Today, I want to focus on the hip — what it means when it's hurting and what we can do about it. We're going to walk through some common causes of hip pain in adults, look at traditional therapies and then talk about some newer non-surgical options that are showing promise.
So, where does hip pain come from?
That’s a question I get all the time. And it’s not always easy to answer. Hip pain is one of those things that can be frustrating for both the patient and the provider. There’s so much overlap — it can be the joint itself, muscles, tendons, bursal structures, nerves or even referred pain from the spine or abdominal and pelvic organs. Sometimes we have to go through a bit of trial and error to figure it out.
One of the first things I tell patients is to focus on location. Is the pain in the front of the hip? That might be from the joint or the hip flexors. Pain on the outside is usually muscles, tendons or bursitis. If it's in the back, that could point to deeper joint issues or even something like the piriformis muscle irritating the sciatic nerve.
We also need to consider history. Was there trauma or a fall? Is it something new or has it been nagging for months? We see patients who have had chronic injuries and others who have had slow-building pain from arthritis or stress injuries. All of that matters when we are trying to decipher the puzzle.
Common culprits
Osteoarthritis is the big one. It’s just the wear and tear of the joint over time. We’re seeing more of it as people live longer. We also see conditions like hip impingement and labral tears that can be pain generators across patients of multiple ages.
Other causes include stress fractures in runners, avascular necrosis (where blood flow to the bone is compromised) and, yes, sometimes the pain isn’t even coming from the hip — the back, pelvis or even your internal organs could be the real problem.
Traditional treatments
Physical therapy has always been one of the mainstays for treating hip pain. The two big goals I look at are strengthening the muscles in and around the joint and improving joint mobility. Weight loss can also help minimize the load on the joint and together, these strategies can really help patients manage pain, especially if it’s from arthritis or issues within the joint.
For stress injuries, relative rest is important. Telling a runner to stop running is tough, but sometimes we need to find other ways to keep people active while letting the injury heal. Gate helpers, such as canes or walkers, can offload pressure from the joint and are most effective when used on the opposite side of the affected hip.
Over-the-counter options like Tylenol, ibuprofen and topical versions — such as Biofreeze or menthol-based creams — are reasonable to consider. Just be sure to talk to your doctor, especially if you have kidney problems, take blood thinners, or have stomach issues. Supplements like glucosamine chondroitin have mixed data, but some patients do feel better using them. Turmeric has shown some benefit compared to a placebo in arthritis patients, while fish oil, collagen and Boswellia have more limited or anecdotal support.
Prescription options include NSAIDs and tramadol. But we’re steering away from narcotics for arthritis pain. Recent clinical trials have shown no improvement in function with narcotic use in moderate to severe arthritis, which is why many societies now recommend against it.
What’s new in non-surgical techniques?
On the non-surgical side, there are a few exciting developments to help manage hip pain. One is the use of ultrasound-guided injections. Traditionally, hip injections were done using fluoroscopy (live X-ray), which exposed both patients and providers to radiation. Now, with improved ultrasound technology, we can perform these in the office using just local anesthesia — no sedation — while avoiding radiation and getting great visualization in real time. You can watch the joint or muscles move on screen, and the patient can confirm if that movement is causing pain.
We can also use ultrasound to guide needles into specific muscles, tendons, bursae or joints — like the piriformis or the sacroiliac joint — and deliver medications like steroids or even off-label viscosupplementation (gel shots). This real-time approach helps confirm the pain source and monitor relief.
Another newer option is percutaneous tenotomy, used to treat chronic tendon irritation that doesn’t improve on its own. Using a small incision and ultrasound guidance, we insert a device that essentially “pressure washes” the tendon, clearing out debris and promoting healing. The procedure takes about 15–20 minutes.
Lastly, nerve block techniques have evolved to help some patients suffering from chronic hip pain. A femoral-obturator block, followed by an ablation, can provide 6 to 12 months of relief by targeting only the sensory fibers to the joint, with no motor impact. It’s a great option for patients who aren’t surgical candidates but need pain control and improved quality of life.
Recap
The key to treating hip pain is identifying the real source. You might need a little patience — and some trial and error — but once we find it, we can match you with the right therapy. Whether it's therapy, medication or one of the newer interventions, we’ve got more tools than ever to help.
If you’re struggling with hip pain and don’t know where to start, give us a call. We’re happy to walk you through the process and help improve your quality of life.
Learn more about hip pain relief available from Northside Hospital Orthopedic Institute.
