Hip and knee pain

1. Your knees and hips may get “wear and tear.” Cartilage covers your joints and lets them glide smoothly. Over time, it can wear away, particularly in the knee and hip joints. The result is that the bones of the joints rub against each other without enough cushioning. This is called osteoarthritis (OA).

2. The first sign you’ve got hip OA is often stiffness in your groin or thigh. You may also notice pain in your groin, thigh, or buttocks when you exercise. It may be worse in the mornings. If your OA is in the early stages, rest usually makes you feel better.

3. The first sign of knee OA is often pain and stiffness. Just like hip trouble, it usually aches more in the morning. You may find that your knee locks or buckles when you walk. Eventually it starts to hurt and you may have trouble flexing the joint. You may feel worse when you kneel or go up and down stairs.

4. You can relieve OA at home. Make sure you get enough rest. While it’s important to stay active, give your joints time off when they hurt. You can also try acetaminophen (Tylenol) and anti-inflammatory drugs like ibuprofen (Advil, Motrin) or naproxen (Aleve) if your doctor says these are safe for you. They provide fast relief for mild to moderate arthritis pain.

5. You can ease pain and stiffness if you lose weight. Being overweight puts extra stress on your knees and hips. Doctors say that every 10 pounds you lose can lower your arthritis pain by as much as 20%.

6. Exercise helps your joints work better. Keep limber and start with stretching. Try a “low-impact” workout like swimming or cycling. It will make your joints stronger and increase their range of motion. A physical therapist can show you exercises to strengthen the muscles that support your knees or hips. That will help reduce the stress on your joints during everyday activities, too.

7. OA of the knee or hip can make it hard for you to walk. If there isn’t enough cartilage lining your joint, it can hurt when you take a stroll. Your joint may get so stiff that you can’t bend your knee or rotate your hip. People with severe OA of the knee or hip may need a cane to get around.

How Hip Pain Affects Your Body

Your hips — the ball-and-socket joints formed by the pelvic bone and the end of the femur bone — are pretty strong, and it takes a good deal of force to injure them. However, if you have hip pain, it may cause you to feel pain elsewhere in the body. Patients who have hip pain may also complain of hip and knee pain, hip and leg pain, or hip and shoulder pain.

“Where’s your center of gravity? It’s really close to the hip,” says Stephanie Siegrist, MD, an orthopedic surgeon in Rochester, N.Y. “So if you’re limping because your hip hurts, you also could have hip and knee pain or hip and leg pain or hip and back pain.”

How to Manage Pain on the Job

How Hip Pain Affects Your Whole Body

Shakira might have gotten it wrong with her song, “Hips Don’t Lie.” A hip problem can disguise itself as knee, leg, or shoulder pain. Your hips can throw you off course in the hunt to solve where your pain is originating.

  • Hip and knee pain. Sometimes patients complain of knee pain, but it’s really their hips that are the cause, Dr. Siegrist says. “One of the nerves that serves the hip also serves the knee, so it’s pretty common, especially in children who complain of knee pain, to find that the source of the pain is not the knee but the hip.” The pain from the hip often can be referred to the knee. That’s why it’s important to properly diagnose the problem so that you can treat the source of the pain, says Marc Philippon, MD, an orthopedic surgeon in Vail, Colo. It’s also possible that patients who have arthritis of the hip also have arthritis of the knee — a reason why they experience hip and knee pain at the same time, Siegrist says. “The same problem is occurring simultaneously in two locations.”
  • Hip and leg pain. Just as hip and knee pain are connected, hips can cause pain in the thigh or leg. Siegrist says your mobility in the hip is limited because it’s stiff or you have arthritis. The pain causes you to limp, which in turn causes you to strain your calf muscles. “Sometimes hip pain will be associated with lower back pain,” Philippon says. “That will cause referral down the leg, and you will have hip and leg pain.” Herniated disks (spinal disks that press on the nerves) and sciatica (pain or weakness involving the sciatic nerve in the lower back) are the most common back and spine problems that refer pain to the hip region.
  • Hip and shoulder pain. Golfers who have hip pain may find their shoulders hurt as well. The persistent pain in their hips causes them to decrease their rotation when they swing, putting stress on their opposite shoulders. “I have a lot of golfers who require surgery on their right hip and their left shoulder,” Philippon says. It’s also possible that some people have bursitis (inflammation of the cushioning around the joints), osteoarthritis, or tendonitis (inflammation of the tendons) in both places, so they can experience hip and shoulder pain at the same time.

