of gluteal tendinopathy where the tendons of the gluteus medius and minimus muscles get irritated from compressive forces. 

Pain is often triggered during adduction of the leg (a simple example of this will be the crossing of legs). This causes the tendon to be compressed by the iliotibial band (that same infamous culprit). Naturally, lying on the injured hip will also be painful due to the direct pressure but lying on the other side can also trigger pain if the injured leg falls past the midline of the body. 

Hip osteoarthritis, which has been mentioned earlier, can also cause pain at the side of the hip and can co-exist with gluteal tendinopathy. An experienced physiotherapist will be able to help you to differentiate between these two conditions.

Causes of posterior hip pain

Posterior hip pain, or quite literally a pain in the butt, can come from a few sources and one of them is not even from the hip!

It is surprising but a lot of patients who come in with pain at the back of their hip do not actually have a problem in their hip but rather, the pain is a referral from their lower back. An even more interesting fact is that these patients need not present with back pain at all for there to be a referral down to the buttock. The pain will be generally around the mid to lower buttock area with a possible referral down to the back of the knee; it rarely extends beyond that. Aggravating factors are linked to the movement or loading of the lower back, which can be hard to pinpoint. 

In the buttock, there is a very famous nerve called the sciatic nerve. When the sciatic nerve is irritated, it can present quite similarly to a referral pattern from the lower back. The difference is that pain from the sciatic nerve tends to be sharper and is described as shooting or burning pain. Tingling or cramping can be common and direct pressure on the area can aggravate symptoms. If you find yourself needing to get up every 30 minutes or less to relieve these symptoms, there is a high chance that you may have an irritated nerve.

The last common condition causing posterior hip pain will be proximal hamstring tendinopathy. In this condition, pain is localised at the attachment of the hamstring muscles right at the bony protuberance at the bottom of the buttock. Pain is often experienced when the hamstring muscles are activated or stretched, causing either compression or tension on the tendon. At early stages, pain may only be present during exercise but as it progresses, it can manifest during daily activities such as walking or climbing stairs.

Still confused?

Don’t worry, there is a lot to digest with regards to hip pain and these are only the common conditions. If you are currently experiencing hip pain and will like to understand more about it, feel free to book a consultation with any of our experienced physiotherapists!

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