Causes of Hip Pain in Females

Arthritis is an inflammation of the joint and commonly occurs in those that sustain a significant amount of force, such as the hip joint.

Hips that incur trauma causing misalignment or those that congenitally have an abnormal shape can change weight distribution patterns and cause an increased degeneration at the joint. In general, females tend to have more flexible joints. This increased mobility at the hip joint can intensify the degeneration with age.

Aging is a major contributor to hip osteoarthritis, especially in women. This is because hormones, such as estrogen, contribute to bone growth and strength. During menopause, estrogen levels decline, contributing to bone degeneration and arthritis.

Symptoms: The main symptom of hip arthritis is pain, but other symptoms, such as stiffness and difficulty walking or sleeping, can occur. The pain can be variable and located in the buttocks, front of the thighs, or groin.

Tasks such as walking or sitting for prolonged periods can exacerbate the pain. This increased pain may cause one to compensate by limping. The stiffness can make it difficult for people to do daily activities such as tying shoelaces or getting up and down in a chair. In the early stages of hip arthritis, the pain is worse with movement, but as the condition progresses, the pain will continue at rest and while sleeping.

Treatment: While there is no cure, various treatments can help alleviate hip pain and slow down the progression of degeneration. Conservative treatments, including pain medications and physical therapy, can help strengthen and stabilize muscles and ligaments around the joint and minimize pain. In severe cases, hip arthroscopy or a hip replacement can be considered.

Minimally invasive arthroscopy allows the surgeon to remove tissues around the joint that are causing irritation. Hip replacement includes replacing a person’s hip with an artificial hip. For younger patients with severe arthritis, hip resurfacing can be an option that minimizes bone removal.

Top tips for relief: Having correct posture, exercising, eating healthy, doing low-impact activities such as cycling, yoga, or strength training, losing weight, and wearing proper shoes can help minimize the progression of arthritis. These modifications can impact how the body transfers the load of the pelvis to the lower extremity.

Dysplasia / Impingement:

Causes: Hip dysplasia occurs when the femur (thigh bone) and the acetabulum (part of the pelvis where the thigh bone sits) do not fit together correctly and cause hip impingement. This allows for bone to rub against bone, creating pain. While arthritis and impingement can occur together in an aged hip, a younger hip may have impingement due to hypermobility of the joint.

Hip impingement can further be caused by developmental dysplasia of the hip (DDH), a congenital condition of an abnormally structured hip joint, repetitive activity from sports activities, injury, Perthes disease (lack of blood supply to the hip), and slipped capital femoral epiphysis (SCFE, displaced femoral head, a part of the hip joint).

Symptoms: Similar to hip arthritis, hip dysplasia or impingement can cause pain or stiffness in the buttocks, front of the thigh, or groin. Hip impingement, however, can be asymptomatic for several years and is more common in young adults.

In addition, when movement occurs in a person with hip impingement, a clicking noise may be heard at the front of the hip. This can discourage the full range of motion during walking.

Treatment: For minor cases, treatment may include conservative options such as non-steroidal anti-inflammatory medications (NSAIDs), activity modifications, exercise, physical therapy, and rest. These treatment options can help reduce the joint’s inflammation and the stress being applied. However, surgery may be considered if conservative measures do not resolve the symptoms.

Iliotibial Band Syndrome (ITBS):

Causes: The iliotibial band (IT Band) is a thick ligament located on the outside of the hip and travels down to the outer portion of the lower leg. The ligament does not stretch like muscle but instead tightens and inflames when overused. Iliotibial Band Syndrome (ITBS) occurs when knee flexion and extension are repeated in activities such as running and cycling.

Several factors can increase one’s risk for ITBS, including gender, bowlegs, flat feet, uneven leg lengths, prior IT band injury, muscle weakness in knee flexors and extensors and hip abductors, knee arthritis, and excessive sitting, running, or cycling.

Compared to males, the angle of hip tilt in females is larger, which can cause the knees to turn in and create difficulty with walking. Similarly, when the muscles around the thigh are weakened, walking patterns can change and increase tension on the IT band.

Symptoms: ITBS is characterized by a sharp pain located on or near the IT band on the outside of the hip, thigh, and knee. The pain can occur during activity, when striking one’s heel on the floor, or when one walks downhill or down steps. In addition to pain, a snapping noise may be heard, and swelling around the knee joint can be present.

Treatment: Conservative treatment modalities can include activity modifications that minimize aggravating pain factors. For example, one can switch to a lower-impact activity such as swimming instead of running.

Furthermore, pain medications, hot or cold ice packs, compression, stretching, ultrasound therapy, muscle stimulation, iontophoresis, and physical therapy can be effective treatment options for ITBS. In rare cases, surgery can be an option. However, surgical intervention is mostly a nonindicative treatment for ITBS.

Top tips for relief: There are several ways to reduce ITBS risk, including running on an even surface, regularly replacing shoes, stretching outer and back thigh (hamstring) muscles, and decreasing training intensity. Furthermore, an expert may be used to evaluate proper posture while performing activities.

