Features March 2006 Issue

Hip Pain: It’s Not Always Arthritis

Your lower back, bursitis, or a fracture may be the culprit.

Fourteen percent of U.S. adults over the age of 60 regularly face hip pain, yet the source of this pain may not be an aging hip. What may seem to be arthritis of the hip could be something entirely different, and pinpointing the source of pain is the first step to living without it.

“When a patient refers to hip pain, he often points to his buttock, which can actually be the result of a back problem,” says A. J. Cianflocco, M.D., medical orthopaedist at The Cleveland Clinic Spine Institute and Department of Sports Health. “While you can experience pain in the hip from arthritis, you can also suffer referred pain to that area from problems in the lumbar spine or lower back—be it osteoarthritis of the lumbar spine or degenerative disc disease.”

Pinpointing pain’s source
Feeling pain in the middle of the thigh or in the groin can be a sign of arthritis of the lower back—one of the most common causes of referred hip pain. Arthritis of the back involves the facet joints (those between the vertebra) and occurs in conjunction with degeneration of the discs between the vertebra, a condition sometimes referred to as spondylosis. This frequent source of hip pain is best first treated with acetaminophen (Tylenol), heat or ice compresses, or massage for temporary relief.

Hip pain and stiffness may also originate from the upper part of the thigh bone (femur), specifically the large bony part, called the greater trochanter, which you can feel on the side of your hip. A common cause of pain in this area is trochanteric, or hip, bursitis. This type of pain results from inflammation of the bursa, a fluid-filled sac between the greater trochanter and the tendon that passes over it that allows smooth motion between the bone and tendon. When the bursal sac becomes inflamed, pain results each time the tendon moves over the bone. Because the tendon moves with each step, patients with bursitis can find the condition quite painful.

“Bursitis is often related to an underlying problem, such as arthritis and degenerative disc disease of the back,” says Dr. Cianflocco. “This type of pain usually responds well to rest, anti-inflammatory medication—such as ibuprofen—ice, and physical therapy, with special attention to stretching exercises.”

If hip pain caused by bursitis does not respond to traditional treatments, cortisone injections may be the best option. In this procedure, cortisone (a steroid) is injected into the bursa over the trochanter. The injection does not require X-ray of the hip for guidance and may actually “cure” the pain indefinitely, says Dr. Cianflocco.

Yet, it is important to keep in mind that a cortisone injection is an invasive treatment.

“Deeper steroid injections into the lumbar spine or an arthritic hip joint should only be done in a setting where fluoroscopy, or live X-ray, is available,” says Dr. Cianflocco.

Fracture pain
Because the hip is one of the body’s largest weight-bearing joints, pain in this area should be taken seriously. A fracture is one source of hip pain, and it can be life-threatening. Hip fractures become more common as people age because bones become brittle and falls are more likely. Symptoms of a fracture include a mis-shapen or badly bruised hip, or sharp, sudden hip pain. Unlike arthritis of the hip or referred back pain, a hip fracture requires emergency medical care, with the possibility of surgery as a treatment.

“If you’re older, you also need to be concerned about non-musculoskeletal causes of hip and back pain, such as the possibility of a tumor,” says Dr. Cianflocco. “Red flags of a condition more serious than arthritis include pain at night that awakens you, pain that cannot be minimized or alleviated through traditional treatments, or weight loss, fever, and chills. These symptoms may indicate tumors of the lung, breast, kidney, prostate, or stomach.”

While hip and back pain can be a sign of a more serious condition, it is more likely the result of aging. With proper treatment, the pain does not have to be permanent.