Hip pain is a VERY common problem among older adults that can affect their ability to remain independent. While it’s common to assume that hip osteoarthritis (HOA) is responsible for the prevalence of hip pain in the aging population, the Framingham Osteoarthritis Study (FOS) found this isn’t always the case.

The authors of the FOS reported that the presence or absence of HOA on x-ray correlated poorly with hip pain. Of the participants with frequent hip pain, only 15.6% had x-rays showing HOA. On the other hand, only 20.7% of the men and women with x-rays that showed evidence of HOA had frequent hip pain! If only about one-in-six patients with hip pain have HOA, where is their hip pain coming from?

A common cause is bursitis. The bursae are fluid-filled sacs located near joints and muscle tendon attachments that cushion and protect the area. Bursitis is an inflamed bursa and is usually the result of trauma̶—repetitive over time or after a one-time macro-traumatic event, like a sports injury.

Hip synovitis (HS) is an inflammatory condition of the hip’s synovial membrane (SM) that is located within the joint capsule. The function of the SM is to lubricate and nourish the cartilage and bones inside the joint capsule. The SM is what causes a joint to rapidly swell after an injury (think knee or ankle injury with LOTS of swelling). Due to the deep nature of the hip joint, swelling is not visible from the outside.

Hip synovitis can result from trauma, such as a labral tear where the thin ring of cartilage or labrum (located on the rim of the hip socket) tears. The labrum cushions the hip joint and acts like a rubber seal or gasket that helps hold the ball into the hip socket. Sports and slip-and-fall injuries can cause labral tears.

Other causes of hip pain include arthritis (several types), injury (bursitis, synovitis, dislocation, fracture, labral tear, inguinal hernia, sprains, tendinitis, or strains), pinched nerves (sciatica, femoral nerve pinch), cancer, and more.

What do chiropractors do for hip pain? The first step is to establish an accurate diagnosis using the patient’s history, a thorough examination, and diagnostic tests such as x-rays or even an MRI, when warranted. If infection or certain types of arthritis are suspected, a patient may be referred out to their medical physician for blood tests.

If the cause is musculoskeletal in nature, treatment may include manipulation, mobilization, and soft tissue therapy of the hip and nearby joints, including the pelvis and low back. Patients may also receive nutritional and exercise recommendations to reduce inflammation and aid the healing process.