Seek Treatment if Pain Persists

If you have persistent hip and knee pain, hip and leg pain, or hip and shoulder pain, see your doctor. Treatment depends on the cause of the pain, so it is important that it be diagnosed correctly.

8 Alternative Treatments for Pain Management

“Often if you correct the hip, you will decrease the stress in the other joints and consequently alleviate the problem,” Philippon says. “Sometimes I treat the hip pain first and the other joints second, if necessary.” Many times, problems that start in the hip and trigger pain in other parts of the body can be fixed with physical therapy and exercise.

Hip Pain and Arthritis

The hips allow us to run, walk, sit down, bend over and move our legs in many directions. When the hips are a source of pain, everyday life is affected. In the absence of a recent trauma, hip pain in adults is most often caused by some form of arthritis.

The hip connects the torso to the leg, and hip-related pain may not be felt directly at the hip. Instead, pain may be felt in the groin, down the thigh, inner knee, buttock or lower back. Conversely, lower back problems may cause pain to radiate to the hip. Because the pain can be diffuse, hip problems can be a challenge to identify and diagnose.

See Hip Anatomy

Despite its reputation as a sign of old age, hip pain is not a normal part of aging that should simply be accepted. Whether the pain is felt as a dull ache, stabbing pain, stiffness or inflexibility, it is advisable to get a diagnosis for the underlying cause of the pain as soon as possible. Early diagnosis allows treatment to begin and steps to be taken to prevent or slow further joint degeneration.

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Hip Joint Pain from Arthritis

Hip pain can vary depending on the degree and nature of the joint degeneration, the patient’s physical condition (such as weight and fitness level), and the patient’s individual perception of pain.

That being said, the hip pain associated with osteoarthritis is usually characterized by some combination of the following symptoms:

Hip pain that comes and goes
Arthritic hip pain may come and go and, unlike knee arthritis pain, is often predictable, meaning hip arthritis patients can anticipate what time of day and what activities will result in pain.1 Remember though, that this is a trend and not a rule.

Two distinct types of hip pain
In a clinical study designed to learn how people experience osteoarthritis pain, researchers found that hip osteoarthritis patients generally felt two distinct types of pain: a dull ache and intermittent sharp pain.2

  • Ache. A persistent, dull aching is commonly felt in the groin and front of the thigh. Some people may experience a dull ache in the buttock, outside of the hip and/or in the lower back. People with hip arthritis use words like dull, aching, nagging, sore and throbbing to describe this type of pain.
  • Intermittent Sharp Pain. Intense, stabbing pain episodes due to hip arthritis are sudden and brief. People describe this hip pain using words such as sharp, stabbing, ice pick, spike or paralyzing.2

Certain things make the hip pain worse

  • Prolonged inactivity. People with hip arthritis often complain of pain in the morning when getting out of bed. The pain will often dissipate within 30 minutes of getting out of bed or from a seated position.
  • Abduction, external and internal rotation. Spreading the legs or rotating the toes inward or outward can cause hip pain. Lying on the back causes a natural outward rotation of the toes and legs, so sleeping on the back can be uncomfortable. Sexual intercourse can be painful, also.
  • Bending over. Deep bending can be difficult to impossible for patients with hip arthritis. Many complain that bending over to put on socks and shoes is challenging.
  • Difficulty getting in or out of a car. People suffering from hip joint pain will often complain of a difficulty with driving and need the assistance of their arms to lift the leg and thigh both into and out of the car.
  • Prolonged physical activity. Participating in weight-bearing physical activity, including sports, can result in stabbing pain or be followed by an aching pain.

