Hip Pain

Hip pain can have a significant impact on the daily life of those affected. The hip joint is extremely important: it is the second largest joint in the human body after the knee joint. As a ball joint, it consists of two bony components that interlock: the cup-shaped acetabular cup and the spherical femoral head (caput femoris). This joint sits in the groin area between the pelvic bone and the femoral neck - so deep that it cannot be felt.

Hip pain occurs when the hip joint can no longer perform its shock absorber function, for example due to wear, a rheumatic disease, poor circulation or inflammation. The cartilage tissue between the ball joint and the socket is subsequently destroyed until the bones rub against each other at some point. Hip pain is usually noticeable in the groin or in the area of the large rolling hill (trochanter). The trochanter is the large bone protrusion on the side of the upper thigh bone.

The characteristics of the complaints can be very different: for example, in some patients the hip pain is one-sided with radiation in the leg, in others the pain radiation is absent, in a third group both hip joints are affected. Some patients complain of hip pain when walking, while others feel the pain in their hips when they get up in the morning. In some cases, there is also persistent hip pain.

Other symptoms may accompany the hip pain. These accompanying symptoms include, for example, restricted movement of the hip joints or swelling and redness in the pain area. All symptoms together give the doctor clues to the cause of the hip pain.

Usefull Information About Hip Pain

The main reasons for sudden (acute) pain in the hip area are:

  • Femoral neck fracture: sudden hip pain in the groin area after a fall, less often without an identifiable cause (with osteoporosis); the movement of the affected leg is very painful.
  • Traumatic hip dislocation: "dislocation" of the hip joint due to an accident; severe pain in the buttocks or groin.
  • Septic coxitis: bacterial inflammation of the hip joint; Usually the hip pain is one-sided, increases rapidly and is accompanied by a high fever and a strong feeling of illness.
  • Coxitis fugax ("runny nose"): hip inflammation in young children; sudden leg and hip pain in the groin area; the children limp and don't want to go anymore.
  • Epiphysseolysis capitis femoris at puberty: detachment of the femoral head cap from the neck of the thigh bone in the area of the growth plate; sudden, violent pain in the groin, thighs and / or knees with inability to walk.

In other cases, hip pain develops more slowly and can last for a long time. The main causes are:

Leg length difference (BLD)

About 75 percent of the population have legs of different lengths. With a slight difference, those affected usually have no symptoms. A larger difference in leg length, on the other hand, is noticeable by a shortening limp. Over time, spinal or hip pain often arises. Because the hip of the longer leg is subjected to increased stress, it wears out more: hip arthrosis (coxarthrosis) can also result, as can periarthropathia coxae.

Osteoarthritis of the hip joint (coxarthrosis)

Doctors call coxarthrosis (hip arthrosis) a joint wear in the hip. It mainly occurs in old age, but sometimes also affects younger people. Patients suffer from chronic hip pain with increasing movement restrictions. The symptoms are noticeable, for example, when getting out of the car or climbing stairs. In later stages of the disease, hip pain also occurs at night and at rest.

Periarthropathia coxae

Those affected complain of hip pain, more precisely pain in the area of the large rolling hill. This is the strong bone protrusion on the side hip joint. The pain radiates along the outside of the thigh to the knee. They are particularly noticeable when bending or strongly spreading the hip joint.

The cause is a non-inflammatory, wear-related disease of the tendon insertion in the area of the large trochanter ("rolling mound"). Sometimes the bursa in this area (Bursa trochanterica) is also affected.


Depending on which bursa is inflamed, those affected may feel pain in the area of the trochanter, the buttocks or in the groin area. In the case of bursitis on the trochanter (trochanteric bursitis), the hip pain when lying down is often noticeable on the affected side. The bursitis can be acute or chronic.

Arthritis of the hip joint

In general, hip pain occurs in the groin area with coxitis and often extends to the knee. The hip can only be moved to a limited extent, and the patients usually adopt a gentle posture (with slight flexion and rotation of the thigh outwards).

