Hip Pain Treatment

Most cases of hip pain are treated with a combination of self-care and non-surgical treatments, such as medication, physical therapy, joint alignment, and injections. Typically, two or more treatments are combined, such as medication and physical therapy, or an injection followed by chiropractic care or physical therapy.

Surgery is considered when non-surgical treatments fail to provide relief or for serious injuries, such as fractures or dislocation.

Self-Care Treatments for Hip Pain

Here are a few ways to manage hip pain at home:

R.I.C.E

The RICE protocol helps manage acute hip pain caused by a recent injury. RICE stands for:

• Rest: Keep the hip joints in a relaxed position for a few hours by lying on the back and modifying or avoiding activities to prevent aggravating the pain. In general, activity modification is the first step in rehabilitation. Avoid prolonged standing, sitting, running, or stressing the hip joint.
• Ice: Apply an ice pack to the hip area for 15-20 minutes at a time, several times a day. Wrap the ice pack in a towel or t-shirt to prevent an ice burn and wait for at least 2 hours before reapplying the pack. See 3 Useful Tips for Icing Your Injury
  Ice therapy works best when used in the first 48 hours after the injury, but some people find it to be an effective part of long-term pain management.
• Compression: Use an elastic bandage or compression shorts to provide gentle compression around the hip joint.
• Elevation: When lying down or reclining, elevate the hip by placing pillows under the lower back, buttock, and upper thigh.

The RICE protocol is most commonly used for soft tissue injuries such as a pulled muscle or ligament.

Assistive devices

For hip pain that is aggravated by walking or weight bearing, assistive devices such as a walker or cane provide support and limit weight bearing on the hips, reducing pain.

Heat therapy

For hip pain that lingers more than 48 hours, apply a heat pack to the hip area for 15 to 20 minutes. Heat stimulates blood flow and increases the supply of oxygen and nutrition to the injured tissues, reducing pain and fostering healing.

Heat therapy tends to be most beneficial before engaging in physical activity or exercise, and before going to bed.

Wrap the heat pack in a towel or t-shirt to prevent burns and wait for at least 2 hours before reapplying the pack.

See How to Make Your Own Moist Heat Pack Infographic 

Medication

Over-the-counter or prescription medications are used to manage inflammation and/or pain.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended to reduce inflammation in conditions such as muscle strains, ligament sprains, labral tears, arthritis, or synovial membrane inflammation in frozen hip.
  • NSAIDs are available as oral tablets (eg, Advil) and topical ointments (eg, Voltaren), and can be purchased over the counter or with a prescription.
  • Oral NSAIDs are not suitable for all patients due to significant potential risks, such as gastric irritation and/or bleeding, and cardiac problems.
  • NSAIDs can potentially slow bone healing and are avoided during hip fractures or procedures like hip replacements that require bone healing or fusion.
• Oral steroids, such as methylprednisolone and prednisone, may be prescribed to control inflammation and pain.
  • Steroids are prescribed for short courses and start at a high dose, quickly tapering down to a lower dose, and discontinuing the medication within a period of 1 to 2 weeks.
  • Steroids are not indicated when certain co-occurring medical conditions, such as diabetes or heart disorders, are present.
  • Long-term use of steroids has significant risks, such as damaging bone health and slowing down natural healing processes.
• Opioids, such as tramadol, may be prescribed for severe, debilitating pain from hip fractures or other serious injuries.
  • Opioids are only recommended for short-term use, such as 1 to 2 weeks.
  • Opioid pain medications carry significant risks, such as addiction, drowsiness, constipation, vomiting, and nausea.

It is always recommended to take medications under the guidance and supervision of a qualified medical professional.

Chiropractic Care

Chiropractic treatment focuses on restoring joint alignment within the mobile kinetic chain connecting the lumbar spine (low back), pelvis, hip, knee, leg, and foot. This hands-on treatment aims to reduce hip pain by stimulating sensory nerve endings and restoring the nutrient exchange to the hip joint cartilage and soft tissues without the use of invasive procedures or medicines.

Physical Therapy

Guided physical therapy is recommended to reduce joint pain and stiffness, increase soft tissue strength and flexibility, and improve the hip’s range of motion.

Physical therapy and exercise for hip pain focus on:

• Stretching exercises
• Strengthening exercises

A home exercise program is recommended for long-term symptom control and to prevent recurrences.