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Certain things make the hip pain better

  • Rest. The surrounding muscles, tendons and ligaments that support the hip joint can tire, placing more pressure on the joint. Resting the hip can ease this type of pain.
  • Gentle/moderate activity. Gentle activity can relieve the pain and stiffness caused by prolonged rest. When the hip joint is used, synovial fluid is secreted, lubricating and delivering nutrients to the joint.
  • Medical treatment. Medical treatment for hip pain can include any combination of physical therapy, aqua-therapy, hip injection, oral anti-inflammatory and weight loss to name a few. Hip surgery can often be avoided. It is important to have pain in your back, hips or legs evaluated by a physician so that a proper treatment plan can be made.

What Causes Hip Pain When Walking?

Arthritis

Arthritis can cause hip pain at any age. Old injuries to the hip may increase the risk of arthritis later on. Research shows that professional athletes in impact sports are more likely to have arthritis in the hip and knee.

One study reported that more than 14 percent of people 60 years or older reported serious hip pain. Hip pain when walking in older adults is typically due to arthritis in or around the joint.

There are several kinds of arthritis that can lead to hip pain when walking. These include:

  • Juvenile idiopathic. This is the most common type of arthritis in children.
  • Osteoarthritis.This condition is due to wear and tear on the joints.
  • Rheumatoid arthritis. This autoimmune disease causes arthritis in the joints.
  • Ankylosing spondylitis. This type of arthritis mainly affects the spine.
  • Psoriatic arthritis.This type of arthritis affects the joints and skin.
  • Septic arthritis.This arthritis is caused by an infection in the joint.

Injury, damage, inflammation, and disease

Injuries or damage to the hip joint can cause pain when walking. An injury to the hip and connecting areas, like the knee, can damage or trigger inflammation in the bones, ligaments, or tendons of the hip joint.

Muscle or tendon conditions

  • Bursitis. This condition is caused by inflammation in the fluid-filled “ball bearings” around the hip joint.
  • Sprain or strain. These conditions occur from overusing the muscles and ligaments in the hips and legs.
  • Tendinitis. This condition is caused by damage or irritation to tendons that connect hip muscles to bones.
  • Hip labral tear. The labrum or cartilage ring socket keeps the hip bone in place.
  • Toxic synovitis. This is an inflammatory condition in the joint that causes hip pain in children
  • Inguinal hernia. Pain is due to weakness or a tear in the lower stomach wall.

Injuries or damage to the hip bones can lead to pain when walking. This includes cancer that has spread from another area of the body.

Bone conditions

  • fractured or broken hip
  • dislocation. This occurs when the top of the thigh (leg) bone slips partly or fully out the socket joint.
  • osteoporosis. This condition causes weak or brittle bones in the hip and other areas, it usually occurs in older adults.
  • Osteomyelitis. This is a bone infection in or around the hip.
  • Bone cancer
  • Leukemia. This is a blood cell or bone marrow cancer.
  • Legg-Calve-Perthes disease. This disease occurs in children where the thigh bone doesn’t get enough blood.
  • Avascular necrosis or osteonecrosis. This disease stops or limits blood flow temporarily to the head of the femur of the hip and other bones.

Nerve issues or damage

Nerve problems in or close to the hip joint can also cause pain when walking. Pinched or damaged nerves in the back can lead to nerve pain in the hip.

  • Sciatica. A pinched nerve in the lower back can cause hip and leg pain.
  • Sacroiliitis. Nerve damage due to inflammation where the spine joins the pelvis bone can also cause pain.
  • Meralgia paresthetica.Nerve irritation in the outer thigh can be due to obesity, tight clothing, or too much standing or exercise.

Knee Pain: It’s Not Your Knee – It’s Your Hip!

When it comes to your knees, there’s a lot that could go wrong. The source of your knee pain could be one of many conditions including arthritis, a strain or sprain, jumper’s knee (patellar tendinitis), or runner’s knee. In addition, your knee pain may be caused by problems with your back, hips, or feet.
Here we focus on just one of the common sources of knee pain caused by issues in the hip. We also describe some of the exercises that your physiotherapist may prescribe if it’s determined that your hip is the cause of your particular kind of knee pain. Be sure to check with your doctor or physiotherapist to determine if these exercises are appropriate for your particular needs.

