June 20, 2021

What are the Most Common causes of Hip Pain in Older Adults

Written by: Amanda Cheong, M.D.
Reviewed by: Mubashar Rehman, PHD

It can start with a joke, a groan as you’re rising from the chair. “I’m getting old!” The joints are creaky door hinges that need to be oiled. Then, there’s the grating feel in what used to be a smooth walk. All of these things can slowly culminate into a dull and constant ache right at the hips. Most wave a hand at it and say that’s all a part of aging.

Sometimes, it’s not like that. Sometimes, it’s a slip on the bathroom floor, followed by a sudden sharp pain. It can be staying in bed the whole day because your leg can no longer bear the weight and the pain that comes with it. It can be tingling and numbness at your toes when your legs are in a certain position.

As much as 20% of seniors reported a significant amount of hip pain during most days over the past year, leading to functional limitations in some of them. [1] Hip pain in elderly individuals can come from a variety of sources.[2] Your healthcare provider will go through some detective work to unveil the culprit. But let’s go through some of the suspects here.

Let’s talk anatomy: Bones and Joints

The pain could be coming from the hip joint itself. When the symptoms come in slow and without any specific inciting incident, this could be hip osteoarthritis. That is medical-speak for the wear and tear of the hip joint.[2]

The human body is a kind of machine that needs to be maintained regularly with appropriate levels of exercise and rest. Otherwise, the constant friction between the joints will grate cartilage against cartilage, resulting in the breakdown of the bone’s padding. The lack of cartilage worsens the problem by causing bone grinding against bone. Because it’s the friction and grind that causes pain, it usually aches more after a day of being on your feet or after doing some strenuous errand.[3]

Imagine your doctor raising the hip X-rays like prison mug shots, one from each side. The lack of space in the hip joints where the bones almost touch would clinch the diagnosis. This is often accompanied by a distinct difference in a person’s gait. They walk slower with a shorter stride, lingering longer at the moment when both feet are firmly planted on the ground and share the body’s weight. Even standing up from a sitting position has its modus operandi.[3-4]

But, hip osteoarthritis isn’t the only cause of hip pain that is bone-deep.

Hip fracture is another common source of hip pain in elderly individuals, especially since older people are more at risk of falls. Often, this happens in the bathroom where the floor is slippery, and there might be fewer places to hold on to for stability. However, there may be times when the traumatic cause isn’t even significant enough to be remembered.[5]

Whether or not grandpa or grandma remember the fall, hip fractures are often signaled by pain on the hip that prevents one from standing and walking. When examined, the hip could have an obvious bone deformity or some swelling and bruises.[5]

At this point, it’s best to get this checked by a doctor.

 

Side hip pain in trochanteric bursitis

The body needs the bones to move against each other properly. It also needs tendons and muscles to glide gracefully over those bones. This is the bursae's job, the fluid-filled sacs in the joints--- and a specific one to the hip is called the trochanteric bursa that lies right on top of the leg bone that connects to the hip.[6

The bursae can be temperamental and can cause inflammation due to an assortment of activities. Sometimes, especially in younger people, repetitive movements can cause the bursae to initiate an inflammation cascade. Other times, this happens due to a traumatic hit in the area—it might not be enough to cause a fracture but an inflammation instead. (An X-ray is needed to be sure.) In elderly patients, especially those who are bedbound, constant lying down over the trochanteric bursae can cause inflammation.[6]

This type of hip pain often goes away on its own with over-the-counter painkillers or a corticosteroid injection to the affected area. This rarely, if ever, leaves any traces of its presence once it’s been treated.[6]

The nerve of this pain

Nerve entrapment presents another cause of hip pain in elderly adults. Some nerves course all over the hip region and impingement of any of them, be it by tight muscles or a bone problem, can cause many symptoms. Sometimes, it isn’t painful per se. But, it is a tingling sensation, almost like a current running through the leg in a very precise course.[7]

There are several maneuvers that your doctor can perform to zoom in or “localize” the cause of a person’s hip pain. Sometimes, this involves moving the affected limb to see whether the pain is present only when an older adult actively moves it or whether even a gentle movement can elicit it. They may press on the site and watch for a reaction to determine how worried they should be about the pain. But often, an X-ray of the hip is needed to make a firm diagnosis.[4-7]

Often, hip pain is dismissed as an inescapable part of aging. The body grows old and the once sleek mechanisms that keep everything moving smoothly, eventually, break down. We have seen countless older adults shuffling through the pain and bearing with it because of this accepted idea. However, the anatomy of hip pain in elderly individuals is not always that simple, with many interlocking parts that can cause this sensation. Some sleuthing may be required to hone in on the prime cause and to suggest the proper treatment.

No one needs to live with pain, especially if medicine or surgery can be done to alleviate it. 

 

References:

  1. Quintana, J.M., Escobar, A., Arostegui, I. et al. Prevalence of symptoms of knee or hip joints in older adults from the general population. Aging Clin Exp Res 20, 329–336 (2008). https://doi.org/10.1007/BF03324864
  2. Chamberlain R. Hip Pain in Adults: Evaluation and Differential Diagnosis [published correction appears in Am Fam Physician. 2021 Mar 1;103(5):263]. Am Fam Physician. 2021;103(2):81-89.
  3. Constantinou M, Loureiro A, Carty C, Mills P, Barrett R. Hip joint mechanics during walking in individuals with mild-to-moderate hip osteoarthritis. Gait Posture. 2017;53:162-167. doi:10.1016/j.gaitpost.2017.01.017
  4. Higgs JP, Saxby DJ, Constantinou M, et al. Individuals with mild-to-moderate hip osteoarthritis exhibit altered pelvis and hip kinematics during sit-to-stand. Gait Posture. 2019;71:267-272. doi:10.1016/j.gaitpost.2019.05.008
  5. Emmerson BR, Varacallo M, Inman D. Hip Fracture Overview. [Updated 2021 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan
  6. Seidman AJ, Varacallo M. Trochanteric Bursitis. [Updated 2020 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
  7. Martin R, Martin HD, Kivlan BR. NERVE ENTRAPMENT IN THE HIP REGION: CURRENT CONCEPTS REVIEW. Int J Sports Phys Ther. 2017;12(7):1163-1173. doi:10.26603/ijspt20171163

 

Article written by Amanda Cheong, M.D.
Dr. Amanda Cheong spent her formative medical years within the walls of the Philippine General Hospital, a high-volume tertiary institution built to serve the underserved. After graduating with a degree in medicine, she went on to write, edit, and compile healthcare stories from the start of the COVID-19 pandemic for an online anthology. Currently, she is involved in medical research as well as volunteer telemedicine consults. She enjoys writing fiction on the side when she’s not tending to her plants and three pet turtles.

Leave a Reply

Your email address will not be published.