What Is Your Hip Pain Really Made Of?

Introduction

Your hip joints and the tissues that support them are precious gifts that support your ability to lead a normal active life.

Hips are weight bearing structures so we need them for just about everything active that we do, most of us also lie on one or the other hip at night so they even support healthy sleep. If your hips become ‘unwell’ they can be a source of great suffering for you… so they are worth having a conversation about.

What Is Hip Pain?

Hip pain is a complex thing. Not only are there many different ways a ‘hip’ can end up hurting there are also a multitude of different tissues that can get themselves involved in hip pain. 

There are in fact so many variables with hip pain that it is realistically not that accurate to refer to hip pain as a single condition. In the same way that there are many reasons to cough; there are many reasons to have pain in the general region we call hip. This perspective highlights hip pain as a ‘symptom’ rather than a ‘condition’. 

At the extreme ends of the spectrum if you have bone cancer causing pain in your hip it becomes relatively meaningless to refer to that situation as ‘hip pain’. In less extreme but far more common terms if you have scar tissue at your greater trochanter causing your hip pain then it is the scar tissue that is the actual diagnosis, hip pain is the symptom.

The various tissues involved in generating hip pain are obviously a major part of the story of how different hip pain diagnoses show up. 

The primary tissues involved with hip pain are muscle, joint, facia, tendon, ligament & bursa, nerve and the central brain centres connected to the hip. All of these tissues listed can and do cause hip pain. 

There are many anatomical structures in the hip that can cause hip pain.

What Causes Stubborn Hip Pain?

Our hips go through unimaginable mechanical stress and strain during the course of our lifetime. Even the most sedenatary of us take several million steps per year on extremely hard and unnatural surfaces. Every time your heel strikes the ground the forces travel up the bones of the leg and all that strain goes straight into the tissues of your hip. This is a major recipe of repetitive strain and over time even degeneration. It is not a random fact that hips are one of the 2 most commonly replaced joints in the body.

The truth is that just about every hip that hurts does have one thing in common… weakness. I have been caring for people with hip pain for 20 years and I can honestly tell you that I have never seen a case of hip pain in a hip that has a strong set of stabilising muscles . I can also say honestly that I have only seen a very small handful of hip pain cases in people with ideal weight bearing mechanics.. or ‘good wheel alignment’ if you will!!

A lesser known, but I can assure you pretty major factor in most stubborn hip pain cases is the role of emotions. In the same way that postural shoulder and neck issues can be amplified/aggravated by anxiety and stress (I trust that most of you knew this) so can hip pain issues. 

As a society we still live under a cognitive shadow that was cast over our understanding of our bodies around 500 years ago by a Frenchman.. the idea of a mind-body split. This short article on hip pain is not really the moment for us to start unpacking this scientific antique from its box so hopefully you can trust me when I say that there isn’t really a border or barrier between your mind and your body. If you have a re-occuring thought in your mind it has very real physical and impactful resonance in your bodies cells. If it didn’t how is it possible that you physically  salivate when you think about Hugh Jackman and custard squares? If we accept this connection it gets a whole lot easier to understand that impactful emotional patterns may have a role to play in generating stubborn hip pain.

The truth is that we can only hypothesise about how a pattern of emotional stress or trauma might impact a case of hip pain as stubbornly and persistently as it can. It may be that hip pain sufferers hold tension in their hips and pelvis the same way some others do in their neck and shoulders. What I can tell you is that for a very long it has been observed by practitioners who know their stuff that sufferers of stubborn hip pain are often also struggling with the concept of ‘control’. Some of them it is because they are predisposed to being ‘control freaks’ (I use that term with a great deal of sympathy and acknowledgement that it is a pretty silly one). For others it is because they are struggling with significant life events and circumstances that it is o only natural to want to control.

As an example I will offer up an observation from my own present day clinical life. Among the several hundred cases of hip pain I manage at any one time I know 3 women under 45 who stand out like sore thumbs as extreme and stubborn cases of hip pain. All 3 are as harder to manage than most 75 year olds with hip pain that relates to arthritis. In all 3 cases pain relief is like trench warfare, there is progress at all times but it is extremely slow going with frequent relapses despite extremely comprehensive treatment plans. And in all 3 cases they have a teenage child with severe disabilities. The ultimate and most important thing in their lives that they want to control they cannot, their child’s wellbeing and ability to thrive. If this observation against the backdrop of countless easily managed cases of hip pain is not a crystal clear illustration I don’t know what is.

Conclusion

The good news is that there are answers and there are solutions. All 3 of the women we talked about for example are making very good and very real (if painfully slow) progress with their pain over time. By luck or judgement it happens that the 1 who is receiving some counselling on top of rehabilitation for her physical pain is progressing the quickest of the 3.

We do have the ability to turn our emotional pain into physical symptoms, but we do also have the ability to heal, in fact that may be exactly what our primary life purpose is. With an open mind, an open heart and some serious grit most of what we suffer with in terms of physical pain can be resolved.