The Reason

When we walk, run, jump, or land, your foot naturally turns inward, a process called pronation. When your foot pronates, this starts a chain of events that travels up the leg and creates an inward rotation of the femur (thigh bone). Because the femur is also one of two bones of the hip joint, the movements and control of your femur has a significant effect on your knees. This inward twisting movement places strain on your tendons, ligaments, cartilage and kneecap alignment, which can lead to a sudden injury or an overuse injury over time. Many muscles in your legs can control this inward rotation of the femur. In current rehabilitation practices, there has been a large focus on the bum muscles for this control: the gluteals!

Treatment

In professional sports, it’s a well-known fact that athletes who strengthen their hip muscles considerably reduce their risk of sustaining knee injuries. Here is an article that goes into a little more depth regarding the relationship between glutes, hips and knees. Let’s look at three simple exercises to strengthen your hip muscles.

The Clamshell

A common and simple exercise to help keep the gluteals conditioned includes something called the ‘clamshell’. While lying on one side bend both knees to 90 degrees, and keep the feet in alignment with the hips. While keeping the pelvis still (belly button pointing slightly downward) and your feet together, raise the top knee. Completing 20 repetitions for three sets should make you feel as if someone poked you in the middle of your back pocket. Check out this brief video to make sure your technique is good:

The Sideways Walk

An advanced exercise for athletes that can simply be included as part of any warm up is sideways walking with a piece of tubing wrapped around the legs just above/below the knees. Again, complete 20 repetitions for three sets. Here’s another how-to video:

The Plank

If you’re familiar with the exercise called the plank (the one arm on your side version is called the side plank) has also been shown to be very effective in strengthening the lateral gluteals.

If completed one to two times per week, these exercises can not only prevent many different types of knee injuries, but can also improve performance for athletes and active individuals of all levels! Click here for a great guide of stretches and exercises by the American Academy of Orthopaedic Surgeons to strengthen your hip muscles.

However, you obviously have a definite and major problem since your whole life is being affected by it.

I would suggest complementary medicine as the next step since all the pointers in your letter suggest a mechanical mal-alignment of your shoulder girdle and spine as the root cause of your symptoms.

This puts your whole skeleton under undue pressure and will cause the problems you experience after 10 minutes driving, ie when your spine is in a certain position.

The sensible option here would be either osteopathy or chiropractic treatment.

The aim of both is to re-align the skeleton into its normal position although osteopathy tends to focus more on the spine than the whole body.

Ask your doctor for details of reputable practitioners in your area and I am sure several treatments here will be of considerable benefit to you.

If you are not doing so already, it would also be sensible to take cod liver oil daily as well as a supplement called glucosamine which are of proven benefit to many people with similar symptoms to yours, and which may reduce the need for you to take Voltarol.

Yours sincerely

The NetDoctor Medical Team

Last updated 14.10.2014

What causes hip, knee, and shoulder pain?

The most common cause of joint pain is arthritis and the most common form of arthritis is osteoarthritis. Knee pain caused by arthritis may come on gradually and get worse with activity. It is often accompanied by swelling. You may have stiffness after waking in the morning or after sitting for long periods of time. Another cause of knee pain is inflammation of the bursa, or bursitis. Bursae are jelly-like sacs in the joint area that usually contain a small amount of fluid. They act as cushions between bones and the overlying soft tissues, helping to reduce friction between the gliding muscles and the bone.
Bursitis can also be a cause of pain in the shoulder and hip areas.
Your trunk area includes the hips and pelvis; together they form the “pelvic girdle.” The outer bony point of the hip is called the greater trochanter. It is an attachment point for muscles that move the hip joint. The trochanter has a large bursa overlying it that occasionally becomes irritated, resulting in hip bursitis (trochanteric bursitis). Pain in the joint of the hip is a common repercussion of arthritis and usually presents as pain located in the groin and front of the thigh.
Similar to hip pain, shoulder pain may also be present directly at the joints. Osteoarthritis is a frequent cause of shoulder joint pain. Other areas of the shoulder such as the bursa, rotator cuff or tendons can be additional sources of pain.

