How your hip works

Your hip is a very stable and strong joint.

It’s known as a ball-and-socket joint. This is because the top of the thigh bone is shaped like a ball. This ‘ball’ sits inside a hollow socket in your pelvis.

Ball-and-socket joints give the most movement of all the different types of joints in the body.

The hip joint is held together by a covering of muscles which are secured to the bones by strong cords called tendons.

These muscles and tendons form a capsule around the joint and support its movements. They help move the joint, supporting your leg and upper body movement.

Inside the capsule is the synovium, which lubricates the joint with synovial fluid and keeps the cartilage healthy. The cartilage sits between the bones of your hip joint to stop them rubbing together and reduces any impact when you walk or move your hip.

With all this support, it is unusual for the hip to become dislocated, even after a high-impact injury.

When to see a doctor

Most of the time you can treat your hip pain yourself with simple self-help treatments. If your pain is extremely bad or hasn’t improved after two weeks of regularly taking painkillers, you should see your doctor.

You should see your doctor straight away if:

  • you’ve had a fall or injured your hip
  • the pain is getting worse
  • you’re having difficulty with daily activities, for example walking, going up stairs or leaning forwards when sitting
  • you feel feverish or unwell, or you’ve been losing weight.

Causes

Most of the time there is a very simple explanation for hip pain, for example if you’ve overdone it while exercising. In this case your pain is usually caused by strained or inflamed soft tissues, such as tendons, and it often clears up within a few days.

Long-term hip pain can be caused by specific conditions.

If you have a problem with your hip joint you may feel pain in the groin, down the front of the leg and in the knee. Sometimes knee pain is the only sign of a hip problem – this is called referred pain or radiated pain and is fairly common.

You may feel pain on the outside of your hip or in your buttock – though this can also be caused by problems with your lower back.

Diagnosis

If your hip pain hasn’t improved after two weeks you should see your doctor.

It’s a good idea to make some notes about your condition before you go, so you can be sure to discuss everything that’s bothering you.

Your doctor will ask about your pain and what movements make it feel worse. They’ll ask how your symptoms started, how they affect your daily activities and whether you’re in pain at night.

Pain when you bend your hip going up or down the stairs or when you put on your socks is often a sign of a hip problem.

They’ll examine your hip to find out how well it moves, and this will usually give them enough information to plan your treatment. But you may need other tests to diagnose some conditions.

What tests are there?

X-rays

X-rays are often the best way of finding out what’s wrong with your hip as they show the condition of the bones. They may also show problems in your pelvis which could explain your pain. They’re not as useful for looking at the soft tissues around the joint.

CT scans

A CT (computerised tomography) scan can often be very helpful to work out if the hip joint has an unusual shape. CT scans use x-rays to show sections or ‘slices’ of the hip, which a computer then puts together to form a 3D image of the hip.

There are conditions where the socket of the hip can be very shallow, and a CT scan can show this.

MRI scans

MRI (magnetic resonance imaging) scans use radio waves to build a picture to show what’s happening to the soft tissue, such as the muscles and tendons, inside your hip. They’re particularly helpful for diagnosing the painful condition avascular necrosis, which reduces the flow of blood to the ends of bone, causing them to collapse (See Specific hip conditions section for more information).

Blood tests

If your doctor thinks your pain is caused by an infection or rheumatoid arthritis, blood tests can often help.

Treatment

If your hip pain doesn’t improve with simple medications such as paracetamol and ibuprofen, and a mixture of rest and gentle exercises, you should see your doctor for further advice. They may recommend the following treatments:

Drugs

Non-steroidal anti-inflammatory drugs (NSAIDs)

Your doctor may prescribe stronger NSAIDs, such as diclofenac, naproxen, or a higher dose of ibuprofen, to help ease your pain.

Like all drugs, NSAIDs can sometimes have side-effects. If you’re taking prescription NSAIDs your doctor will take precautions to reduce the risk of these – for example, by prescribing the lowest effective dose for the shortest time.

Bisphosphonates

Bisphosphonates are used to treat Paget’s disease of the bone and osteoporosis. They work by slowing bone loss, which reduces the risk of hip fractures.

