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4 Common Reasons for Hip Pain in Women

a/professor andrew dutton hip pain in women
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Like most types of chronic pain, women tend to experience hip pain more than men. It can be a mild inconvenience, or it can be severe that it interferes with daily functioning.

If you’re bugged by some nagging discomfort, particularly to the hip, here are four of the usual reasons behind it. We also tackled four possible reasons not directly related to the hip joint itself. Read to understand why this is happening to you and what to do about it.

1. Hip Arthritis

Arthritis refers to inflammation of the joint that often develops in weight-bearing joints such as the hips. The most common type affecting females is hip osteoarthritis and avascular necrosis, and if left untreated, these can lead to severe disabilities that will reduce your overall quality of life.

Causes of Hip Arthritis

Some people are predisposed to hip arthritis due to an abnormality in the shape of the joint. An injury sustained early in life can also change your hip alignment, resulting in uneven weight distribution that can speed up the wear and tear process. But, in most cases, the gradual decline of the hip joint can be chalked up to the effects of ageing.

For women, in particular, evidence suggests that your susceptibility to osteoarthritis may be related to hormone levels. These are known to fluctuate with menstruation cycles and change during menopause.

At specific points in your menstrual cycle, hormone levels increase, which also increases joint laxity. This condition is associated with joint instability and injury, which can contribute to the development of osteoarthritis. A drop in estrogen levels during menopause can also significantly increase your risk of developing hip osteoarthritis. It can even accelerate the process.

a/professor andrew dutton what increases your risk of hip arthritis

Symptoms of Hip Arthritis

Pain is a common symptom of arthritis. You can feel it when you put weight on the affected hip, like when walking or sitting for prolonged periods. You feel the pain in the groin, buttocks, or over the front of the thighs. It may cause you to limp as you inevitably try to reduce the amount of force the hip has to withstand.

Your hip also stiffens with arthritis, making it difficult to do simple movements such as getting up from the toilet, tying your shoelaces, or even getting in and out of a car. As the condition worsens, pain not only occurs with movement but also at rest. It can persist to a point where it can even disrupt your sleep.

Treatment of Hip Arthritis

Unfortunately, there’s no cure for hip osteoarthritis. But, there are therapies to help ease discomfort and control joint decline. Typically, doctors prescribe medications to control the pain. In addition, physical therapy will help manage the symptoms and maximise hip function.

Surgical interventions can address severe cases. A less invasive option is a hip arthroscopy, or a keyhole surgery, which is suitable for earlier issues of the condition. This procedure can remove loose fragments of cartilage or bits of tissue that may irritate the hip joint.

A hip replacement is a definitive treatment for severe cases of hip arthritis in women. In this procedure, patients receive artificial hips, which can reasonably last a lifetime. But, in younger patients who have a physically demanding lifestyle, hip resurfacing is a suitable option to help restore function.

a/professor andrew dutton types of hip replacement illustration

2. Iliotibial Band Syndrome

The iliotibial band is a thick band of ligament that runs across the front of the hip joint itself. It works with the muscles in your thigh to provide stability to the outer portion of your knee. Iliotibial band syndrome (ITBS) is an overuse injury to the knee or hip that can sideline even the hardiest endurance athletes like runners or bikers.
a/professor andrew dutton iliotibial band illustration

Causes of Iliotibial Band Syndrome

Flexing and extending the knee can cause the IT band to rub over the thigh bone. Since it is not a muscle but connective tissue, it doesn’t lengthen, stretch, or shorten like a muscle. That’s why it tightens and inflames rather than adapts to the demands.

ITBS equally occurs in men and women. But, females are more susceptible due to anatomical differences in the thigh and knee. The way that some women’s hips tilt can cause their knees to turn in, causing mechanical problems in the way they walk.

Those at risk of ITBS are individuals who suddenly increase their activity level, such as runners who increase their mileage. Having weak hip muscles is also one of the common reasons why people get IT band syndrome. It usually contributes to faulty movement patterns, which increases the tightness of the IT band over time.

Other predisposing factors include:

  • bowlegs
  • flat feet
  • preexisting iliotibial band tightness or prior injury
  • walking or running on a track or uphill
  • weakness or lack of flexibility
  • excessive sitting
  • weak knee extensor, knee flexors, and hip abductors
  • repetitive activities such as running and cycling
  • knee arthritis
  • unbalanced leg lengths

Symptoms of Iliotibial Band Syndrome

The typical symptom of IT band syndrome is a sharp pain in the outer hip, thigh, or knee. You feel it when your heel strikes the floor or when you’re in the middle of activities like running or cycling.

Pain also increases in intensity when you’re running downhill or descending a flight of stairs. An audible snapping sensation and swelling may even accompany pain to the knee.

Treatment of Iliotibial Band Syndrome

Modifying your activity levels is a good starting point. Avoid activities that aggravate pain and find other alternatives. For example, instead of running, choose less traumatic options like swimming.

Treatment modalities that can help relieve ITBS pain include cold or heat compress, taping, or stretching. If inflammation persists, ultrasound therapy, muscle stimulation, and iontophoresis are also possible options. You can also undergo physical therapy to help strengthen the muscles and stabilise the hips.

Surgical intervention is not indicated for ITBS except in rare cases where prolonged conservative treatment has failed to address the patient’s symptoms or resolve the ITBS.

a/professor andrew dutton what you can do to prevent iliotibial band syndrome

3. Hip Dysplasia and Impingement

Hip dysplasia is an abnormality in which the femur (thigh bone) doesn’t fit together with the hip socket as it should. The ball and socket of the hips are lined with a thin layer of smooth cartilage that cushions and protects the bones, preventing them from rubbing or grinding against each other. Securing the femoral head inside the hip socket is a ridge of cartilage lining the socket’s rim.

a/professor andrew dutton hip bone illustration

However, when something prevents the smooth, easy, and free movement of the ball-and-socket joint, hip impingement occurs. As a result, bones in the hip joint rub together, causing pain. As such, hip dysplasia and impingement often go together.