I have shoulder pain…..Why are you working on my hips???
When a client comes into Pain Free for an Egoscue session, the therapist will look at the position of the bones. We evaluate:
1. head position
2. neck position
3. shoulder position
4. hip position
5. leg position
6. foot position

Why does this matter?
You can have back pain that comes from a misalignment somewhere else in the body. You can have shoulder pain that comes from hips that are misaligned. You can have neck pain that comes from your back being flexed forward. You can have any number of combinations of imbalances causing pain somewhere else in your body. The point is, focusing on the area of pain will help treat the symptom but it will not treat the real problem.

I have a client who has right shoulder pain. He exercises all the time. He bikes, runs, swims and lifts weights. He is really fit, however on examination, his head is forward, his shoulders are rounded, his hips are tight, his legs and feet turn outward.

If he had come to see me several years ago when I was working in physical therapy, I would have treated the heck out of his shoulder –therapeutic massage, electrical stim, ultra sound,etc.—–and when he left my clinic, he’d have felt better — until the next day or the next week or month when the pain returned. I treated the symptom without addressing the cause of the symptom.

Today, evaluating my client using the Egoscue method, I know that the posterior tilt in his pelvis is driving his back into flexed position which is causing his shoulders to round forward. Every time he lifts his arm he has muscles that are already being pulled , then they pull even more and his shoulder joint does not line up causing uneven wear in the joint – which causes the pain. To correct his shoulder problem … I have to get his hips to line up and then get the flexion out of his back.

So when a client asks why are you working on my hips when my shoulder hurts???? The answer…. It’s all connected!

Of the joints in the leg that are commonly injured in runners, hip pain often poses the most difficult diagnosis. There are a couple of reasons for this: First, there are simply too many possible causes of hip pain, and a second, less obvious reason, relates to the frequency of these injuries.

The bony anatomy of the hip is actually quite straightforward. The head of the femur ends in a ball that articulates with a pocket in the pelvic bone, the acetabulum. This forms the classic ball-in-socket joint. Yet, because of the extreme forces that this joint is subjected to, especially when running, and because of the very complicated supporting structures that help make it among one of the strongest and most stable joints in the body, many potential sources of hip pain are possible. Because the hip plays such an important role in weight bearing and locomotion, it is of the utmost importance to identify these injuries as early as possible, and treat them before they result in joint damage.

We’ll review the more commonly encountered causes of hip pain in runners: muscular strains and pulls in the groin, hamstring or piriformis, hip flexor tightness, bursitis, stress fractures and labral tears. Iliotibial band friction syndrome (ITBFS) may also cause hip pain, but has been widely covered, and therefore will not be discussed in this article.

Groin Pulls or Tears

A pulled groin is caused by a strain in the hip adductors, muscles that pull the legs together. These muscles attach to the thighbones at the level of the hip and run down the inside of the thigh, stabilizing the joint. When overstretched or overused, small tears can develop resulting in hip pain, swelling, and a dull ache in the groin area. Severe tears occur more suddenly and are associated with very sharp pain and bruising down the leg.

Unfortunately, many hip injuries can cause groin pain as well, so distinguishing a true groin pull from other possibilities may not always be that straightforward. Usually a focused history and physical exam suffice to confirm the diagnosis.

The treatment of a groin pull is similar for other pulled muscles. Rest, ice, compression and elevation can all help to alleviate symptoms. Anti-inflammatory medications or acetaminophen can be used to treat pain and once the injury has healed sufficiently, a gradual return to activity can then follow.

Hamstring Injuries

The hamstrings are made up of three distinct muscles that run down the back of the thigh, which then operate together as powerful knee flexors. Like all muscular injuries, hamstring injuries occur when fibers within the muscles tear. The severity of the injury is determined by the amount of damage and how completely the fibers are torn—the least severe form being a strain, while the most severe consists of a complete tear.

Hamstring injuries are almost always associated with pain in the back of the leg that gets worse with flexing the knee. However, if the injury is higher up in the muscle body, then the symptoms can be experienced in the hip itself.

Piriformis Syndrome

The piriformis is a small muscle that runs from the sacrum to the outside of the hip. For a small muscle it can cause big problems when inflamed or overused. Because it runs over the sciatic nerve, the piriformis has a nasty habit of putting pressure on this nerve and causing exquisite pain in the glute and posterior hip area when it swells or spasms.

