Hip Pain and Sciatica

Distinguishing between musculoskeletal hip pain and pain originating from intra-abdominal issues can be challenging. Asking your healthcare provider about specific symptoms, such as location, severity, and exacerbating factors, may help clarify the underlying cause of your hip pain.

Making lifestyle modifications may help alleviate hip pain and improve overall joint health. Your healthcare provider can offer guidance on activities to avoid and recommend exercises or ergonomic adjustments to support hip health and minimize discomfort.

Identifying risk factors or predisposing factors for hip pain can help you take proactive steps to mitigate these risks and prevent future episodes of discomfort. Your healthcare provider can provide personalized recommendations based on your medical history, lifestyle factors, and overall health status.

Psychological factors, including stress and anxiety, may contribute to or exacerbate hip pain in some individuals. Integrating strategies for addressing psychological factors, such as stress management techniques or cognitive-behavioral therapy, as part of a comprehensive treatment plan may help improve overall pain management and quality of life.

Posture and body mechanics can influence the development and management of hip pain. Your healthcare provider or physical therapist can recommend exercises or techniques to improve posture, strengthen supportive muscles, and reduce strain on the hip joint, which may help alleviate discomfort and prevent further injury.

Hip pain may be interconnected with other musculoskeletal conditions, such as lower back pain or knee pain, due to biomechanical relationships within the body. Addressing underlying issues in one area of the body, such as through physical therapy or targeted exercises, may positively impact overall hip health and reduce pain.

Certain dietary supplements or nutritional interventions may offer benefits for joint health and pain management. Your healthcare provider or a registered dietitian can provide guidance on safe and effective use of supplements, as well as recommend dietary modifications to support overall joint health and reduce inflammation.

Weight management can play a significant role in managing hip pain, as excess body weight can increase stress on the hip joint and exacerbate symptoms. Your healthcare provider can offer personalized recommendations for weight loss strategies, including diet modifications, exercise programs, and lifestyle changes tailored to your individual needs and goals.

Alternative or complementary therapies like acupuncture or massage may offer relief for some individuals with hip pain. Your healthcare provider can discuss the potential benefits and risks of these therapies, as well as help you determine if they are appropriate for your specific condition and overall health

Chronic hip pain can have significant long-term effects on quality of life, including decreased mobility, functional limitations, and psychological distress. Learning effective pain management strategies, engaging in regular physical activity, and seeking support from healthcare providers or support groups can help you cope with ongoing discomfort and maintain overall well-being.

Aging can impact the prevalence and management of hip pain due to factors such as degenerative changes in the joint, decreased muscle strength, and changes in activity levels. Your healthcare provider can provide age-specific recommendations and considerations for managing hip pain, taking into account your individual needs, preferences, and overall health status.

Hip pain can sometimes be a symptom of more serious underlying conditions, including infection or cancer. It’s important to be aware of warning signs such as persistent pain, unexplained weight loss, fever, or changes in bowel or bladder function that may indicate the need for urgent medical attention. If you experience any concerning symptoms, seek prompt evaluation from a healthcare provider.

Gender may influence the risk of developing hip pain due to differences in anatomy, hormonal factors, and activity levels between males and females. Your healthcare provider can discuss gender-specific considerations and recommendations for diagnosis and treatment based on current research and clinical guidelines.

Certain occupations or activities that involve repetitive motions, heavy lifting, or prolonged periods of sitting or standing may increase the risk of hip pain and injury. Your healthcare provider or occupational therapist can offer guidance on ergonomic modifications, proper lifting techniques, and preventive measures to reduce your risk of hip pain related to occupational or recreational activities.

Inflammation may contribute to the development and progression of hip pain, particularly in conditions such as arthritis or bursitis. Your healthcare provider or a registered dietitian can discuss dietary and lifestyle factors that may help reduce inflammation and alleviate symptoms, such as consuming anti-inflammatory foods, maintaining a healthy weight, and managing stress.

Genetic factors or hereditary conditions may play a role in predisposing individuals to hip pain or musculoskeletal disorders. Discussing your family history with your healthcare provider can help determine if you have any genetic predispositions or familial patterns that may influence your risk of developing hip problems, allowing for proactive management and preventive measures.

Surgical interventions for hip pain carry potential limitations and risks, including complications, prolonged recovery periods, and uncertain outcomes. Your healthcare provider can discuss the potential benefits and risks of surgery, as well as alternative treatment options, allowing you to make an informed decision about whether surgery is the right option for you based on your individual circumstances and treatment goals.

