Non-surgical ways to treat hip pain
Hip pain may result from injury or cumulative wear and tear, but most cases can be managed non-surgically with medication and exercise, according to Kevin W. Dwyer, MD of Cape Cod Orthopaedics and Sports Medicine in Hyannis.
About half of his patients complain of hip pain, Dr. Dwyer said. Unless hip pain progresses to where it’s preventing someone from going about their daily life, he recommends non-operative methods for relief.
“I spend some time in clinic talking people out of surgery,” he said.
Remedies include:
- Oral over-the-counter NSAIDs (non-steroidal inflammatory drugs), such as ibuprofen and naproxen
- Diclofenac gel (Voltaren, an NSAID preparation applied to the skin)
- Physical therapy
- Cortisone (a corticosteroid) taken orally or by injection
- Hyaluronic acid injections; and/or
- Weight loss, to reduce pressure on the hip joint
Sources of Hip Pain
Dr. Dwyer identified three main categories of conditions that cause hip pain:
- Osteoarthritis, ranging from mild to severe, common in older patients
- Trochanteric bursitis, abductor tendinitis and abductor tears, which can affect any age group
- Abnormalities of the hip joint, including femoroacetabular impingement (FAI) and hip dysplasia, which affect adults 20-50 years old
Hip pain is “incredibly common,” Dr. Dwyer said. The Cape Cod “patient population is definitely older with a lot more arthritis and bursitis than I’ve seen before. They desire to continue to be active. Offering them strategies to stay active is really important.”
Physical Therapy and Exercise
Osteoarthritis is the type of arthritis associated with damage to joints accumulated over years of use. It gets gradually worse with time, so treating it promptly can limit pain and stiffness, according to the American Academy of Orthopaedic Surgeons (AAOS). In the hip joint, osteoarthritis breaks down the cushioning cartilage between the femur’s head, which is the ball of bone at the top of the thigh bone, and the acetabulum, the socket in the pelvis that the head fits into. The group recommends physical therapy and exercises to promote range of motion and flexibility, while also strengthening hip and leg muscles.
Trochanteric bursitis refers to inflammation of a small fluid-filled sack on the outside of the hip end of the femur, the greater trochanter, and occurs more often among women and people middle-aged or older, according to the AAOS. Repetitive stress – overdoing the same motion – can cause it, so can a hip injury. It responds well to physical therapy, Dr. Dwyer said, as does abductor tendinitis, inflammation of the tendons connected to the group of abductor muscles on the outside of the thigh. Overuse or repetitive stress injuries can also be the culprits for this pain in the hip.
“Going to therapy is great, but continue that at home,” he said. “Continuing that home exercise program is really key.”
For people apprehensive about physical therapy, Dr. Dwyer will show them exercises they can do at home. He said the AAOS website contains exercises for maintaining hip health or for recovering from hip surgery.
When is Surgery Called For
“Surgery is purely elective,” Dr. Dwyer said of most hip pain.
But there are instances where quality of life is at stake. He will operate on patients who can’t sleep at night or perform their jobs because of debilitating pain. A patient’s age and general health should be considered when deciding to operate.
Before pursuing a hip operation, Dr. Dwyer requires an X-ray or other imaging showing severe arthritis.
“Pre-emptive surgery in mild arthritis is not a winning option,” he said.
However, surgery can remove inflamed bursae and repair abductor tears, Dr. Dwyer said. It may also be necessary for hip abnormalities.
“FAI can be treated very conservatively, at first,” he said.
Later stage FAI may necessitate surgical arthroscopy to repair and debride the labrum, the cartilage around the exterior of the hip joint, a procedure he doesn’t perform. A procedure called periacetabular osteotomy (PAO) may be used to correct hip dysplasia, when the socket is too shallow because it didn’t develop correctly in childhood. However, mild cases may be dealt with via observation, avoidance of activities that cause pain and medication, according to the AAOS.