Coxitis is an inflammation of the hip joint. If it is caused by bacteria, it is called septic coxitis. However, the disease can also occur as rheumatoid arthritis (“rheumatism”), as an inflammatory flare-up of hip arthrosis (activated arthrosis) or as a side effect of a disease close to the hip joint (such as tumors). The most common and most harmless variant is acute “runny nose” (coxitis fugax) in young children.

"Rapid hip" (Coxa saltans)

With the Coxa saltans, the hip pain is on the outside, i.e. in the area of the large rolling hill (trochanter). When flexing the hip joint, a taut tendon ligament (iliotibial band) usually slides from the back to the front over the trochanter. With the Coxa saltans, the tendon ligament hangs briefly and then snaps abruptly over the trochanter. This painful snapping is visible and audible when walking. The Coxa saltans mainly occurs in young women.

Idiopathic femoral necrosis

With idiopathic femoral head necrosis, patients report increasing, stress-related hip pain in the groin area; knee pain may also occur. Internal rotation and spreading (abduction) of the thigh are increasingly restricted.

Behind the clinical picture is the death of bone tissue on the femoral head (femoral head necrosis) without a recognizable trigger (idiopathic). In half of the cases, both hip joints are affected. Risk factors for idiopathic femoral head necrosis include the use of glucocorticoids ("cortisone"), alcohol abuse, metabolic disorders (such as increased blood lipid levels) and vascular diseases (such as arterial occlusive disease).

Femoral head necrosis in children is called Perthes disease. In the beginning, it is usually only noticeable by a limp. Hip pain in the groin or knee pain usually follow later.

Bottleneck syndrome (impingement) of the hip

It manifests itself in occasional, stabbing hip pain in the groin. These pains occur especially with strong hip flexion and prolonged exertion. This is due to changes in the shape of the femoral head or acetabulum, which hinder the movements of the hip joint, especially the flexion.

Meralgia paraesthetica

Initially, the hip pain only shows up when standing and improves when the leg is bent in the hip joint. Persistent pain occurs later.

The complaints in this clinical picture are based on nerve compression under the groin band. Patients suffer from sensations (paraesthesia) as well as burning pain and sensitivity disorders on the front or outside of the thigh.

Epiphysolysis capitis femoris

Epiphyseolysis capitis femoris is characterized by slowly increasing hip pain in the groin as well as knee pain and limping. In most cases, both hip joints are affected.

It is the chronic variant of hip head gliding (see above). It is much more common, but also occurs during puberty.

The affected women report sometimes severe pelvic, lower back or hip pain. Early pregnancy can be accompanied by such symptoms. The growing weight of the growing child can add to it as the child progresses.

Hip pain in pregnancy is caused by hormonal changes that cause the connective and muscle tissue in the pelvic area to loosen. In addition, hip pain in expectant mothers can also have non-pregnancy-related causes, such as bursitis or hip infection (coxitis).

If you have hip pain, you should always go to the doctor to find out the cause. How this hip pain can be treated then depends on this diagnosis and individual factors. Some examples:

Treatment options for coxarthrosis include:

  • Exercise therapy
  • Heat treatment
  • Electrotherapy
  • Medications: They are used in advanced stages of coxarthrosis, for example anti-inflammatories. For hip pain due to bursitis, glucocorticoids ("cortisone") can be useful as an injection.
  • Artificial hip joint: If conservative measures do not help sufficiently against the restricted movement and pain in the hip, many patients receive an artificial hip joint.

Inflammation of the hip (coxitis) is treated depending on the trigger: In the case of septic coxitis, in addition to immobilization and antibiotics, the surgical opening and irrigation of the joint are recommended. This removes infected tissue. An artificial hip joint may also be used. Such a joint replacement is also necessary in the case of rheumatic coxitis if other therapeutic measures (medication, physical therapy, etc.) cannot eliminate the hip pain and mobility is severely restricted as a result (as with activated hip arthrosis).

With coxarthrosis can help:

  • Relieve the hip: Treatment for coxarthrosis initially involves a lifestyle change: In the case of obesity (obesity), weight loss, various aids for everyday life (walking stick, dressing aids for shoes and stockings etc.) are recommended.
  • Moving and strengthening: A lot of movement with little joint strain such as cycling or swimming maintains mobility and relieves hip pain. Exercises such as those shown by the physiotherapist to the patient should therefore be carried out regularly at home. They also strengthen the muscles that surround the hip joint, which is thereby better stabilized.

