Hip pain: Where does it hurt?

When patients come into my office complaining of “hip pain,” my first question usually is: “Where is your pain?”

At that point, people often look at me like I have three heads, so I clarify: “Does it hurt in the front? In the back? On the side?” That seems to clear things up a bit and I can get some more information.

WHERE your hip pain occurs is important. There are many different structures around the hip that can contribute to various types and locations of hip pain. The hip is often thought of as a “region” rather than just a joint, thus the need to identify where exactly the problem presents itself to get to the root of what is causing pain.  The hip is a large, deep ball and socket joint with many supporting and connecting structures, so it can get a little bit muddy when trying to pinpoint the reason for pain and dysfunction.

So where does it hurt?

-          THE SIDE OF THE HIP

• What it could be: Trochanteric bursitis or gluteal tendonitis – These problems generally cause pain on the SIDE of the hip. You may experience pain when lying on the affected side, sitting for long periods of time (ie: driving), and with prolonged standing/walking.

-          THE FRONT OF THE HIP

• Hip joint problems (arthritis, labral tear, etc) – Problems within the hip joint itself (ball and socket) generally tend to present in the FRONT of the hip, or in the groin. The hip is a very deep joint – you can’t really push on the hip and reproduce true joint pain. You may feel like you “can’t put a finger on it” or “it’s a deep pain that I can’t pinpoint” - this is the description of classic hip joint (ball and socket) pain. Other symptoms of hip joint problems include limited range of motion – such as difficulty and pain putting on socks and shoes or getting in and out of the car. Generally, people with hip joint problems have increased pain when they pull their knee to their chest, which puts the hip in deep flexion.

-          THE BACK OF THE HIP

• Gluteal musculature problems/tears/weakness – There are three gluteal muscles: gluteus maximus, gluteus minimus, and gluteus medias. Gluteus minimus and medias are usually the trouble-makers for active individuals! Generally, gluteal muscle problems present with pain in the upper section of the BACK of the hip, near where the hip meets the low back. There can also be pain that goes from the back of the hip around to the side of the hip. Gluteal muscle problems or weakness are incredibly common, but often get overlooked by even experienced clinicians. Luckily, most gluteal muscle problems do not need surgery, but if left untreated they certainly can sideline active people from activities they enjoy.
• Piriformis or hamstring problems – The piriformis and hamstrings cause a true “pain in the butt.” There are many ways these two conditions can present, but the most common complaint of those suffering from piriformis or hamstring problems is deep buttocks pain. This pain is often worse with sitting and gets better with standing or lying down. If there is pain that radiates down the back of the leg, there is a chance the piriformis muscle could also be irritating the sciatic nerve.

The hip problems listed above are just some of the most common hip problems experienced by active people, but by no means is this a comprehensive list of hip pain causes. The good news is, active people (like you!) generally do a good job of paying attention to their body and knowing when something is “off.”  Paying attention to symptoms, including when and where pain occurs, is a vital part of addressing musculoskeletal problems when they arise. Don’t be afraid to be specific the next time someone asks you “Where does it hurt?” The more you can tell your healthcare provider, the quicker you will be on the road to recovery, and back to running those roads or trails again!

- Guest Post written by:

Amy K Jean, MSM, PA-C, AT-ret
Nashville Hip Institute
2004 Hayes Street, Suite 700
Nashville, TN 37203
amy@nashvillehip.org