Non-Surgical Treatments for Frozen Hip

Most cases of frozen hip can be healed with a combination of non-surgical treatments, such as medication, physical therapy, and injections, and some advanced cases benefit from manipulation under anesthesia or pressure dilation.

The goals of non-surgical treatments are to:

• Reduce hip pain
• Increase hip joint flexibility and range of motion
• Prevent symptoms from getting worse

Typically, two or more treatments will be combined, such as medication and physical therapy, or an injection followed by physical therapy.

First-Line Treatments for Frozen Hip

Common first-line treatments for frozen hip are discussed below.

Medication

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

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended during the initial stages of frozen hip when pain tends to be more intense due to acute synovial membrane inflammation.
  • 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.
• 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 flare-ups of severe, debilitating pain.

  • 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.

  Read more about Opioid Pain Medications on Spine-health.com

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

Physical therapy and exercise

Guided physical therapy is recommended to treat joint pain and stiffness by breaking down scar tissue and adhesions in the hip capsule, especially during the “freezing,” “frozen,” and “thawing” stages seen in the latter phases of the condition.¹Eberlin 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

Physical therapy for frozen hip focuses on:

• Stretching exercises – to maintain and improve joint mobility and increase range of motion.
• Strengthening exercises –  to strengthen the muscles surrounding the hip joint and improve joint stability and support during hip and leg movement.

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

When the hip joint is inflamed, gentle stretching is recommended rather than any type of forceful stretching, which tends to worsen pain and discomfort.¹Eberlin 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

Heat and cold therapy

Heat therapy, such as applying a heating pad or soaking in a warm bath, relaxes the muscles and improves blood flow and healing in the hip joint and muscles. Heat therapy tends to be most beneficial before engaging in physical activity or exercise, and before going to bed.

Watch Video: How to Make a Homemade Heat Pack

The use of ice packs for cold therapy reduces pain and inflammation and is beneficial to calm activity-related inflammation after exercise sessions or physical activity.

See 3 Useful Tips for Icing Your Injury

A clean cloth or towel must be placed between the heat or ice pack and the skin to avoid burns or skin damage. Generally, application should be limited to 20 minutes at a time with a break of at least 2 hours before reapplying the pack.

Injection treatments

Injections may be useful for relieving acute hip pain (and are sometimes also used to diagnose hip pain), and include:

• 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.
  • Sustained-release corticosteroid injections release the medication slowly and steadily over an extended period, typically ranging from several days to several months, providing sustained pain-relieving benefits over a period of time.²Joassin R, Vandemeulebroucke M, Nisolle JF, Hanson P, Deltombe T. Adhesive capsulitis of the hip: Concerning three case reports. Annales de Réadaptation et de Médecine Physique. 2008;51(4):308-314. Doi:https://doi.org/10.1016/j.annrmp.2008.03.008
• 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.

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 Treatments for Frozen Hip

In cases where the previously mentioned treatments haven't provided adequate pain relief after a dedicated trial of at least a year, healthcare professionals may consider the following options¹Eberlin 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:

Manipulation under anesthesia (MUA)

This procedure 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.

With the use of anesthesia or sedation, the muscles remain in a relaxed state, which enables the doctor to stretch the hip joint through ranges of motion that would otherwise not be achievable with the patient awake. These manipulations are intended to break up or stretch the scar tissue inside the hip capsule and improve the joint’s range of motion.

A potential disadvantage of MUA is that uncontrolled manipulation could cause serious structural damage in the hip’s ball and socket joint, such as dislocation, and the surrounding soft tissues.

Pressure dilation

This injection procedure is performed under x-ray guidance (fluoroscopy), where a sterile fluid (isotonic sodium chloride) is injected into the capsule surrounding the hip joint to increase pressure within the capsule. This increased pressure stretches the capsule and creates more space for joint movement – thereby reducing hip stiffness.

Potential side effects of pressure dilation include temporary pain, nerve irritation, and bleeding.

Pressure dilation is also called joint distention or hydrodilation.

Complementary and Alternative (CAM) Treatments

Some people find complementary and alternative therapies are effective in managing hip pain and improving overall well-being.

CAM treatments for frozen hip include:

• Massage therapy. Therapeutic massage relaxes muscles, improves circulation, and reduces soft tissue pain. A massage therapist trained in treating frozen hip can tailor the massage techniques to focus on gentle manipulation and avoid aggravating the inflamed capsule.
• Acupuncture. This practice involves inserting thin needles into specific points on the body to restore energy flow and reduce pain and tension. Acupuncture is sometimes used in the treatment of frozen shoulder – a similar condition affecting the shoulder joint’s capsule, although more research is needed to determine its effectiveness specifically for frozen hip.

Before starting any new treatment for frozen hip, 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.