See 3 Simple Stretches for Hip Pain Relief

Injection Treatments

Hip joint injections are useful for relieving acute hip pain or chronic pain unresolved by other non-surgical treatments, and include the following:

• Corticosteroid with or without an anesthetic (numbing) medication is administered directly into the hip joint to reduce inflammation, relieve pain, and improve joint range of motion.
• Hyaluronic acid is a substance naturally present in the joint fluid, acting as a lubricant. Hyaluronic acid injections may help improve lubrication and reduce pain in some cases.
• Platelet-rich plasma (PRP) is made by extracting and concentrating platelets from the patient’s blood and then injecting it into the hip joint. The goal of this injection is to stimulate tissue healing by reducing inflammation and encouraging the growth of new tissue in the joint.

Hip injections are guided by fluoroscopy (live x-ray) for precise needle placement and to reduce the risk of adverse events and damage to nearby tissues.

These injections may not be suitable for everyone, and repeated injections are generally not recommended due to potential side effects, such as infection, bleeding, and damage to soft tissues.

Second-line and Alternate Treatments for Hip Pain

In cases where the previously mentioned treatments haven't provided adequate pain relief, healthcare professionals may consider the following options:

• Manipulation under anesthesia (MUA): This procedure, typically used for treating frozen hip, involves movements of the hip joint to stretch the capsule and improve the range of motion while the patient is under general anesthesia or moderate sedation.

Read about the MUA procedure: Non-Surgical Treatments for Frozen Hip

• Pressure dilation: This injection procedure is also used for treating hip stiffness associated with conditions like frozen hip and aims to improve hip mobility by stretching the ligamentous capsule around the hip joint.

Read about the pressure dialation procedure: Non-Surgical Treatments for Frozen Hip

• Massage therapy: Therapeutic massage relaxes muscles, improves circulation, and reduces soft tissue pain. A massage therapist trained in treating hip pain can tailor the massage techniques to focus on the underlying cause of pain.
• Water therapy: This treatment is recommended for those who have hip pain while walking or bearing weight on the hip joints. Water therapy involves walking and/or exercising in a swimming pool.
  • The buoyancy of water allows for a greater range of motion at the hip joint due to the virtual elimination of gravitational forces.
  • Water's viscosity provides gentle resistance through friction, allowing strengthening and conditioning of the hip joints and muscles.
• Acupuncture: This practice involves inserting thin needles into specific points on the body to restore energy flow and reduce pain and tension.

Before starting any new treatment for hip pain, the benefits and risks of the procedure or treatment must be carefully discussed with a healthcare professional to determine the most suitable approach for the patient’s individual situation.

Surgery for Hip Pain

Surgical procedures are typically reserved for cases where:

• Hip pain and/or stiffness is severe or progressive even after several combinations of non-surgical treatments have been tried
• There are significant limitations in daily activities due to restricted hip mobility
• The joint is affected by more than one condition, such as hip impingement and hip labral tear
• The joint is fractured or dislocated

Both minimally invasive and open surgical options are performed on the hip.

As with any surgical procedure, potential risks and adverse events, such as nerve damage, infection, and bleeding are possible, but the incidence is low.

Minimally invasive surgeries

Arthroscopic or minimally invasive surgeries use small incisions (around 5 mm), specialized instruments (such as an arthroscope), and fluoroscopy (live x-ray) to guide surgeons into the hip joint. Muscles are separated, not cut, to access the joint.

Depending on the underlying causes of hip pain, more than one procedure may be performed at the same time.

Common minimally invasive procedures performed on the hip joints are:

• Adhesiolysis: Removal of scar tissue from the hip joint or surrounding areas
• Synovectomy: Removal of the inflamed synovial membrane
• Capsulectomy: Release of tight portions of the hip joint capsule
• Labral tear repair: Reattaching a torn hip labrum to the hip’s socket
• Labral debridement: trimming or smoothing a frayed or torn labrum by cutting or debriding the labral tissue
• Labral replacement: Replacing a damaged hip labrum with a graft (tissue from another part of the body or a donor)
• Femoral osteoplasty: Removal of excess bone from the upper part of the thigh bone (femoral head) to correct hip impingement and restore range of motion
• Periacetabular osteotomy: repositioning the hip socket to treat the symptoms of painful hip dysplasia (underdeveloped hip socket)
• Total hip replacement: replacing the damaged hip joint with an artificial hip

Potential benefits of minimally invasive surgeries are shorter hospital stays, improved recovery time, and quicker return to daily activities.

Open surgery

This surgery uses a larger incision to allow for direct visualization of the entire hip joint. The joint is dislocated – or taken apart – to treat the underlying condition.

Open surgery is preferred for:

• Complex cases requiring extensive joint repair
• Revision surgery
• Certain types of hip replacement, such as total hip replacement for hip arthritis

Open surgeries have longer hospital stays and recovery periods compared to minimally invasive procedures.

It is advisable to discuss the risks, benefits, and alternatives of the recommended surgical procedure with the treating physician before consenting to the procedure.