Non-Surgical Hip Pain Treatment
What is hip pain?
Hip pain can be a debilitating and frustrating manifestation of hip pathology. The pain can have a profound impact on your life by impairing your capacity to perform a number of activities, ranging from those of your normal day-to-day routine to participating in sports and recreational activities. If you begin to notice that the pain lingers for more than a couple of weeks or is more severe than what you typically experience, then it’s important to consult a physician for further evaluation.
Initial Evaluation with my practice
At your initial evaluation with our team, x-rays will typically be obtained in order to further evaluate the bone structure and anatomy. Following the x-rays, a physical exam will help to determine where the source of the pain may be. In some cases, further diagnostic imaging, such as a MRI or CT scan, may be required to confirm the diagnosis and help establish potential treatment options for you.
Where is your pain?
Your treatment will be tailored according to where the symptoms are coming from. Depending on where you feel the pain and other clues from your history and physical exam, we can determine where is your pain coming from.
How to manage your hip pain
In our practice, we are very conservative in regard to our first line of treatment. We believe that most people benefit from non-surgical approaches first, as the majority of our patients will improve without the need of an invasive procedure. In the case of femoroacetabular impingement or a labral tear, conservative approaches might not heal the tear, although they can significantly help with the pain. With the appropriate muscular training and activity modification, symptoms can often be relieved completely, allowing many patients to return to their desired level of activity without ever having required surgery.
Read below for some of the options that we encourage our patients to try after their initial visit with our team.
Anti-inflammatory medications can be utilized as a first line of treatment, primarily when treating mild to moderate pain associated with inflammation. Joints and tendons sometimes get inflamed after experiencing an injury, accident, or repetitive use of the joint. In some cases, inflammation can occur with no eliciting reason at all. In these cases, anti-inflammatories can significantly help to reduce the inflammation, resulting in a decrease in your pain. It is important to know the dosage in order to avoid side effects from these medications. Additionally, they should not be taken for an extended period of time, as they can lead to further systemic problems.
Physical therapy is a key component in treating hip pain. Physical therapy can target several areas that can help mitigate and often times solve hip pain. Under the guidance of a skilled physical therapist who specializes in hip pathology, physical therapy can help strengthen muscles around the hip joint, increase flexibility and maintain range of motion of the joint, decrease the inflammation of the joint or tendons surrounding the hip, and correct hip joint or low back positions that might be adding to your overall pain.
Injections are another reasonable conservative treatment option to consider when struggling with hip pain, as they can:
- Help diagnose where exactly the pain is coming from. This type of injection is called a diagnostic hip injection.
- Help treat the pain by decreasing inflammation within the joint or tendons surrounding the hip joint.
Diagnostic Hip Injections
For this purpose, a numbing drug (lidocaine) is injected directly into the joint using either ultrasound guidance. If you experience relief from pain, or at least a reduction in more than 50% of the pain, immediately following the injection, then we can confirm that the hip joint is the actual source of pain. However, if there is no relief in pain, it means that the pain is coming from somewhere else besides the joint.
- Intra-articular Injections are an ultrasound-guided cortisone, hyaluronic acid, or platelet rich plasma (PRP) injection made directly into the hip joint that can provide symptomatic relief. Ultrasound-guided injections use dedicated, precise, high-resolution ultrasound equipment that allows the provider to target the injections directly into a specific area, maximizing therapeutic outcomes. Following the injection, pain relief varies from patient to patient. Some may feel symptomatic relief within two to five days. However, if a patient feels no relief within ten days following the injection, the patient is unlikely to gain any additional improvement and further diagnostic testing may be needed to identify other options for relief.
- Psoas Injections are often prescribed when the diagnosis is thought to be a symptomatic psoas tendon, which runs outside of the hip joint. In some cases, this diagnosis is difficult to make, as a painful psoas tendon often results in abnormal rubbing of the tendon on the hip, causing symptoms consistent with intra-articular pathology as well. Similar to the intra-articular injection, an ultrasound is used to help guide the provider in administering the injection directly into a specific area. However, for a psoas injection, the provider will inject directly into the psoas tendon. As a result, pain relief following a psoas injection will only occur outside of the hip joint. Thus, if there is involvement of the labrum as well, which is inside the joint, additional evaluation is recommended.
Trochanteric Bursa Injections are prescribed for patients who present clinically with bursitis on the outside of their hip but have failed to experience symptomatic relief with physical therapy and an anti-inflammatory regimen.