These exercises, which you should not undertake without consulting a doctor or physiotherapist, could include, for example:

  • Mobilize your hips: face down to the wall on a low step or a thick book, stabilize with your hands on the wall. First let the right leg swing back and forth, then change legs.
  • Strengthen side muscles: Stand parallel to a wall or chair, right shoulder facing the wall. Support yourself on the wall / chair with your right hand, stand steadily with both feet. Raise the left leg straight up and down and lower it again towards the right leg. Hold briefly above the ground, set down. Turn around and repeat with the right leg.
  • Stretch hip muscles: Stand hip-width apart. Take a lunge forward with your right leg, push your hips forward, you can place the knee of the back leg on the floor for a firm stand (place a towel / mat under it). Back to the starting position. Change leg. Alternatively, you can place one leg on the seat of a chair and lean forward.

If you have a septic inflammation of the hip (septic coxitis), you should keep your hip still as much as possible to support the healing process and relieve the pain.

With "runny nose" (coxitis fugax), which mostly occurs in children and only rarely in adults, the pain can generally be alleviated with a few days of bed rest and the administration of the pain reliever paracetamol. However, as long as the leg and hip pain in the groin persists, the affected child should not participate in school sports.

To find out the cause of your hip pain, the doctor will first talk to you in detail. Possible questions during this anamnesis interview include:

  • Where exactly do you feel the hip pain?
  • When did the hip pain start?
  • Do the hip pains only appear when you are under stress or can you feel them at rest or at night?
  • How far can you go on level ground without hip pain?
  • Is there gait uncertainty? Do you use a walking stick?
  • Do your joints feel stiff for more than half an hour in the morning (morning stiffness)?
  • Do you have pain in other joints?
  • Do you know of any diseases (such as metabolic diseases)? Did you have a musculoskeletal disorder in your childhood?
  • Do you notice any abnormal sensations (paraesthesia) in the legs?
  • Are you taking any medication (pain reliever, cortisone preparation, etc.)?
  • Which job do you have? Do you do sports?

Physical examination

The physical examination follows. The doctor will always examine both sides equally, even if the hip pain may only appear on one side.

The doctor examines the gait pattern of the patient and pays attention to possible limping. He checks whether the leg axis is straight or whether the patient has X or O legs. The doctor also checks whether the pelvis is straight and the legs are the same length.

In the next step, the doctor gropes and pats the groin area and the area around the trochanter on the outside of the pelvis. He pays attention to signs of inflammation such as local redness, overheating and swelling. These symptoms could indicate bursitis as the cause of the hip pain.

Blood test

A blood test is also helpful to get to the bottom of hip pain. For example, the sedimentation rate (ESR) is an important parameter for identifying inflammatory and rheumatic causes of hip pain. In the case of wear-related illnesses, on the other hand, the BSG is not or only slightly increased. The number of white blood cells (leukocytes) is also significant: An excessive number of leukocytes (leukocytosis) can be found, for example, in unspecific arthritis, osteomyelitis (inflammation of the bone marrow) and in bacterial hip inflammation.

Imaging procedures

An x-ray examination of the pelvis is primarily used to discover any signs of osteoarthritis as the cause of hip joint pain. More detailed images can be obtained using computer tomography (CT). It can better represent the severity of joint destruction (such as in femoral head necrosis).

An ultrasound examination of the hip joint can, for example, identify bursitis, joint effusion and inflammation of the inner skin of the joint (synovitis) as the reason for the hip pain. Changes in the muscles and tendons in the hip area can also be visualized using ultrasound.

Magnetic resonance imaging (MRI) is well suited for diagnosing inflammatory soft tissue changes as well as early stages of osteonecrosis or a fatigue fracture.

If the hip pain is due to inflammation or tumors in the joint area, this can be determined with the help of a nuclear medical examination (joint scintigraphy).

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