Sciatica pain is usually radiated along the back or the side of the thigh and knee into the leg. Occasionally, patients may present with a confusing picture of knee problem, but maybe having sciatica. A thorough history and examination by the physician as well as diagnostic tests in the form of x-rays and MRI may be needed to confirm the diagnosis.

Sciatica nerve pain can be relieved to various modalities. To start with, antiinflammatory medications like ibuprofen, naproxen or Tylenol may help. If pain is not relieved with the medications, physical therapy, chiropractor and acupuncture may also help. The patient may also take medications including gabapentin or pregabalin for pain relief.

The patient should take a short period of bed rest for a day or two. The patient should continue to do normal usual activities. If the pain is not relieved, he should see his doctor. Epidural injection or nerve root blocks may help in relieving the sciatica pain. Patients who are not having any relief with any of the above-mentioned treatment plans, may need an MRI for confirmation of diagnosis and possibly surgery to relieve their pain.

Sciatica is a clinical diagnosis, which can be corroborated by imagings with or without nerve conduction/EMG studies. Typical patient will present with pain radiating down one leg along the back or the side of the thigh index. They may have been associated with tingling and numbness or back pain.

Occasionally, patients may have weakness in the toes or the ankle. Once the clinical diagnosis is made, confirmation can be done using x-rays and MRI. In patients who have a confusing picture due to underlying comorbidity or atypical presentation, nerve conduction study and electromyographic study can be done to further confirm or rule out sciatica.

Heat is usually better in patients who have sciatica, though patients who are not relieved with heat should also try ice or occasionally rhythmic use of heat and ice, cyclic use of heat or ice may help better than one alone.

Massage is one of the modalities of adjuvant therapy for sciatica can be helpful and can decrease pain by strengthening the muscles as well as stretching the nerves. Deep massage can also help decrease the muscle spasms that develop in patients with sciatica.

For sciatica, an ice pack or even a heating pad can be used by placing it into the lower back and the gluteal region. It helps decrease the inflammation of the nerve there and thereby decreasing the pain and associated symptoms.

Inversion table similar to traction helps sciatica by increasing the height of the disk and thereby allowing the disk to go back into space thereby decreasing the compression of the nerve root may help in decreasing the pain of sciatica. The issue of inversion table as well as traction is that this is effective until the patient uses them and once the patient is upright and moving, the effect of the inversion table or the traction may not be persistent.

Sciatica or lumbar radiculopathy causes pain radiating from the back or the hip into the lower extremities down the leg. The pain radiates along the back or the side of the thigh and leg and radiates down foot. An isolated ankle pain may not be caused by radiculopathy. If the pain is on outer or inner side of the ankle and is radiating down or coming from the top then it may be associated with sciatica or lumbar radiculopathy.

90% of patients with sciatica will eventually get better in a period of four to six weeks. During this time, the pain may worsen also or it may keep on improving. Patients who have severe pain with or without tingling or numbness usually will need medical attention to relieve their pain during this duration. The treatment may involve medications, physical therapy and cortisone shots. Patients who have sudden onset of neurological deficit or weakness or worsening of the neurological deficit may need surgery also.

Sciatica like any other neurologic pain can have relation with the mental status and cognitive functions of the person. Though stress may directly not be the causative factor for sciatica, it may have its effect on the severity as well as course of the disease process of sciatica. Patients with high stress levels may have difficulty coping with sciatica and may take longer time to get better.

Sciatica in most patients will get better by itself in a period of four to six weeks. The pain as well as tingling and numbness tend to improve over time, though it may have periods of worsening. Patients may need treatment in the form of medications or injections to relieve the pain, so as to spend this period of four to six weeks, till then the relief is evident.

Occasionally in about 10% of the patients, there will be no relief, worsening or recurrence of sciatica pain despite all treatment modalities over four to six weeks. These patients may need surgical management to relieve their pain due to the pressure over the nerve roots.

Sciatica is usually self limiting in 90% of patients and only needs treatment in the form of medication and physical therapy and occasionally cortisone injection. In about 10% of patients, this may not be relieved by any modality and these patients may need to undergo surgical treatment.

