The Underlying Causes Of Hip Pain

Virtually all of the symptoms that our bodies generate have many possible causes, it’s a big part of what makes ‘doctoring’ so challenging and it’s definitely the case with hip pain. If you have had hip pain for some time it can become unsettling to be unclear about the underlying cause of your pain. For many, this type of concern escalates as they find that despite seeing multiple practitioners answers and solutions are not forthcoming. If you are seeking to better understand the possible causes of your hip pain the following overview should help. 

Hip Pain Caused By Movement Issues

The hip is a key mechanical structure within the body, not only do the hips bear our weight through thousands of steps per day, they create mechanical synergy between the upper and lower body. The mechanical nature of the hip joint inevitably means the majority of the issues we may face with the hip are mechanical in nature. ‘Mechanical’ pain is pain caused by movements or positions that have a negative impact on tissue. 

Most mechanical issues are surprisingly subtle and take a long time to turn into hip pain. If for example you are born with somewhat flat feet the chances are you won’t have any hip pain during your childhood. When you get a bit older though that may change. As you start to wear business shoes every day and become more sedentary you may find that the flat-footedness starts to catch up with you in the form of hip pain, knee pain, or back pain. The reason for this is that when the arch collapses it creates increased strain in the hip with each step, bearing in mind we take millions of steps per year. The more the years roll by and the less ideal your footwear and lifestyle become the more likely your flat feet are to show up as hip pain. This is just one of many possible ways that a subtle mechanical issue with alignment can turn into hip pain. 

One of the more confusing attributes of mechanical hip pain is that it can behave more like a sudden injury to the hip or lower back region. Sudden hip injuries feel fine one minute and hurt the next, the hip pain comes without warning. The same surprisingly is often true of hip pain from stubborn mechanical issues. The pain associated can come on suddenly during minor movements and without any prior warning much like a true injury. It’s important to remember that our bodies are ‘hunter-gatherer’ machines; they are very good at suppressing pain signals for long periods of time in order to sustain activities necessary for survival.

Mechanical issues that may contribute to hip pain include…

Flat Feet

High Arches

Weak Glutes

Weak Quads

Tight Hamstrings

Wide Pelvis

Unresolved Scar Tissue (Old Injuries) 

When the type of issues above come under fire from certain lifestyle choices (too much exercise/not enough exercise/wrong kind of shoes)  that don’t suit the body you have a recipe for pain. 

Hip Pain Caused By Injuries

It is not easy to injure a healthy hip. Nonetheless there are numerous injuries that can lead directly to hip pain. The hip is a very strong joint and has the most stabilising muscle relative to joint size of any joint in the body. The sheer bulk of stabilising muscle makes the hip extremely resistant to fractures and dislocations, in addition the muscles around the hip are so robust that they are not prone whatsoever to tears. There are however limits to all physical tissues and the hip does have some smaller structures that are susceptible to damage under more extreme circumstances. 

Like any joint the hip has boney components, cartilage components, connective tissues and adjacent muscles all of which can most certainly be injured. To fracture the bones that form the hip joint would normally take a very significant compressive force,  like a fall from a very high place or a car crash. Dislocation of a healthy hip is certainly not easy but it can occur if the hip joint is pushed into an extreme position, this would usually take a large external force. Slightly more common are cartilage tears within the joint, it is debatable how many of these occur in healthy hips as its likely that if the cartilage tears it had already been undermined by a mechanical issue.

The truth is that if your hip pain is being caused by a legitimate hip injury it will almost certainly have been quite a significant event. Most hip pain caused by hip injuries is accompanied a significant limp, a good deal of stiffness and in many cases loud clicking from the hip joint. If your hip pain has come about through a ‘minor incident’ like a trip or a fall or if it came on after a run it is far more probable that you are experiencing mechanical type pain that has become symptomatic as a result of the incident. 

Hip Pain Caused By Scar Tissue

Scar tissue is a part of the way our bodies deal with being overloaded. If you have had stubborn or recurring hip pain it is likely that you have at least some scar tissue component. Scar tissue is most well known for its obvious and visible work, resolving wounds to the skin after trauma. Scar tissue is less well known for the work it does deep inside the body in response to stubborn stress and internal injuries. 

Many stubborn pain conditions including hip pain have a scar tissue component. If for example you spend years working long hours on hard concrete floors it places highly unnatural stresses on the soft tissues of the hips. Over time the body can react to the persistent strain and scar tissue will be laid down through the soft tissues of the hip, this is felt as pain and stiffness. These kind of processes are in essence the bodies way of reinforcing itself against excessive strain and micro-trauma. 

The bodies inflammatory response is essential to its survival and yet if it is over-activated it can be a destructive force. Scar tissue is similar, it is helpful to the hip and the body in general but if you have too much of it built up it can be an issue that plays a significant role in chronic stubborn hip pain

Hip Pain Caused By Bursitis

Bursae are ingenious fluid filled sacks that are your body uses to reduce friction. The basic idea behind a bursae is that if you have an area of high friction between a tendon for example and bone,  a super smooth sack of fluid between the two will reduce the friction. Bursae are similar to bearings in that they are lubricated spheres that prevent friction. 

Bursitis related hip pain that comes from inflammation of an unhappy bursa. There are two major bursae in the hip that are susceptible to irritation. One bursa covers the bony point of the hip bone called the greater trochanter. Inflammation of this bursa is called trochanteric bursitis. The iliopsoas bursa is located on more towards your groin region and can also cause hip pain and groin pain. 

