Hip pain - what is it, what causes it, and how do you deal with it? Orthopedic Surgeon Dr. Steven Nowicki, MD with South Central Orthopedics answered those questions while speaking at the South Central Regional Medical Center September community service educational program held at South Central Place, Friday, September 6.
Nowicki began by explaining that the hip joint is a ball-and-socket joint, is the largest joint in the body, and is surrounded by muscles and cartilage. “When you stand, two times your body weight goes across those muscles and joints,” exclaimed Nowicki. “When walking, five times your body weight crosses the joint and when running, ten times your body weight. There is a tremendous amount of pressure that goes across that joint every time you walk. That’s the first consideration about the hip joint that we need to keep in mind.”
“Secondly we have to ask ourselves, what is pain,” continued Nowicki. “Pain is a phenomenon that is felt in the brain. It is not something that is necessarily intrinsic to the tissue that’s damaged on the periphery. The tissue sends a message up to the brain and the brain perceives that message as pain, which is a protective mechanism that has evolved over the years to keep us from putting our hands in a hot fire, or hot stove, or not step on a snake.”
Nowicki said the current state of pain relief has to do with the present “opioid crisis.” “Opioids are our main class of pain relievers,” explained Nowicki, “and they act in the brain to counteract the pain. Any chemical that acts in your brain is bound to cause a lot of side effects. The two biggest side effects of those opioids are addiction and respiratory depression. That’s the problem today.” Nowicki commented to the group that if anyone has a son or daughter to encourage them to become chemical researchers and develop a new pain medicine that is not addictive.
Nowicki discussed the most common causes of hip pain and explained how each is treated. The most common causes of hip pain include arthritis, bursitis, hip fractures, tendinitis, muscle strains, and cartilage tear.
Nowicki said a cartilage tear causes a dull nagging pain that worsens over time. He said physical therapy is used to treat cartilage tear, which will help to strengthen the hip muscles surrounding the torn cartilage, and stretch some of the ligaments around the hip to take some of the pressure off the hip. Non-steroidal anti-inflammatory drugs, NSAIDS, such as Motrin, Aleve, Advil, and etc. will work locally, as opposed to the opioids which work in the brain, to decrease the chemical signal that is sent to the brain. He added that rest will help and occasionally there will be a need for surgery.
According to Nowicki, muscle strain in the hips most often occurs with athletes and dancers. “There are a lot of muscles that support the joint,” said Nowicki, “and like any muscle in the body they can be stretched or overused and the fibers can tear. Depending upon the amount of stress that we put on them they can occasionally tear completely in half.” He stressed the importance of warming up the body and muscles prior to exertion. He said the best way to warm up is fast walking.
In treating muscle strain, Nowicki said, “Remember the old RICE treatment we learned in boy scouts and girl scouts; rest, ice, compression, and elevation. When icing an acute injury, my favorite trick is a bag of frozen peas; they will bend and shape to the area. Twenty minutes on and twenty minutes off to begin with. With compression be careful not to cut off circulation by wrapping too tightly. A few days later, a strained muscle may be helped by alternating heat and ice. Be careful with heat. Heat can cause swelling and stiffness and can be a little more painful in general. Ice tends to make things less painful and decreases swelling.”
Nowicki strongly recommended the gentle stretching of muscles in Yoga. He added, “Yoga is great for maintenance of overall elasticity, health, and mental well-being.” He also recommends physical therapy.
Bursitis is another problem associated with the many patients with hip pain that Nowicki sees. “The bursa is a sack that nature puts there to relieve the friction and felicitate movement of one muscle on another muscle,” explained Nowicki. “There are a number of them around the hip joint which can become irritated.” He said Bursitis comes from overuse injuries, hip injuries, and body misalignment.
He said treatment of Bursitis is the same as muscle strain, but occasionally a steroid injection is needed.
Prevention includes refraining from activities that causes those muscles to overwork, Yoga, and weight loss if needed.
South Central offers these educational luncheons on the first Friday of each month at South Central Place located at 2260 Highway 15 North. In October, SCRMC Physical Therapist Dan Diers, DPT, ATC, MPT will speak on the subject of balance. For more information contact Karen Vanderslice, community education coordinator, at 601-399-0506 or email kvanderslice@scrmc.com.