The hip joint contains the largest ball-and-socket type joint allowing for a large degree of motion. However, like anything in the body, the hips are subject to wear and tear leading to hip pain.
How does the hip work?
In order to properly function, the hips require the coordinated participation of tendons, ligaments, bones, muscles, and synovial fluids. This is something your body does without thinking, and we really only take notice when some aspect of the motion isn’t happening the way it usually does.
What are the symptoms of hip pain?
Telltale signs that the joint itself is affected are pain in the hip or groin, while pain with the tendons, muscles, or ligaments will show up on the outer hip, thigh, or buttock. You may experience a change in your walk such as limping, difficulty sleeping on a certain side during sleep, and warmth or redness around the area.
What causes these symptoms?
1. Osteoarthritis. When we hear the word, ‘osteo’, our brains should lean towards a bone related condition. In this case, osteoarthritis, a degenerative disease where the hip joint cartilage breaks down and the bones develop osteophytes. As the cartilage breaks down, the bones and tissues of the joint that are normally frictionless begin to rub against one another.This condition worsens over time and you may not even notice symptoms until your 50’s.
This joint is meant to absorb shock from motions such as jumping, walking, running, etc, so a breakdown can lead to issues with all of these activities. As the bones breakdown, the body experiences an alarm and needs to build more bone to replace what was lost. This process of breaking down and building up bone is constantly occurring around the body, but in those affected by osteoarthritis, the abnormal architecture of the hip joint as it wears down can lead to the formation of osteophytes. These small bony spurs appear in areas that have worn down and can further rub against surrounding tissues and bones, decreasing the motion of the normally free joint.
2. Bursitis. Inflammation of the bursae, small fluid-filled sacs located around the body, can lead to hip pain. These sacs serve the purpose of providing additional cushioning in areas that are subject to a lot of wear and tear such as joints. Normally, bursae are almost flattened and allow the adjacent structures to swing right on by, but when they become inflamed, they swell and impede movement.
3. Hip fracture. As we stand against the hands of time, our bones inevitably become more brittle as they weaken. Our bone building cells, known as osteoclasts, become less efficient with age as their numbers shrink. Fractures are breaks in the bones that can result from a range of things such as attempting the splits after a few glasses of wine, taking a tumble on the ski hill, or even a simple fall.
These fractures don’t always have to be large to cause hip pain either. You may not even notice any pain until weeks after the impact or accident, by which time the bones may have healed improperly or the fracture widened by some motion.
4. Tendinitis. Tendons are cord of collagen that attach muscles to bone. They are tough but flexible and allow humans to perform many of the motions we perform every day. If the tendon were to detach from the bone for instance, how would it move? A puppet is only as mobile as the one pulling its strings. When tendons inflame, usually as the result of infection or overuse, this can limit your range of motion since further actions irritate the tendon and cause pain.
Who is most at risk?
Unfortunately, elderly individuals living in a community are the most prone to falls which lead to hip pain. Of those over 64 years, 28-35% will experience a fall within a year, and that range jumps to 32-42% in those 70 years or older! Certain home modifications can be done such as placing non-slip mats in the shower, adding grab bars along hallways, and eliminating trip hazards.
As a major weight bearing joint, the hip is also subject to increased pressure due to obesity. The added mass can shift the centre of gravity and place additional stress on the joints which may accelerate degeneration, increase the risk of a fracture, and limit the range of motion.
Additionally, it isn’t just the added mass either, certain agents that encourage inflammation are known as cytokines. They are produced by a variety of tissues, but fat (adipose) tissue contributes to the release of a pro-inflammatory player known as TNF- α. Therefore, the more adipose tissue you have, the more TNF- α circulating throughout the body which can exacerbate the inflammation in the hips.
I need something to alleviate my pain now!
Plants such as Arnica montana and Devil’s claw (harpagophytum procumbens) have anti-inflammatory effects comparable to many of the over the counter medications available. Arnica achieves this through the active components in the plant known as sesquiterpene lactones that can prevent the breakdown of cartilage.
Devil’s claw contains harpagosides which reduce pain and can be found in products such as Joint Pain Relief tablets, while products such as Absolüt Arnica Gel can be applied topically to the hip to relieve some pain.
How can I prevent this?
Studies have shown that an exercise regime combining aerobic exercise and resistance training can reduce joint pain in adults by 14 - 71.4%. An exercise regime serves the dual purpose of decreasing the load on the joints and strengthening the muscles responsible for stabilizing the hip joint.
Going back to TNF- α, weight loss has been shown to reduce the amount of pro-inflammatory cytokines circulating through the body and actually encourages adipose tissue to secrete anti-inflammatory agents known as adipokines. Creating a plan that suits your needs and allows the tissues to strengthen safely is best worked out with your physician.
References:
https://www.hindawi.com/journals/isrn/2013/139239/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4332294/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363366/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839620/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295114/
https://www.ncbi.nlm.nih.gov/pubmed/19235681
https://www.ncbi.nlm.nih.gov/pubmed/22940241
https://www.ncbi.nlm.nih.gov/pubmed/23728701
https://www.ncbi.nlm.nih.gov/pubmed/25966322
https://www.ncbi.nlm.nih.gov/pubmed/27209428
https://www.ncbi.nlm.nih.gov/pubmed/28275210
https://www.ncbi.nlm.nih.gov/pubmed/28401567
http://www.who.int/ageing/projects/1.Epidemiology%20of%20falls%20in%20older%20age.pdf