Where in the hip is my pain?

Key Points

1. Understanding hip pain: Hip pain can originate from posterior, lateral, and anterior areas, each associated with different pathologies.
2. Study findings: Comprehensive review highlights diagnostic challenges and the importance of a thorough clinical examination combined with imaging.
3. Pain categorisation: Hip pain is divided into posterior, lateral, and anterior based on location and associated conditions.
4. Clinical implication: Clinicians should consider overlapping pain sources and use a multidisciplinary approach for diagnosis and treatment.
5. Patient advice: Patients should seek thorough evaluation and consider both non-surgical and surgical treatment options based on their specific condition.

What is traditionally understood about hip pain?

Hip pain is a common complaint, especially in adults over the age of 60. It can significantly affect mobility and quality of life. Traditionally, hip pain is understood to be complex due to the intricate anatomy of the hip region, including bones, muscles, tendons, and nerves. Pain can originate from various structures within and around the hip, making diagnosis challenging.

What was done in the study?

The study titled “Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin” conducted a narrative review of the literature to classify and understand the different causes of hip pain. Researchers used search terms related to hip pain and categorised the pain into posterior, lateral, and anterior locations. They reviewed various sources, including PubMed, and selected 116 papers for inclusion in their review​​.

What did they find?

The study categorised hip pain into three main areas: posterior, lateral, and anterior, each associated with specific conditions:

1. Posterior hip pain:
• Commonly caused by lumbar spine issues, sacroiliac joint pathology, and proximal hamstring tendinopathy.
• Can also be due to conditions like piriformis syndrome and ischiofemoral impingement.
• Diagnostic imaging like MRI is crucial for accurate diagnosis.
2. Lateral hip pain:
• Often results from gluteal tendinopathy, iliotibial band thickening, or trochanteric bursitis.
• External snapping hip and neuropathies of the lateral femoral cutaneous nerve are also significant contributors.
• MRI and ultrasonography are valuable for diagnosing these conditions.
3. Anterior hip pain:
• Associated with conditions like osteoarthritis, femoroacetabular impingement, and acetabular labral tears.
• Stress fractures and osteonecrosis of the femoral head are other causes.
• Imaging methods such as MRI, MRA, and CT are essential for thorough evaluation​​.

What is concluded in the study?

The study concluded that hip pain should be evaluated based on the pain’s location (posterior, lateral, or anterior) and associated pathologies. It emphasised the importance of a comprehensive history, physical examination, and appropriate imaging to identify the underlying cause. Myofascial pain and peripheral neuropathies should also be considered in each compartment. Clinicians must recognise the overlap between different sources of pain to avoid misdiagnosis and ensure effective treatment​​.

Hip pain can be divided into three main areas:

1. Posterior hip pain:
• Often related to the lumbar spine, sacroiliac joint, and proximal hamstring.
• Includes conditions like piriformis syndrome and ischiofemoral impingement.
2. Lateral hip pain:
• Primarily caused by gluteal tendinopathy and iliotibial band issues.
• External snapping hip and nerve entrapments can also cause lateral pain.
3. Anterior hip pain:
• Commonly due to intra-articular issues like osteoarthritis, femoroacetabular impingement, and labral tears.
• Stress fractures and osteonecrosis are significant contributors​​.

Clinical differentiation of hip pain

If you have hip pain, consider the following steps:

1. Seek a thorough evaluation: Consult a healthcare professional for a detailed assessment of your hip pain, including history, physical examination, and appropriate imaging.
2. Understand the pain location: Identify whether your pain is posterior, lateral, or anterior, as this can help pinpoint the possible underlying cause.
3. Consider conservative treatments: Explore non-surgical options such as physical therapy, medications, and lifestyle modifications before considering surgery.
4. Follow your treatment plan: Adhere to the recommended treatment plan and attend follow-up appointments to monitor your progress and adjust the plan as needed​​.

For Physiotherapists, you can use this information to inform your clinical decision process or clinical reasoning:

1. Conduct comprehensive assessments: Perform detailed history taking, physical examinations, and use appropriate diagnostic imaging to identify the cause of hip pain.
2. Categorise hip pain: Divide hip pain into posterior, lateral, or anterior categories to narrow down the potential causes and guide treatment.
3. Consider overlapping conditions: Recognise that different sources of hip pain can overlap, and use a multidisciplinary approach for accurate diagnosis and effective treatment.
4. Educate patients: Inform patients about their condition, the importance of following the treatment plan, and the potential outcomes.
5. Stay updated: Keep up with the latest research and guidelines to provide evidence-based care for your patients​​.

Conclusion

Hip pain is a common issue that can significantly impact daily activities and quality of life. Understanding the different causes of hip pain based on location and associated conditions is crucial for accurate diagnosis and effective treatment. Both patients and Physiotherapists should use a comprehensive, evidence-based approach to manage hip pain, considering both conservative and surgical options. Contact our Physiotherapists today to find out how we can help you address your hip pain! 

Ref:

Battaglia, P. J., D’Angelo, K., & Kettner, N. W. (2016). Posterior, lateral, and anterior hip pain due to musculoskeletal origin: A narrative literature review of history, physical examination, and diagnostic imaging. Journal of Chiropractic Medicine, 15(4), 281-293. https://doi.org/10.1016/j.jcm.2016.08.004

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