Hip pain
One of the most common causes of hip pain is greater trochanteric pain syndrome (trochanteritis), inflammation of the tendons or ligaments around the greater trochanter (the bony prominence you can feel on the outside of the thigh). It is usually caused by a gait pattern in which the thigh moves inwards together with dynamic knee valgus during single-leg stance. Treatment involves biomechanical correction. Ultrasound-guided hydrodissection of the iliotibial band usually controls the pain, making biomechanical correction easy and pain-free.
Femoroacetabular impingement, labral tears and hip osteoarthritis are the most common causes of pain inside the hip joint. The pain usually gets worse when rotating the hip and is felt in the groin or in a “C” shape around the hip. Depending on the cause, image-guided hyaluronic acid injections (viscosupplementation) are a useful tool for pain control.
At the back of the thigh, hamstring tendinopathy/tendinitis is common in athletes. Treatment involves re-educating these muscles and tendons through controlled, progressive loading. An ultrasound-guided platelet-rich plasma injection usually provides symptom relief. Also at the back of the thigh, ischiofemoral impingement, pain that worsens with external hip rotation, can be relieved by an image-guided anti-inflammatory injection into the quadratus femoris muscle.
In the buttock, piriformis pain causes a deep ache that can radiate into the thigh through intermittent irritation of the sciatic nerve. An anaesthetic block is usually both diagnostic and therapeutic; if the pain returns, an image-guided botulinum toxin injection may be used.
Right or left hip pain: does it make a difference?
In most cases, no. The causes are the same on both sides and depend mainly on exactly where the pain is:
On the outside of the hip: trochanteric pain (gluteal tendinopathy or trochanteric bursitis).
In the groin, worse with rotation: femoroacetabular impingement, a labral tear or hip osteoarthritis.
At the back, in the buttock: piriformis syndrome, hamstring tendinopathy or pain coming from the lower back.
The exception: low, front, right-sided pain with fever, nausea or abdominal pain may be appendicitis. Groin pain with a lump that appears on exertion may be a hernia. In these cases, go to A&E.
When to seek urgent help
Being unable to put weight on the leg after a fall, especially in older people.
A warm, very painful hip with a fever.
Severe night pain that doesn't ease with rest, or unexplained weight loss.
How we treat hip pain at Clínica Myalgia
Pain medicine consultation: clinical examination and ultrasound to tell tendon, joint or spinal pain apart.
Ultrasound-guided procedures: iliotibial band hydrodissection, hyaluronic acid, PRP or botulinum toxin, as described above.
Physiotherapy: progressive loading of the glutes and hamstrings and gait correction.
Movement analysis and made-to-measure insoles: when the thigh "drops inwards" on landing, the pattern behind trochanteric pain.
Hip pain algorithm: a free tool (in Portuguese) to understand your type of pain before your appointment.
Frequently asked questions about hip pain
Can hip pain come from the spine?
Yes. Buttock pain that travels down the back of the thigh may come from the lower back. A clinical examination helps tell the two apart.
My hip hurts when I lie on my side. What could it be?
This is typical of trochanteric pain. A pillow between the knees helps at night, but treatment involves biomechanical correction.
Do I need tests?
An ultrasound during the consultation and, when indicated, an X-ray are often enough. MRI is kept for suspected labral tears or when the pain doesn't improve.
Will my health insurance cover it?
We work privately, but most insurance policies with reimbursement refund part of the cost. Find out how in Health insurance and reimbursements.
What our patients say
"I was very well looked after from the first appointment [...] the assessment was extremely careful and professional." — Google review (translated from Portuguese)
"Excellent care, with the results of the treatments and procedures carried out monitored for each patient." — Google review (translated from Portuguese)
Dr. Miguel Reis e Silva
Doctor at Sport Lisboa e Benfica
Medical Director and Founder of Clínica Myalgia
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