In the elderly, impingement also accompanies osteoarthritis. But it can also affect a normal hip, particularly when exposed to extremes of joint motion.

Causes of Hip Dysplasia/Impingement

Some people may have been born with a structurally abnormal hip joint due to developmental problems already present from birth. It is called Developmental dysplasia of the hip (DDH).

a/professor andrew dutton hip dysplasia illustration

Repetitive activity that involves recurrent movement of the legs beyond the normal range of motion may cause hip impingement. It is common among football, baseball, soccer, tennis, hockey, lacrosse players, dancers, gymnasts and golfers. An injury may also cause symptoms of hip impingement. Furthermore, certain conditions, such as Perthes disease and slipped capital femoral epiphysis (SCFE), may also cause hip impingement.

Symptoms of Hip Dysplasia/Hip Impingement

A hip impingement usually has no symptoms for many years. But when you continuously walk on a misshapen joint for a long time, the condition intensifies slowly over time. It eventually causes pain and stiffness in the groin, at the front of the thigh, or down the buttocks.

Impingement also comes with a popping or clicking sensation at the front of the hip when you move, and your range of motion can suffer. It is common in young adults, and they initially present with hip pain.

Treatment for Hip Impingement

You can minimise symptoms by practising these activities at home:

  • Changes to your daily routine to avoid activities that trigger symptoms.
  • Taking non-steroidal anti-inflammatory medications (NSAIDs) to reduce the pressure and inflammation in the joint.
  • Strengthening exercises and physical therapy to relieve some stress on the injured cartilage.
  • Resting the affected hip.

If these measures fail to relieve your symptoms, it might be time to consider hip impingement surgery.

4. Hip Fractures

a/professor andrew dutton risk of developing osteoporosis and broken bones

In Singapore, the incidence of hip fractures in those aged 50 and above has increased in the past three decades. Hip fractures affect more women by up to two to three times than men. It’s an injury that causes considerable loss of function that may lead you to be fully independent in others.

A Singapore study showed that ethnic differences play a role in the incidence of fractures in women. For example, Chinese women had fracture rates that are 1.4 times higher than their Malay counterparts and 1.9 times higher than Indian women. Hospital admissions for hip fractures are also projected to increase with the ageing population.

Causes of Hip Fractures in Women

If you’re younger, hip fractures are often caused by accidents or any severe trauma. But in the elderly, calcium loss that comes with ageing makes hip fractures more common. At this stage, bones become thinner and weaker, and the effect is more profound in women as they lose bone density faster than men do.

Menopause is associated with a gradual decline in estrogen levels. Furthermore, women biologically have smaller and thinner bones than men, but the fall of estrogen levels also causes rapid acceleration of bone loss. It will start a year before menopause.

Furthermore, the repeated impact can weaken the hip bone and result in stress fractures often seen in long-distance runners.

Symptoms of a Hip Fracture

Symptoms of a fractured hip may include:

  • Sudden pain to your hip or groin.
  • Difficulty in lifting, moving or turning your leg.
  • Inability to stand or bear weight on your leg
  • Bruising or swelling around your hip.
  • Obvious deformity.
  • Your injured leg appears shorter than your other leg.
  • Your injured leg turning outwards

Treatment for Hip Fractures

Most hip fractures require surgical treatment at least within 1 to 2 days of injury to lessen the risks of complications. Unfortunately, only a very small group of nondisplaced fractures in healthy patients can be corrected without surgery.

You need to be thoroughly assessed by an orthopaedic surgeon who will fully evaluate you and consider your age and condition. The treatment for a hip fracture depends on the type and location.

Other Reasons Why Your Hip Hurts

Besides the common causes for hip pain in women mentioned above, other conditions trigger referred pain to the hip. Thus, pain in one part of the body is caused by pain or injury in another area.

Other possible reasons for that hip pain include:

  • Groin Hernias – Groin or inguinal hernias are often located close to the hip bone, and they may cause hip pain. These types of hernias develop later in life when the muscles have weakened with age.
  • Sciatica – Unexplained pain in one of your hips may also originate with the sciatic nerve in your lower back. Your sciatic nerve root comes out of your spine and then passes behind the hip joint. When this nerve is in pain, it causes a burning or tingling sensation feeling like one leg “goes to sleep”.
  • Back issues – Hip pain can also stem from a back problem or a soft tissue problem around the hip region.
  • Endometriosis – In some cases, endometrial tissues grow in and around the nerves that travel through the pelvis and hip. Abnormal growths can put pressure on the pelvic nerves, which may trigger pain and numbness to the hips, buttock, and legs.

All this information shows that not all pain is what it seems. That’s why you need to seek professional help to sort it out. Besides the possible reasons for that hip discomfort, there are also other ways to diagnose the problem and solve it.

If you’re troubled by painful hips, get it checked as soon as possible. Pain is always your body’s cry for help. So, make sure that you give it the proper support. Start with a non-obligatory consultation today.

A/Professor Andrew Quoc Dutton Orthopaedic & Sports Clinic Insurance

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About A/Professor Andrew Quoc Dutton

A/Professor Dutton, also known as, has been in clinical practice since 1996 after graduating from Marist College, Canberra and the University of New South Wales, Sydney, Australia. A/Professor Dutton has worked at the Prince of Wales Hospital, Sydney, and the St. George Hospital, Sydney, before completing his orthopaedic surgery training in Singapore. He is currently an associate professor of orthopaedic surgery at the National University of Singapore (NUS).

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