Managing your symptoms

There are several ways you can help your hip pain such as using painkillers, exercising and reducing the strain on your hip.

Painkillers

Simple painkillers, such as paracetamol, or non-steroidal anti-inflammatory drugs (NSAIDs) – like ibuprofen tablets or gels – from a chemist or supermarket can help. A pharmacist should be able to give you good advice on what could work best for your condition. But don’t use them for more than two weeks without speaking to your GP.

You can try rubbing anti-inflammatory creams or gels onto affected areas, but some hip problems are so deep within the joint that this may not help. A pharmacist can advise you on what’s best for your condition.

Specific hip conditions

Some of the specific conditions that affect the hip are:

Osteoarthritis

Osteoarthritis is one of the most common causes of hip pain in adults. It mainly affects the joints in the fingers, knees and hips.

Your hip joint can become painful, swollen and stiff because OA thins the cartilage that stops your bones rubbing together and causes bony lumps – known as osteophytes – to form on the bones of the joint.

You can feel a great deal of pain from osteoarthritis of the hip, which can restrict your movement and sometimes makes you limp.

In extreme situations, the leg can become shorter and the hip can become fixed in a bent position, making movement difficult.

Hip replacement surgery

Not everybody with hip pain will need surgery, but hip fractures almost always need fixation, which stabilises the bone and helps it to heal, or replacement of the ball of the hip. Hip fractures often occur in elderly people, and they can take a long time to fully recover from. People can often be in hospital for a couple of weeks or more to get over the fall and the operation, and many often need extra help at home after discharge.

Hip replacement surgery

If your hip pain is caused by arthritis and it’s getting worse, your doctor may talk to you about hip replacement.

Hip replacement is an extremely good treatment for arthritis-related hip pain, and modern techniques make the operation very safe with good outcomes.

Nowadays, many people only need to stay in hospital for a few days after their hip replacement, but it may be helpful if somebody is available to stay with you for a couple of weeks as your mobility and confidence improves. Physiotherapists will help you become mobile when you’re in hospital, and they’ll help you practise getting in and out of bed, out of chairs and up and down stairs safely.

If you’re being considered for hip replacement, it’s important that you’re in good health before the operation.

You’ll probably be referred to the hospital for an assessment before the operation and they’ll check your general health.

Your surgeon will talk to you about the operation itself, and you’ll meet the physiotherapists and occupational therapists who’ll be involved in your treatment after surgery.

The outcomes of hip replacements are extremely good – 90% or more of people who have had a hip replacement find their pain is greatly reduced. Modern hip replacements should last many years – around 80% of cemented hips should last for 20 years.

Revision surgery

If your hip replacement becomes loose, infected or otherwise fails, it’s possible to have surgical treatment. Modern revision surgery techniques are developing quickly and most failed hip replacements can be dealt with, which can restore function and activity.

Revision surgery is carried out by specialists in the field. You’ll be in hospital longer than for your first hip replacement, and it might take longer to recover. You’ll need physiotherapy after revision surgery to help you gain confidence in your new joint, and you’ll need someone to help you out for a couple of weeks or more when you go home.

Acetabular labrum surgery

A torn acetabular labrum can be repaired by surgical reshaping of the hip. In some cases this procedure can be performed through just a small incision (arthroscopically), so your joint doesn’t have to be opened up. This is also known as keyhole surgery, and it can be done as a day case or one-night stay in hospital.

You’ll need between one and two months off work.

We don’t yet know what the long-term effects of acetabular labrum surgery are, but you may get better hip movement as a result of it.

Research and new developments

Our research has shown that certain occupations, such as farming, can put you at greater risk of developing hip osteoarthritis.

Because of this hip osteoarthritis in farmers and other high-risk jobs is now recognised as an occupational injury, which entitles these people to claim Industrial Injuries Disablement Benefit.

We're currently funding research into developing new techniques to measure hip shape and abnormalities in babies and children.

Children with hip problems are more likely to develop osteoarthritis and to need hip replacement surgeries as young adults. This study will develop a tool to identify children who would most benefit from treatment as early as possible, reducing long-term pain and disability.

