Frozen Hip: What You Need to Know

Frozen hip causes pain and limits movement in the hip joint. It occurs when the ligamentous capsule surrounding the hip joint becomes inflamed, thick, and less flexible – reducing joint movement and increasing pain and stiffness.

What Is Frozen Hip?

The condition starts with a mild, generalized ache in the hip joint area and progresses in stages, with increasing pain and stiffness followed by a gradual improvement.

Essential points to know:

• The medical term for frozen hip is adhesive capsulitis of the hip.
• It shares similarities with frozen shoulder: both involve inflammation and thickening of the joint capsule, leading to pain and stiffness.
• It can occur in one or both hips.
• It is not a well-researched condition,¹Chellamuthu G, Sathu S, Jeyaraman N, Jeyaraman M, Khanna M. Adhesive Capsulitis of Hip-A Systematic Review of Literature. Indian J Orthop. 2023;57(2):238-244. Published 2023 Jan 8. doi:10.1007/s43465-022-00808-z and the diagnosis is relatively uncommon.
• It resembles other hip disorders, such as hip labral tears and hip impingement (femoroacetabular impingement) due to similar symptoms.

Early diagnosis and treatment, including physical therapy and medication, can help improve hip mobility and reduce pain.

Hip Joint Anatomy that Locks Up or “Freezes” in Place

The hip joint is a ball-and-socket construct formed by the ball” – the head of the femur (thigh bone) fitting into the bony socket” , the acetabulum of the pelvis.

A joint capsule made of tough and resilient ligaments surrounds this joint, providing stability and allowing for smooth movement.

A thin synovial membrane lines the inner portion of the capsule and produces a lubricating fluid (synovial fluid) that facilitates smooth movement within the joint.

See Your Visual Guide to Hip Anatomy

In frozen hip, the hip joint locks up because:

• Membrane thickens: The synovial membrane becomes inflamed, leading to an increase in the production of synovial fluid.
• Fluid builds up: This excess fluid builds up within the capsule and irritates the surrounding tissues, causing pain.
• Capsule tightens: Simultaneously, the capsule itself thickens and tightens, with deposition of fibrous scar tissue inside the capsule – restricting the movement of the hip’s ball within the socket.

This combination of inflammation, fluid buildup, and capsular thickening creates a locked-up” or frozen” sensation in the hip joint, causing significant pain and stiffness in the hip joint.

4 Stages of Frozen Hip

Hip adhesive capsulitis typically progresses through four stages.²Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive capsulitis of the hip: a case presentation and review. Orthopedic Reviews. 2022;14(4). Doi:https://doi.org/10.52965/001c.37679 The timeline below is approximate, and the duration of each phase varies for everyone.

1. Acute stage (Months 1 to 3):

The first stage of frozen hip is commonly called the “painful stage.” In this stage:

• The synovial membrane is inflamed and begins to thicken
• The ligamentous capsule thickens and becomes tight
• There’s increased blood flow to the hip joint area

The hallmark symptom of stage 1 is acute, generalized hip pain that cannot be pinpointed to a specific location. Pain increases while sitting on the floor – especially in the “tailor’s position” – by bending and crossing the legs, lying down on the affected side, and bearing weight on the hip joint, such as squatting.²Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive capsulitis of the hip: a case presentation and review. Orthopedic Reviews. 2022;14(4). Doi:https://doi.org/10.52965/001c.37679

2. Freezing stage (Months 4 to 9):

In the second stage, the painful hip begins to “freeze” or “lock up” due to the following changes²Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive capsulitis of the hip: a case presentation and review. Orthopedic Reviews. 2022;14(4). Doi:https://doi.org/10.52965/001c.37679:

• The synovial membrane continues to thicken due to increased inflammation
• Collagen fibers begin to deposit inside the joint capsule
• The fibers form “adhesions” or scar tissue inside the capsule, causing the inner walls of the capsule to stick together

In this stage, hip pain continues to increase, and the range of motion in the hip joint begins to decrease.²Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive capsulitis of the hip: a case presentation and review. Orthopedic Reviews. 2022;14(4). Doi:https://doi.org/10.52965/001c.37679 Simple daily activities such as bending down to put on shoes or squatting to pick up something from the ground become bothersome due to hip joint pain and stiffness.