If you consult the many medical pages covering hip pain caused by bursitis you will often hear bursitis referred to as a ‘cause of hip pain’. It is important to interpret this carefully given that bursitis itself is merely a reaction to some form of ‘underlying strain’ that is occurring in the hip. Whatever is causing that underlying strain is the true ‘cause’ of the hip pain, and it is the reason the bursa has become inflamed. We frequently see people in our clinic who suffer from hip bursitis because they have extremely weak gluteal muscles for example. The weak glutes allow awkward repetitive hip movements when they walk and run,  the bursa becomes inflamed and causes hip pain. 

Hip Pain Caused By Arthritis

Degenerative tissue disorders like osteoarthritis or ‘arthritis’ are common in older people with persistent hip pain. Osteoarthritis is the medical term for cartilage degeneration inside the hip joint. Osteoarthritis when it is symptomatic can produce pain, stiffness, clicking, weakness, and movement issues like ‘giving way’ when weight-bearing. 

There is so much more to authentically modern and scientific management of arthritic hip pain than just drugs and surgery. The overall provision of healthcare for conditions like osteoarthritis is quite poor compared with many other conditions. In the U.S. research has shown that the average length of a ‘pain consultation’ at doctors’ offices for older people is a little over 2 ½ minutes. To put that in perspective when older patients come to our clinic with pain in their back, hip or knee the average initial consult is over 40 minutes. If you have stubborn hip pain and arthritis seek professional advice from multiple trained sources and perspectives. 

The way that osteoarthritis comes about is complex. For most, it requires several underlying factors to come into play before we are at risk of osteoarthritis and associated hip pain. Some examples of possible underlying factors in osteoarthritis and hip pain include… 

Dietary factors like collagen deficiency leading to osteoarthritis. 

Genetic factors like weak cartilage leading to osteoarthritis 

Lifestyle factors like overuse and injury leading to osteoarthritis.

Environmental factors like concrete floors leading to osteoarthritis. 

Wellness factors like lack of appropriate exercise leading to osteoarthritis.

Perhaps the most meaningful observation of all on osteoarthritis is the fact that over 90% of hip replacement surgeries are single replacements. This means that the hip being replaced has a neighboring hip with significantly less or sometimes even no osteoarthritic changes. Both of those hips are always the same age so it’s not just caused by aging !!!!! Both hips also have the same mileage in every sense and yet one wore out and the other didn’t! The reasons for this are often movement and repetitive strain-based. 

Diagnosing and proactively managing the underlying movement imbalances that cause one hip to wear out and the other to prevail can be a huge help to hip pain sufferers. 

Hip Pain Caused By Diet

There is a relatively small percentage of hip pain sufferers for whom diet is a major contributing factor in the generation of their hip pain. If diet is a significant factor in your hip pain it’s quite likely you will also have stubborn pains in multiple other areas. Any time you have multiple areas of pain in the body it is worth considering the possibility of some broader issue in the gut, blood, joints, or nervous system. In addition to disease states in the body ( like rheumatoid arthritis for eg.) dietary intolerances can most definitely make it onto the list of ‘broader issues’.

Intolerances like gluten intolerance and salicylate intolerance can most definitely contribute to stubborn hip pain and other joint pains in certain individuals. Given the number of people who report significant relief from hip pain when they consume supplementary fish oils and turmeric it is also safe to assume that nutrient deficiencies also have a part to play.

If you have stubborn hip pain it is probably fairly safe to assume it is on some level mechanical or relating to the health of the hip specifically. If however, you have struggled with successful treatment and/or you have multiple areas of pain in addition to your hip it may be worth considering the possibility of dietary influences. 

Hip Pain Caused By Internal Organs

There are many lifestyle choices that can inflict forms of repetitive strain on the body. A great example would be the classic ‘supporting a child on your hip while doing things around the house’ on a daily basis. Being forced into slightly unnatural movements and positions by life is perfectly normal and healthy; it’s when these movements are excessively constant and repetitive that they can become a cause of back pain. 

Hip Pain Caused By Systemic Diseases

Rheumatoid arthritis is an example of an inflammatory arthritic condition that is a body-wide condition with the capacity to cause hip pain. These types of arthritic conditions include other more obscure forms of arthritis-like psoriatic arthritis. Inflammatory arthritis can also be caused by many other conditions, for example by the formation of uric acid crystals in joints, infections, or other underlying diseases like lupus. We have most probably yet to even begin to identify the full complexity and subtlety of many of these conditions, some of which may it seems maybe more to do with the health of the gut than anything else. 

In reality, there are a host of possible disease states in the body that on rare occasions can be the reason for hip pain. This spectrum of conditions that may cause knee pain is not confined to the joints and muscles and can include certain cancers and referred pains from the internal organs. 

If you have persistent painful swelling and or redness and stiffness of one or more hip joints you need to get checked out!! These kinds of conditions can usually be identified with blood tests scans and x Rays. If all your scans and tests come up all clear medically then almost certainly your pain will be mechanical in nature and more than likely very treatable. 

Closing Thoughts

As we have seen, there is certainly far more to hip pain than a question of arthritis vs no-arthritis. Our hips are subjected to a huge amount of mechanical strain during a lifetime, perhaps inevitably it is most commonly this mechanical strain that causes hip pain conditions rather than any other factor. A good way to think of and understand this is the following. Your gut is primarily in the business of digesting food, therefore wrong foods are the most common cause of problems in the gut is ‘wrong foods’. Your hips on the other hand are primarily in the business of bearing your body weight, the most common cause of problems with the hip is with weight-bearing.