Hobbling with hip pain?

Typically presenting as pain in the groin that occurs with deep hip flexion, hip pain in young adults (late teenage years to 40s) is “extremely common,” according to Queensland-based Orthopaedic Surgeon Dr David Agolley. If conservative treatments such as physiotherapy, osteopathy, massage and even injections are not giving long-term pain relief, a second opinion from a specialist with an interest in young adult hip pain is recommended – so to avoid complications down the track, Agolley said. What’s the cause? “Common causes of hip pain are muscle or tendon strain sports injuries, and the increase in [hip joint injuries] such as labrum (hip joint cartilage) tearing due to high hip flexion sports. “Hip pain is becoming more common as amateur sport is increasing, [often involving] high-kicking sports” such as ballet, dance, AFL, football and surfing, Agolley said. “Sometimes one specific event will have caused the pain due to deep hip flexion, causing impingement (abnormal collision of the thigh bones) and a labrum tearing.” Repetitive stress is another cause, “more so in patients with hip dysplasia – instability of the hip that causes hip pain from a labrum tear,” Agolley said. “Underdiagnosed conditions like hip dysplasia (shallow hip socket), cause pain from instability of the hip. “For some the pain will present as just a niggle in the groin, sometimes with referred pain to the buttock that’s [about] a three out of 10. But in [undiagnosed patients], pain can progress to up to a nine out of 10. “Mild cases might only have pain when running or standing for long periods, or for a few hours to a few days after playing sport. In the most severe cases it is difficult to walk.” Proper diagnosis and treatment A detailed case history will first address the cause of the hip pain, when it occurs, and why conservative treatment is not helping, Agolley said. A physical examination and basic investigations by a trained specialist will follow via a series of plain X-rays and MRI scan, which can be helpful with diagnosis, he said. “Treatment usually involves strategies with targeted physiotherapy to improve strength of the core and hip girdle.” Activity modification, such as altering a cyclist’s bike or altering a desk worker’s work environment (elevating a seated work station with a saddle chair for example) can also be beneficial. “People are happy to modify their bikes, but if you ask them to change their sport [because it’s aggravating the pain], they tend not to do that. If other therapies don’t help, [athletes] are the ones who tend to go onto surgery,” Agolley said. “Surgery is tailored to the patient’s individual problems. [It can range] from keyhole surgery to the hip and performing labrum repair, or removal of a bony bump in the hip, to more complex hip reconstructive surgery for hip dysplasia. “Recovery is quite painless and rapid for keyhole surgery. The patient will be off crutches and back to work within a week. “For osteotomy surgery [where the bone is cut], recovery is longer with a more dedicated rehabilitation process.” Early diagnosis is key “Patients are often told that nothing is wrong [and that it’s just] groin pain, and they’ll hobble around for 10 or 20 years [before proper diagnosis],” Agolley said. “If [the cause of hip pain is] not diagnosed early enough, [the patient can] end up getting hip arthritis early in life – whereas preventative [measures] can be [made] beforehand to essentially minimise [that risk]. “We try to avoid hip replacements in young people [wherever] possible,” Agolley said.

If conservative treatments such as physiotherapy, osteopathy, massage and even injections are not giving long-term pain relief, a second opinion from a specialist with an interest in young adult hip pain is recommended – so to avoid complications down the track, Agolley said.

What’s the cause?

“Common causes of hip pain are muscle or tendon strain sports injuries, and the increase in [hip joint injuries] such as labrum (hip joint cartilage) tearing due to high hip flexion sports.

“Hip pain is becoming more common as amateur sport is increasing, [often involving] high-kicking sports” such as ballet, dance, AFL, football and surfing, Agolley said.

“Sometimes one specific event will have caused the pain due to deep hip flexion, causing impingement (abnormal collision of the thigh bones) and a labrum tearing.”

Repetitive stress is another cause, “more so in patients with hip dysplasia – instability of the hip that causes hip pain from a labrum tear,” Agolley said.

“Underdiagnosed conditions like hip dysplasia (shallow hip socket), cause pain from instability of the hip.

“For some the pain will present as just a niggle in the groin, sometimes with referred pain to the buttock that’s [about] a three out of 10. But in [undiagnosed patients], pain can progress to up to a nine out of 10.

“Mild cases might only have pain when running or standing for long periods, or for a few hours to a few days after playing sport. In the most severe cases it is difficult to walk.”

Proper diagnosis and treatment

A detailed case history will first address the cause of the hip pain, when it occurs, and why conservative treatment is not helping, Agolley said.

A physical examination and basic investigations by a trained specialist will follow via a series of plain X-rays and MRI scan, which can be helpful with diagnosis, he said.

“Treatment usually involves strategies with targeted physiotherapy to improve strength of the core and hip girdle.”

Activity modification, such as altering a cyclist’s bike or altering a desk worker’s work environment (elevating a seated work station with a saddle chair for example) can also be beneficial.

“People are happy to modify their bikes, but if you ask them to change their sport [because it’s aggravating the pain], they tend not to do that. If other therapies don’t help, [athletes] are the ones who tend to go onto surgery,” Agolley said.

“Surgery is tailored to the patient’s individual problems. [It can range] from keyhole surgery to the hip and performing labrum repair, or removal of a bony bump in the hip, to more complex hip reconstructive surgery for hip dysplasia.

“Recovery is quite painless and rapid for keyhole surgery. The patient will be off crutches and back to work within a week.

“For osteotomy surgery [where the bone is cut], recovery is longer with a more dedicated rehabilitation process.”

Early diagnosis is key

“Patients are often told that nothing is wrong [and that it’s just] groin pain, and they’ll hobble around for 10 or 20 years [before proper diagnosis],” Agolley said.

“If [the cause of hip pain is] not diagnosed early enough, [the patient can] end up getting hip arthritis early in life – whereas preventative [measures] can be [made] beforehand to essentially minimise [that risk].