Researchers at our Centre for Sport, Exercise and Osteoarthritis are also studying the reasons why hip pain is commonly seen in young footballers.

We're also funding research looking into whether it is possible to predict the success of joint replacement surgery by looking at genetic risk factors.

This study will help doctors understand which patients are most likely to have good outcomes from joint replacement. It aims to improve patients’ experiences of surgery and make their new joints last longer.

Our researchers are also developing a tool to help patients make informed decisions about their treatment according to their lifestyle and needs.

Exercises for hip pain

Here are some exercises designed to stretch, strengthen and stabilise the structures that support your hip.

It’s important to keep active – you should try to do the exercises that are suitable for you every day. Repeat each exercise between 5–10 times and try to do the whole set of exercises 2-3 times a day.

Start by exercising gradually and build up over time. Remember to carry on even when your hip is better to prevent your symptoms returning.

If you have any questions about exercising, ask your doctor or physiotherapist.

It’s also a good idea to try to increase your general fitness by going for a regular walk or swim, this will strengthen your whole body – which helps support your hip. It can also improve your general health, fitness and outlook.

Simple stretching, strengthening and stabilising exercises

The following exercises are designed to stretch, strengthen and stabilise the structures that support your hip.

It’s important not to overstretch yourself if you’re in pain. It’s normal to feel some aching in the muscles after exercising, but you should stop and seek advice if you have joint pain that lasts more than a few days.

If you’ve had a hip replacement you will probably be advised to take it easy for the first six weeks and not to push yourself too much. Ask your physiotherapist what exercises they recommend you should start with and how to do them.

You may feel slightly uncomfortable during or after exercise, but this should settle within 24 hours. It shouldn’t be painful. If you feel any sudden pain stop exercising and seek medical advice.

Hip flexion (strengthening)

Hold onto a work surface and march on the spot to bring your knees up towards your chest alternately. Don’t bring your thigh above 90 degrees.

Hip extension (strengthening)

Move your leg backwards, keeping your knee straight. Clench your buttock tightly and hold for five seconds. Don’t lean forwards. Hold onto a chair or work surface for support.

Hip abduction (strengthening)

Lift your leg sideways, being careful not to rotate the leg outwards. Hold for five seconds and bring it back slowly, keeping your body straight throughout. Hold onto a chair or work surface for support.

Heel to buttock exercise (strengthening)

Bend your knee to pull your heel up towards your bottom. Keep your knees in line and your kneecap pointing towards the floor.

Mini squat (strengthening)

Squat down until your knees are above your toes. Hold for a count of five if possible. Hold on to a work surface for support if you need to.

Short arc quadriceps exercise (strengthening)

Roll up a towel and place it under your knee. Keep the back of your thigh on the towel and straighten your knee to raise your foot off the floor. Hold for five seconds and then lower slowly.

Quadriceps exercise (strengthening)

Pull your toes and ankles towards you, while keeping your leg straight and pushing your knee firmly against the floor. You should feel the tightness in the front of your leg. Hold for five seconds and relax. This exercise can be done from a sitting position as well if you find this more comfortable.

Stomach exercise (strengthening/ stabilising)

Lie on your back with your knees bent. Put your hands under the small of your back and pull your belly button down towards the floor. Hold for 20.

Bridging

Lie on your back with your knees bent and feet flat on the floor. Lift your pelvis and lower back off the floor. Hold the position for five seconds and then lower down slowly.

Knee lift (stretch)

Lie on your back. Pull each knee to your chest in turn, keeping the other leg straight. Take the movement up to the point you feel a stretch, hold for around 10 seconds and relax. Repeat 5-10 times. If this is difficult, try sliding your heel along the floor towards your bottom to begin with, and when this feels comfortable try lifting your knee.

External hip rotation (stretch)

Site you your knees bent and feet together. Press your knees down towards the floor using your hands as needed. Alternatively, lie on your back and part your knees, keeping your feet together. Take the movement up to the point you feel a stretch, hold for around 10 seconds and relax. Repeat 5-10 times.