Bursitis/Tendonitis:

Causes: Bursitis, inflammation in the bursa, and tendonitis, inflammation in the tendon, usually occur after repetitive motion or severe injury. Bursae are fluid-filled sacs between joints that help reduce friction between the joint and various body tissues.

However, these spaces can become inflamed during a condition known as bursitis. This inflammation can occur from an infection or when tendons around the hip joint are injured or overused. Inflammation can also cause tendonitis.

Symptoms: Like arthritis, movement exacerbates the pain caused by bursitis or tendonitis. In these conditions, the pain tends to be localized to the hip. However, in tendonitis, the pain may also extend further down the thigh. In addition to pain, bursitis and tendonitis can cause stiffness, swelling, tenderness, and a grinding sensation in your hip joint.

Treatment: In treating tendonitis, the main goal is to reduce the inflammation present. Treatment options to relieve hip pain include steroid (anti-inflammatory) injections, rest, ice, compression, elevation, and physical therapy/ activity modifications. Surgical interventions are very rare for treating tendonitis.

If an infection causes bursitis, antibiotics may be given. In addition, cortisone injections and physical therapy can be used for bursitis treatment. If excess fluid accumulates in the bursae and needs to be drained, surgery can be indicated.

Top tips for relief: Various preventative measures can be implemented to alleviate the risk of developing tendonitis and bursitis. These include stretching before and after an activity, having proper body mechanics while exercising, and stopping if hip pain persists. In doing so, the risk of developing these conditions is significantly reduced.

Hip Fractures:

Causes: In the younger population, trauma is the leading cause of hip fractures. However, hip fractures are more common in older adults due to a decrease in bone density that occurs with aging. As one ages, calcium levels decrease, which can cause bones to become weak and brittle.

Similarly, females who have gone through menopause have a reduced level of estrogen, which can contribute to thinning and weakening of the bone. A prolonged lack of calcium and estrogen can cause a condition known as osteoporosis.

Women with this condition have a higher risk of fracturing the hip. Furthermore, high-impact activities such as long-distance running can increase the chances of hip fractures.

Symptoms: When one fractures the hip bone, intense pain can occur around the hip or groin area. In addition, visible signs of deformity may be present such as the leg on the affected side turning outwards and the creation of uneven leg lengths, depending on the severity of the fracture. Usually, patients cannot stand, bear weight, lift, or turn the injured leg. Furthermore, the injury will also cause swelling at the hip.

Treatment: Surgery is the primary treatment modality for hip fractures. After the injury, surgery needs to occur within 1-2 days to decrease complication risk.

Top tips for relief: Various lifestyle modifications can help prevent a hip fracture. Eating healthy, having sufficient Vitamin D and calcium, and exercising can help to strengthen the bone.

Cessation of smoking and excessive alcohol consumption is advised, as these can further contribute to bone breakdown. Smoking decreases blood flow to the bone, and excessive consumption of alcohol can create high cortisol levels, which prevents the new formation of bone.

Other:

While the above are the leading causes of hip pain, many other causes remain. For example, stretched tissues present in injuries to the back can cause hip pain. The sciatic nerve courses through your lower back and passes posteriorly to the hip joint. Compression of the sciatic nerve along its path can cause hip pain.

Sciatica has characteristics of shooting pain, burning, or tingling sensations down one’s leg. Femoral hernias near the hip bone can cause hip pain as well. These can be prevented by eating healthy and using proper form with heavy lifting.

Another condition known to cause chronic hip pain is endometriosis. Endometriosis occurs when an abnormal growth of endometrial tissue (layer lining the uterus) surrounds nerves that travel through the hip and pelvis.

If the ectopic tissue compresses the pelvic nerves, pain signals will be sent to the hips, buttocks, or legs. Reducing alcohol, caffeine, and body weight can help decrease the risk of endometriosis.

Conclusion

If you experience hip pain and want to get to the root of the issue, then schedule a consultation with our helpful healthcare professionals at OrthoNeuro. Our doctors can provide accurate diagnoses and tailored treatment plans. Call us today to schedule your consultation!

Resources

1. 5 causes of hip pain in women. Ozark Orthopaedics. (2021, March 1). Retrieved July 29, 2022, from https://ozarkorthopaedic.com/5-causes-of-hip-pain-in-women/ S
2. Dutton, D. A., About Dr Andrew Quoc Dutton Dr. Dutton has been in clinical practice since 1996 after graduating from Marist College, & *, N. (2022, July 20). 4 common reasons for hip pain in women. Dr. Dutton Orthopaedic & Sports Medicine Clinic in Singapore. Retrieved July 29, 2022, from https://www.drandrewdutton.com/blog/hip-pain-in-women/
3. Hip tendonitis and bursitis. Hip Tendonitis and Bursitis | The Christ Hospital Health Network. (n.d.). Retrieved July 30, 2022, from https://www.thechristhospital