3. Frozen stage (Months 6 to 18):

In the third stage, the freezing process continues, and the hip joint becomes stiffer because²Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive capsulitis of the hip: a case presentation and review. Orthopedic Reviews. 2022;14(4). Doi:https://doi.org/10.52965/001c.37679:

• The amount of collagen fiber and scar tissue deposition inside the joint capsule increases substantially
• Inflammation of the synovial membrane begins to decrease

During this stage, hip pain starts to lessen as the inflammation in the synovial membrane decreases and the joint stiffness worsens due to the buildup of scar tissue.²Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive capsulitis of the hip: a case presentation and review. Orthopedic Reviews. 2022;14(4). Doi:https://doi.org/10.52965/001c.37679 The hip joint becomes very stiff, making activities like climbing stairs or walking challenging, which significantly affects daily life and quality of life.

This stage may last beyond 18 months for individuals with underlying medical problems such as diabetes or thyroid disorders.²Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive capsulitis of the hip: a case presentation and review. Orthopedic Reviews. 2022;14(4). Doi:https://doi.org/10.52965/001c.37679

4. Thawing stage (up to 24 months):

The final stage of frozen hip is characterized by the maturation and eventual breakdown of scar tissue.

Specific changes include²Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive capsulitis of the hip: a case presentation and review. Orthopedic Reviews. 2022;14(4). Doi:https://doi.org/10.52965/001c.37679:

• Absence of synovial membrane inflammation
• No new deposition of collagen fibers
• Gradual breakdown of the collagen fibers and scar tissue

In this stage, there’s generally no pain and a gradual improvement in the hip joint’s range of motion, and a reduction in stiffness.

How Long Does Frozen Hip Last?

The duration of frozen hip depends on the treatment approach and the presence of other underlying problems.

Researchers often look to frozen shoulder as a reference point for understanding the progression, although more research is needed.²Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive capsulitis of the hip: a case presentation and review. Orthopedic Reviews. 2022;14(4). Doi:https://doi.org/10.52965/001c.37679

Without treatment: hip symptoms tend to get better in about 6 to 18 months

Similar to frozen shoulder, frozen hip may resolve on its own within approximately 6 to 18 months, or more, without specific treatment.²Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive capsulitis of the hip: a case presentation and review. Orthopedic Reviews. 2022;14(4). Doi:https://doi.org/10.52965/001c.37679

Individuals with diabetes and/or thyroid disorders take longer to recover without treatment.²Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive capsulitis of the hip: a case presentation and review. Orthopedic Reviews. 2022;14(4). Doi:https://doi.org/10.52965/001c.37679

With treatment: hip symptoms tend to get better in about 6 to 8 months

Studies show that for people with enough symptoms to seek treatment, those who had non-surgical and/or surgical treatments attained significant improvement in hip pain and stiffness within approximately 6 to 8 months.³de Sa D, Phillips M, Catapano M, et al. Adhesive capsulitis of the hip: a review addressing diagnosis, treatment and outcomes. J Hip Preserv Surg. 2015;3(1):43-55. Published 2015 Nov 27. doi:10.1093/jhps/hnv075

Surgery for frozen hip symptoms is rare and generally considered only after non-surgical methods fail to provide adequate pain relief.

See Non-Surgical Treatments for Frozen Hip

Conditions that Mimic Frozen Hip

A variety of problems in the hip joint, pelvis, and lower back are characterized by hip pain and stiffness and resemble frozen hip. It is also possible for these problems to co-occur with frozen hip, making it challenging to determine which one is the underlying cause of pain.

Common hip problems that present like frozen hip are:

• Hip labral tears
• Hip impingement (femoroacetabular impingement)
• Hip fracture
• Hip osteoarthritis

Less commonly, hip infections (osteomyelitis or septic arthritis) or tumors (osteoid osteoma or leukemia) may mimic frozen hip.

In some cases, problems affecting the pelvis or lower back cause referred pain in the hip, and include:

• Sacroiliac joint pain
• Lumbar degenerative disc disease
• Pulled muscle in the lower back
• Piriformis syndrome

Read: Why Does My Lower Back and Hip Hurt? on Spine-health.com

A precise diagnosis of frozen hip hinges on a detailed medical history and a comprehensive examination of the hip joint, pelvis, lower back, and overall health.

When to See a Doctor for Hip Pain and/or Stiffness

Certain hip symptoms indicate a serious medical problem, such as infection or cancer. These symptoms include but are not limited to:

• Pain in the pelvic area: A dull ache or sharp pain in the pelvic region and/or lower abdomen that is constant or worsens with movement
• Pain during sex: Discomfort or deep pelvic pain during sex
• Symptoms following acute trauma: Hip, back, or groin pain that started after an accident or trauma to the hip
• Fever and/or weight loss: Hip pain with unexplained weight loss and/or constant, low-grade fever

It is recommended to have any concerning symptoms promptly evaluated by a healthcare professional.

Frozen hip is diagnosed and treated by physical medicine specialists, such as physiatrists, sports medicine specialists, physical therapists, and orthopedic surgeons.