Navigating Hip and Pelvic Pain: A Comprehensive Overview

Hip and pelvic pain, a frequent complaint among people of varying ages, has complex origins that require careful diagnosis and management. This blog post delves deeper into the insights provided by Kaj Sundqvist and Jari Arokoski in their thoroughly reviewed medical guide, helping demystify the causes and symptoms of this common issue.

Understanding the Causes

In Young Individuals:

Children and adolescents may experience hip and pelvic pain due to several factors:

• Inflammatory conditions such as synovitis and arthritis, which cause swelling and pain in the joints.
• Traumatic injuries, including those that lead to congenital hip dislocation and slipped capital femoral epiphysis, a condition where the ball at the head of the femur slips off in an adolescent’s growing phase.

In Adults:

For adults, especially as they age, the causes of hip and pelvic pain diversify significantly:

• Degenerative diseases like intervertebral disc disorders can refer pain up to the lower thoracic spine.
• Hip disorders, including osteoarthritis and bursitis, specifically target the hip and buttocks areas, worsening with activity.
• Sacroiliitis and pelvic changes during pregnancy can alter the mechanics of the hip and pelvic region.
• Rheumatic diseases and aseptic necrosis of the femoral head can lead to chronic pain and disability if not properly managed.

Diagnosing Hip and Pelvic Pain

From the Spine:

Back-related issues are common sources of referred pain to the buttocks and legs. For example:

Pain in the buttocks that exacerbates upon bending is typical of acute lower back problems.

Hip Joint Specific:

Limitations in hip movements, such as internal rotation and extension, often hint at hip joint pathologies like arthritis. Pain in these conditions usually escalates during physical activities such as walking.

Referred and Radiating Pain:

Sciatica and other nerve compressions can manifest as pain radiating below the knee, often exacerbated by specific movements like forward bending.

Serious Medical Conditions:

Certain types of cancer, including those affecting the small pelvis or prostate, can also present as hip and pelvic pain, underscoring the need for thorough investigations when symptoms persist.

Special Populations and Specific Conditions

Military and Athletes:

Stress fractures, a common occurrence in physically demanding roles or sports, can lead to significant discomfort in the hip and pelvic area.

Pregnant Women:

Pelvic girdle pain affects about 20% of pregnant women, often persisting but typically diminishing postpartum.

Elderly Population:

Osteoporosis increases the risk of stress-related injuries and fractures due to weakened bones, making elderly individuals particularly susceptible to hip and pelvic pain.

Advances in Understanding and Treatment

Medical understanding continues to evolve, as illustrated by changing perspectives on conditions like piriformis syndrome, once considered a major cause of buttock pain but now seen as less significant. Emphasis has shifted towards conditions such as deep gluteal syndrome and the specific management of ischiofemoral impingement, which involve comprehensive treatment strategies ranging from physical therapy to surgical interventions, depending on the severity.

Conclusion

Hip and pelvic pain represents a complex interplay of skeletal, muscular, and neurological issues. Effective management hinges on precise diagnosis, which can be challenging due to the overlapping symptoms of various conditions. The medical community’s growing knowledge continues to improve our understanding and treatment of these painful conditions, offering hope for those affected.

Bibliography

1. Strauss EJ, Nho SJ, Kelly BT. Greater trochanteric pain syndrome. Sports Med Arthrosc Rev. 2010;18(2):113-9.
2. Chowdhury R, Naaseri S, Lee J, et al. Imaging and management of greater trochanteric pain syndrome. Postgrad Med J. 2014;90(1068):576-81.
3. Lequesne M, Mathieu P, Vuillemin-Bodaghi V, et al. Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. Arthritis Rheum. 2008;59(2):241-6.
4. Gonzalez-Lomas G. Deep Gluteal Pain in Orthopaedics: A Challenging Diagnosis. J Am Acad Orthop Surg. 2021;29(24):e1282-e1290.
5. Hu YE, Ho GWK, Tortland PD. Deep Gluteal Syndrome: A Pain in the Buttock. Curr Sports Med Rep. 2021;20(6):279-285.
6. Gollwitzer H, Banke IJ, Schauwecker J, et al. How to address ischiofem