Aside from addressing any mechanical issues that might be exacerbating the problem the main way to treat piriformis syndrome is by stretching the muscle out as much as possible. To stretch the piriformis: lay on your back, bend your knees and cross your right leg over your left so your right ankle rests on your left knee in a figure four position. Bring your left leg toward your chest by bending at the hip. Reach through and grab your left thigh to help pull everything toward your chest.

Iliopsoas Syndrome

The iliopsoas muscle is a powerful hip flexor that runs across the top of the hip joint and works to pull the knee up and off the ground when it contracts. Movement of the tendon is facilitated by the iliopsoas bursa. If the tendon or the bursa becomes inflamed, flexion may become very painful and the pain is felt in front of the hip with an associated snapping or clicking sensation during movement. Iliopsoas syndrome often arises as a result of increasing volume or intensity too quickly, and hence this problem may be easily avoided. Once it has set in though, the only effective treatment is rest with liberal use of anti-inflammatory medications.

Hip Bursitis

Bursae are fluid-filled sacs that assist in lubricating the movement of structures around joints. The hip bursa allows for the smooth movements of various tendons over each other as the hip ranges in different directions. In some instances this sac can become inflamed after repetitive micro-trauma common in long-distance running. The inflammation can be very painful with symptoms predominantly over the outer aspect of the hip radiating down into the thigh.

Once inflamed, the treatment for hip bursitis is similar to many of the other injuries described here: rest, the application of ice and the use of anti-inflammatory medications. Although it is rare, in some cases the bursitis may become severe or chronic and require surgery.

Stress Fracture

Although much more common in the foot and lower leg, stress fractures of the hip may also occur. Stress fractures result from a combination of overuse in the setting of muscle fatigue, and in some cases, predisposed anatomical issues. Under normal circumstances the muscles and tendons absorb the vast majority of the forces transmitted during repeated ground striking in running. However, with progressive fatigue, more and more of the force is transmitted to the underlying bone, and with time the bone may fracture.

Unlike a traumatic injury, in which there is a sudden tremendous force applied that results in an obvious disruption of the bone, stress fractures are insidious and take time to manifest symptoms. Stress fractures of the hip will cause a dull ache either felt in the groin or lower back, and this can delay the diagnosis allowing more time for the fracture to worsen. Once suspected, confirming the diagnosis can also be difficult as the bone may appear normal on plain X-rays. Only more advanced imaging will show the problem definitively.

Once diagnosed, a complete cessation of weight bearing exercise is mandated. This is critical in order to prevent the stress fracture from progressing to a much more serious and complete fracture. The duration of recovery will depend on the severity of the injury and, in rare cases, surgical intervention may be required.

Hip Pain Due to Labral Tear

The labrum of the hip is a cartilage ring that forms a kind of lubricating O-ring around the ball of the femur holding it in place in the acetabulum. In some people, bony abnormalities either of the neck of the femur or of the lip of the acetabulum can cause the labrum to become repetitively impinged with normal ranging of the hip joint. Over time, this impingement causes the labrum to fray and eventually tear.

Until recently, the long-term importance of labral tears wasn’t completely appreciated. Now, these tears are seen as a potential contributor to the early development of arthritis of the hip.

Because the labrum is made of cartilage and therefore completely insensate, the symptoms of a labral tear arise only long after the damage has been done. Patients with this problem frequently complain of pain in the groin that gets worse when crossing the affected leg over the other. Hence, the diagnosis is difficult to confirm and requires an MRI with contrast injected into the joint. Once confirmed, the only treatment options for symptomatic patients are the complete cessation of weight bearing activities or surgery. It is important to note that not all patients with labral tears require surgical repair. This should be discussed with an orthopedic surgeon familiar with the diagnosis and the procedure to address it.

The hip joint is less prone to injury than the lower leg but can still be afflicted by a number of issues both big and small. Quickly arriving at the correct diagnosis is an important part of getting effective treatment and returning to activity. Knowing the common causes of hip and groin pain is also an important part of that equation. See your physician whenever you have vague, non-specific pains that are difficult to ascribe to a specific area. This can often end up being something more important than you might initially think and catching it early is key.

By Jeffrey Sankoff | Featured on Competitor.com

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