Sciatica can also rarely lead to rapid neurological deficit presenting in the form of cauda equina syndrome, which can be potentially disabling. The neurological deficit caused due to cauda equina syndrome may be permanent especially if not treated early in the disease process. Such patients may not only have weakness in their legs, but may also lose control over their bowel and bladder, which may or may not recover over time.

Sciatica pain can be relieved by the help of anti-inflammatory medications like ibuprofen, naproxen. It can also be helped by Tylenol. Stronger pain medications like tramadol and narcotic medications may occasionally be needed for a short period of time.

Neuromodulator medications like gabapentin and pregabalin may also be helpful in decreasing the sciatica pain. Occasionally, medications like amitriptyline, duloxetine and carbamazepine may also be used in some patients to relieve their pain.

Back brace may be helpful in patients who have back pain with or without sciatica. Patients who have only radicular pain in their lower extremity may not be helped by the back brace. Use of back brace for a long period of time may be detrimental by causing atrophy of the back muscles.

Pain in and around the hip joint has a vast myriad of potential causes.  They range from the musculoskeletal in nature (e.g. hip arthritis, greater trochanteric bursitis, iliopsoas impingement) to the intra-abdominal (e.g. sportsman’s hernia, inguinal hernia, athletic pubalgia) to the less clear-cut or multifactorial (e.g. complex regional pain syndrome, fibromyalgia).

Although each of the aforementioned conditions will cause a form of hip pain, the hip pain will be slightly different depending on the cause and these differences will be identified by your healthcare practitioner and will help them achieve a definitive diagnosis of the underlying cause of your hip pain.

Pain in and around the hip can present in great number of different ways, and each identifiable cause of hip pain has a unique presentation and characteristic quality to the pain itself.  For example, hip osteoarthritis pain tends to present as a dull ache that is exacerbated with weightbearing, iliopsoas impingement tends to present as a sore burning sensation that is worsened with resisted hip flexion and an inguinal hernia will present with pain around the hip that is worsened with a Valsalva maneuver.

That being said there are number of conditions that will present with hip pain of very similar nature, for example pain from osteoarthritis can often be confused with pain from femoroacetabular impingement or any other intra-articular cause of hip pain.

Although pain in the hip is generally felt in and around the hip joint, its specific location can give away key clues to the underlying cause of the hip pain.  For example, greater trochanteric pain will worsen with specific palpation of the area directly overlying the greater trochanter. Hernia type pain will be felt more so in groin than the lateral deep aspects of the hip.  Hip pain can even be felt in the buttock area – this is  a common presentation of osteoarthritis.

Any sustained hip pain that lasts longer than a few days and is refractory to conservative management such as over-the-counter analgesics and rest, stretching or continued exercise should be brought to attention of a medical professional.  Although a good amount of hip pain will respond well to over-the-counter analgesics such as Tylenol and nonsteroidal anti-inflammatory drugs, these may temporarily relieve the pain but  on cessation of these medications, the pain may very well return.

Depending on the cause of the hip pain, these may actually be ineffective (for example using anti-inflammatories and Tylenol to treat an inguinal hernia will be largely ineffective. Although it may provide some pain relief, this will be likely incomplete and very temporary). Our specialist orthopedic surgeons would be happy to consult with you regarding any hip pain that you may have been experiencing and will help to reach a definitive diagnosis which is key to successfully treating your hip pain.

One of the most common scenarios a surgeon will see is a patient who presents with pain in the hip and attribute this pain to arthritis of the hip, but on consultation with our specialist orthopedic surgeons and review of plain film radiographs, the patient lacks any radiographic evidence of arthritis in the hips at all, however, assessment of the lower back reveals significant arthritis in this area.

This is a common presentation for many people who experience hip pain that is actually coming from the lower back.  Depending on the extent of the involvement of the lower back and the specific symptoms the patient presents, they may warrant a referral to a spine specialist, but in most cases a course of sustained and effective physical therapy often provides these patients with the muscular training that they require in order to improve their arthritis pain originating from their lumbar spine.

Many patients choose to visit their regular family physician with hip pain complaints and this is perfectly reasonable, as is presenting to a physiotherapist or chiropractor.  However, our specialist orthopedic surgeons have years of experience treating hip specific problems and are best qualified to assist you in achieving a definitive diagnosis for the cause of your hip pain.

Once we have made this diagnosis, we will be more than happy to discuss with you the treatment options and whether this includes surgery or nonsurgical options such as physical therapy, nonsteroidal anti-inflammatory medications, gait aids and injections.