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The most common causes of hip pain are arthritis, bursitis, muscle strain, and nerve irritation.

1. Arthritis — The hip is a "ball and socket" joint formed by the pelvic bones (the socket) and the end of the femur bone (the ball). Both bones are covered with a smooth layer of protective cartilage; loss of this cartilage from wear and tear, inflammation, or injury causes arthritis.

Osteoarthritis is the most common cause of hip pain in those over the age of 50, however, other types of arthritis can be present. These may include

· arheumatoid arthritis

· ankylosing spondylitis

· arthritis associated with inflammatory bowel disease (Crohn's disease or ulcerative colitis).

Some systemic diseases are associated with hip pain, including sickle cell disease, in which a joint may swell during a sickle crisis either with or without an underlying infection. The hip joint is not the only joint that may be involved.

Viral or bacterial infections may cause hip inflammation. Examples include Lyme disease, Reiter's syndrome, and infections caused by food poisoning.

2. Avascular necrosis of the femoral head may occur in people who have taken corticosteroid medications like prednisone for a prolonged period of time. In this condition, the femoral head loses its blood supply, becomes weakened, and causes hip pain. Legg-Calvé-Perthes disease (or just Perthes disease) describes avascular necrosis of the femoral head in children and is idiopathic, meaning the cause is unknown.

3. Fibromyalgia is a systemic pain syndrome associated with pain and stiffness that can cause significant discomfort throughout the body and may present as hip pain. There may be associated sleep disorders, muscle cramps and spasms, tenderness of a variety of muscle groups in the whole body, and fatigue.

4. Bursitis — The hip joint and the large muscles that cover it are lubricated by five large bursa sacs and the fluid contained in the hip joint. Each sac produces lubricating fluid and functions to reduce pressure and friction around the joint. These bursa sacs can become irritated from injury, excessive pressure, and overuse. Inflammation of a bursa is called bursitis.

5. Muscle strain — Three major muscle groups help to move the hip through a wide range of movements. Overuse and irritation of these muscles can lead to muscle strain.

6. Nerve irritation — The major nerves controlling lower leg function cross the hip. Irritation of these nerves can cause pain through the hip and/or down the leg. Injury to the sciatic nerve frequently causes pain along the outer thigh or down the back of the leg; this is called sciatica. This is discussed separately.


Hip arthritis — If you have hip arthritis, you should avoid the extremes of hip motion and should minimize jarring and high impact activities:

· Contact sports such as football, rugby, and wrestling, and stop-and-go sports such as basketball, tennis, and racquetball should be limited or avoided, at least temporarily. These activities can cause flares of arthritis and worsen arthritic damage.

· Avoid running and jumping.

· Avoid activities that require you to spread your legs widely.

Hip bursitis

· Avoid repeated bending of the hip and direct pressure over the hip.

· Do not sleep on the affected side; sleeping on the back or stomach is preferable.

· Stair climbing, stair stepper, step aerobics, rowing machine, bicycling, squatting, and stop-and-go sports (eg, tennis and racquetball) create too much friction and irritation and should be avoided until the pain has subsided.

· Avoid prolonged sitting.

· Minimize working in a stooped position.

· Limit repetitive bending at the hip.

· Do not bend over to touch the toes during the recovery period.


If pain is bothersome, you can take a pain medication such as A nonsteroidal antiinflammatory drug (NSAID), or naproxen can also be used for pain.


Heat — Heat helps prepare the tissues for stretching and is recommended before beginning each exercise session. The preferable method of heating is in a warm shower or bath for 10 to 15 minutes. Local heat (eg, with a heating pad or a towel warmed in a microwave) is an alternative, but may not be as effective.

Hip arthritis — Stretching exercises are recommended once per day, after heating the area.

Knee chest pulls — Lie on the back on a bed or on a towel on the floor. Bring knees up to chest. Place the hands behind the knees and pull toward the chest until you feel a stretch in the lower back and buttocks. Hold for a count of 5. Rest and repeat 15 to 20 times.

Figure of four stretch — Stand next to stable piece of furniture (eg, couch). Stand on the unaffected leg and place the opposite foot along the inside of the knee (imagine a number 4). Gently rock the knee outward. The higher the foot is raised the greater the stretch. Hold for a count of five. Rest and repeat 15 to 20 times.

Sitting stretch — Sit on the floor and place the feet together and the knees apart. Pull the feet up towards the groin. Lean forward gently to increase the stretch, but do not bounce. Hold for a count of five. Rest and repeat 15 to 20 times.

Hip bursitis — Cross leg pulls and outer thigh stretches are often recommended for people with hip bursitis.

Cross-leg pulls — To perform cross leg pulls, cross the affected leg over the other while in a sitting position either in a chair or on the floor. Grasp the knee and pull the leg to the opposite side. Keep the buttocks flat; do not roll the pelvis. A gentle pulling sensation should be felt in the outer buttocks or hip area. Rest and repeat 15 to 20 times.

Outer thigh stretches — Stand at arms length away from a wall with the affected leg near the wall (picture 2). Cross the affected leg behind the other leg. Carrying all the weight on the good side, bend the elbow and lean into the wall. You should feel a stretch through the hip and side of the body. Rest and repeat 15 to 20 times.


Muscle toning exercises may be recommended if you require prolonged bedrest, have been in a cast, or have been inactive. Toning exercises should always be done after stretching exercises.

Straight leg raises — These exercises are performed while sitting on the edge of a chair or while lying down (picture 3). Keep the affected leg straight and bend the knee of the other leg. Lift the affected leg three to four inches off the ground. Hold for 5 seconds. Rest. Repeat 15 to 20 times.

With improved strength, these exercises can be performed with a five to 10 pound weight placed at the ankle.

Leg extensions — These exercises strengthen the muscles in the buttocks. Perform these exercises while lying on the stomach or while on all fours. Extend one leg backwards, hold straight, and raise it 3 to 4 inches off the ground. Hold for five seconds. Repeat 15 to 20 times for each leg.

After three to four weeks, you can increase the difficulty of the exercise by adding a five to 10 pound weight to the ankle. Perform this exercise while lying flat if you have knee cap irritation or arthritis.


The following positions and activities are recommended to reduce the possibility of reinjury to the hip joint and the surrounding bursal sacs:

· Sit in a partially reclined position

· Sit up straight with your legs slightly turned out

· Stand with the weight equally distributed between your right and left legs

· Lift and carry weight close to the body

· Sleep on your back with the legs spread apart

· Sleep on the unaffected side of the body with a pillow between the knees

· Keep your weight under control

· Swim with the crawl kick (legs kept straight)


Hip replacement is perhaps the most common joint replacement surgery. It is considered in patients with progressive arthritis that affects the patient's ability to do daily activities. Hip resurfacing is an alternative to hip replacement. The choice of procedure is a joint decision made by the orthopedic surgeon and patient to be able to return the patient to the level activity that they would like to achieve.

Hip arthroscopy has become more widely available to evaluate and treat hip joint damage, including labrum and cartilage tears, loose bodies within the joint, and early arthritis.


The body is a machine that needs to be well looked after over a lifetime. By maintaining a normal body mass index and avoiding obesity, providing a good diet to build strong bones, and by exercising routinely to preserve normal range of motion of the hip, osteoarthritis of the hips and back pain may be avoided.

Medications that prevent osteoporosis in women should be considered to minimize the risk of hip and back fractures in at-risk women. These include calcium, vitamin D.Bone mineral density screening may be a reasonable screening tool.

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