“Sometimes Your Hip Pain isn’t Your Hip”

Prairie Doc Perspective Week of October 13th, 2024
“Sometimes Your Hip Pain isn’t Your Hip”
By Andrew Ellsworth, MD


“Doc, my right hip has been bothering me.  Do you think I need a new hip?”
“First, tell me more about your hip pain.”


Hip pain is a common complaint which can have a variety of causes.  The first thing that comes to mind is arthritis of the hip joint.  The hip is a ball and socket joint.  The main upper leg bone, the femur, has a rounded top called the head. Under the head of the femur is the neck, which can often be what breaks when someone suffers a hip fracture.  Arthritis and wear and tear over time can cause the cartilage in the ball and socket joint to break down and become thinner and irregular.  This can cause pain especially with movement and walking.  


A simple x-ray of the hip can help show signs of arthritis of the hip joint.  Sometimes one can try physical therapy, non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, or perhaps a steroid injection to help calm down the inflammation and pain.  Over time, if those efforts do not help enough or if the arthritis is advanced enough, sometimes a hip replacement may be beneficial.  


However, when someone reports hip pain, it may not actually be their hip joint that is the problem.  Arthritis of the low back, degenerative disc disease, sciatic nerve pain, lumbar stenosis, and other problems with the back can cause pain that feels like it is in the hip.  Sometimes that pain is felt deep in the buttocks.  Sometimes arthritis or inflammation of the sacroiliac joint, where the low back connects to the pelvis, can cause pain.  This may often be felt as low back pain, but can present as hip pain.  


Another cause of hip pain is bursitis or inflammation of the bursa sac located on the greater trochanter of the hip, the large upper outside edge of the femur where the neck connects to the shaft of the femur.  You may be able to feel this hard area of your hip at your side. This is a common area for pain.  While this pain is located at the hip, it is not coming from the hip joint.  Our body has bursa sacs near bones in many places, essentially fluid-filled pads that can help protect the nearby bone and tendons and reduce friction between tissues of the body.  


Greater trochanteric bursitis can result from a fall, repetitive motion, weakness of muscles, or be associated with some diseases.  Usually rest, NSAIDs, time, and physical therapy can help it to improve.  Exercises can help by strengthening the surrounding muscles which can decrease the rubbing and friction over the bursa sac.  A steroid injection can often be helpful. Surgery is rarely needed.


Other causes of hip pain can be from a pelvic bone fracture, tendinopathy, a muscle strain, a labral tear, other musculoskeletal problems, constipation, infection, and rarely cancer.  Thus, if you are suffering from hip pain, it may be time to see your medical provider, and start figuring out whether your hip is really the problem. 


Andrew Ellsworth, MD. is part of The Prairie Doc® team of physicians and currently practices family medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.