Hip Pain Causes and Treatment Methods

Hip Pain Causes and Treatment Methods

Injury, illness or congenital defect can cause hip pain. Pain in this joint can be debilitating and interfere with activities of daily living essential to quality of life. Here is an overview of the joint, causes of problems and types of hip pain treatment.

Basic Anatomy

The hip joint is a major joint. It is classified as a ball-and-socket joint. The top of the femur (thigh bone) is rounded and fits into a socket in the pelvis. The proper name for the pelvic bone in question is “acetabulum”. The size and shape of the acetabulum make this joint one of the hardest joints to dislocate.

This joint is capable of a wide variety of complex motions. These motions are aided by a large group of muscles. In addition to the well known gluteal and hamstring muscles, there are lesser well known muscles such as the iliopsoas, rectus femoris, Sartorius, pectineus, and the gracilis. They typically work in groups of two or three to create each distinct motion, such as flexion, rotation, and abduction.

There is a layer or cartilage cushioning the joint and reducing the friction that occurs when it moves. The cartilage is further assisted by bursae, which are fluid filled sacs that lubricate the joint.

The pelvis is a central area. Unsurprisingly, multiple nerves pass through it, if only to connect other parts back to the brain. When the hip is injured, the two most commonly nerved are the sciatic nerve and the femoral nerve.

Hip Conditions and Hip Pain Treatment

Osteoarthritis is one of the most common causes of joint pain and is a major cause of hip pain. It involves degeneration of the joint cartilage. Pain is usually worse after sustained periods of walking. Typically, symptoms begin as sporadic or intermittent problems, including pain, stiffness, decreased range of motion, and popping sounds while moving. If left untreated, these issues get steadily worse and can lead to sleep difficulties. Treatment includes gentle exercises and hot and cold treatments. Doctors sometimes prescribe non-steroidal anti-inflammatory drugs to reduce pain and inflammation. In extreme cases, steroidal injections can be part of the treatment plan.

Hip flexor strain is a tear in the muscles involved in flexion, such as the iliopsoas muscle. Minor tears can cause minimal problems. Severe tears can create extreme pain and impairment. You are most likely to notice a problem when taking stairs or engaging in other activities that cause the hip to flex in that fashion. People suffering from this condition frequently wake up with pain and stiffness. They may also notice bruising. It is typically treated with rest and physical therapy.

Sciatica is a commonly used term for pain involving compression of the sciatic nerve in the lower back. It is often caused by a ruptured disc or a bone spur. It can be due to either a sudden trauma or slow degeneration. It is particularly debilitating because the pain may not remain confined to the lower back. It can spread to the lower body.

In most cases, misalignment or dysplasia is congenital. This condition can lead to an increased risk of dislocation. Generally speaking, the acetabulum is misshapen in some way, and this reduces the stability of the joint. It may not need any particular treatment, unless it does lead to dislocation.

When the bursae become inflamed, the condition is called bursitis. Trochanteric bursitis is the name of the condition when the inflamed bursae surround the greater trochanter, a bony prominence that anchors several gluteal muscles. This can be a repetitive stress injury, incurred from excess jumping, lunging, or running. It can also be due to trauma. It typically causes pain in the outer hip and along the outside of the thigh, running down to the knee. Treatment typically starts by cutting back on the activities that created the condition to begin with. It may include other exercises aimed at strengthening or stretching the joint, plus hot and cold treatment. Occasionally, cortisone injections are used.

Snapping hip is the term for a condition that involves a loud, often painful, snapping sound when the joint is flexed or extended. It is very frequently caused by tendinitis of the iliopsoas tendon. As with most hip conditions, it can be caused by either overuse or injury. This tendon is stretched over the bone of the socket. If something goes wrong, it can make a clicking or snapping sound as it rubs back and forth. The most common treatments include rest, reducing certain problematic activities, taking NSAIDs, and cortisone injections. The worst cases are sometimes treated surgically.

Hip pain can impede the simplest and most basic activities of daily life, such as sitting down, getting up again or getting into or out of a car. It should not be ignored.



A clinical exam and diagnostic ultrasound imaging can help your therapist pinpoint the exact location and cause of your hip and groin pain.

Ultrasound enables you and your therapist to view the hip and groin region in real time, while in motion. In addition to ultrasound, video gait analysis can help us identify faulty movement mechanics that contribute to hip and groin pain. Once the exact cause is determined, an effective treatment plan can be initiated.


Explore more advanced diagnostic tools available only at NYDNRehab:


Hip dysfunction and pain can be a complex issue due to interactions of the trunk, pelvis, low back, groin and hip joint. Physical therapy and rehabilitation that is based only on subjective clinical analysis often addresses the symptoms without resolving the underlying cause.


At NYDNRehab, our groundbreaking motion analysis technology and high resolution diagnostic ultrasonography have enabled us to develop a battery of tests that perfectly reveal the dynamic functional pathology of the hip joint and pelvis. Our tests are evidence-based protocols that are considered to be the gold standard in the world of research.

Our testing protocol includes:


Combined lumbopelvic hip stability test using DLEST methodology with C.A.R.E.N., our computer assisted rehab environment


Hip joint stability test using DLEST methodology with C.A.R.E.N.


3D star excursion banner test (SEBT) for assessing the involvement of the hip joint and muscles in postural stability


3D gait or running analysis


3D kinematic joint angle analysis during a squat, lunge, drop jump and pelvis on hip rotation


Rehabilitative ultrasonography for viewing intrinsic hip stabilizing muscle activation patterns

We also perform neuromotor testing with DD Robotech for:

  • Proprioception
  • Tracking ability
  • Force sense
  • Critical power
  • Reactive power
  • Flexibility


Surface electromyography (SEMG) may be added to any of the above tests when needed.

Based on our experience and evidence-based information, we believe that physical therapy and rehabilitation should be based on objective quantifiable data.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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