Hip pain

The hip joint is a unique connection and a weight-bearing structure in which fasciae, muscle fibers, and surrounding tissues perform essential functions. These structures form a system that ensures the stability and mobility of the entire musculoskeletal system. Therefore, the causes and treatment of hip pain can also affect other systems.
The hip joints are the largest joints in the body. Due to their proximity to the spine and internal organs, any inflammatory processes can disrupt the function of other systems.
Often, the root cause of pathology lies not in the joint itself, but in pathological processes of the fasciae and muscles, and the appearance of trigger points. In other words, it is not the hip joint itself that hurts — it is a condition of the tissues surrounding the joint: myofascial pain syndrome of the muscles and fascia around the hip.
It is important to understand that this is a non-inflammatory condition. That is, aching pain and discomfort in the hip joint area are present, but there is no true inflammation.

Hip pain can be divided into two types:

• Inflammatory
• Myofascial (non-inflammatory)

It is important to understand that up to 90% of hip pain cases are myofascial — that is, non-inflammatory — and require a different treatment approach (not classic symptomatic treatment).
Inflammatory pain includes pain from mechanical tissue damage — bruises, ligament tears and sprains, and so on. This is accompanied by swelling, redness, and localized warmth.
Trigger points are areas of increased sensitivity and tension in muscle fibers or fascia. Upon palpation, a hardened area is found deep within the muscle. When this area is pressed, hip pain may radiate to the leg, lower back, or buttocks, while at rest, discomfort may be barely noticeable.
Trigger points develop due to sedentary lifestyle, internal organ dysfunction, metabolic disorders, and excessive training. The area with nodular changes becomes the source of pathology — metabolism in the tissues is disrupted, waste products accumulate, and a painful, non-inflammatory process begins.
When trigger points are present, there may be reduced physiological function, pain, and muscle weakness. Stiffness of movement also appears, which can become permanent if left untreated.

Relieving Hip Pain. Treatment must be comprehensive. In addition to medication, physical therapy and therapeutic exercises are essential. Physical activity not only enhances the effect of medications and normalizes metabolism and blood circulation, but also has a positive impact on the course of the condition. For example:

• Reduces pain and discomfort
• Strengthens muscle fibers, ligaments, and fascia, eliminating connective tissue adhesions that form due to a sedentary lifestyle
• Strengthens and stabilizes cartilage and joint structures
• Slows down destructive processes in the bones

With regular massage, self-massage of trigger points, and muscle stretching exercises, compensatory mechanisms are activated that help restore hip joint function. These treatment methods help relieve heaviness in the legs, overcome stiffness of movement, and promote healing of pain.
Treatment for hip pain can be divided into two types:

• Symptomatic treatment — "masking" the pain, but not addressing the source
• Pathogenetic treatment — aimed at eliminating the cause of pain — that is, treating trigger points in the muscles surrounding the hip joint

Therefore, if there is acute traumatic pain, you can take painkillers, but it is better to immediately focus on treating the trigger points to achieve a lasting result.

There is no fundamental difference in who experiences hip pain — man or woman. The tendency to form and activate trigger points in the muscles surrounding the hip joint is the same. What matters is what preceded the onset of pain.
With prolonged sitting, the gluteal and piriformis muscles remain in a state of compression, which contributes to the slow formation of trigger points.
Risk groups are determined less by demographic characteristics and more by lifestyle.
Hip pain in both women and men temporarily subsides after self-massage, but this does not replace proper treatment — comprehensive therapy including medications. For conditions affecting the hip joint, treatment must be comprehensive: medication should be combined with physiotherapy, therapeutic massage, and other procedures.

Before thinking about which doctor treats hip pain, it is worth considering physical stretching exercises and trying to treat trigger points in the muscles surrounding the hip joint. These exercises are aimed at restoring mobility, eliminating discomfort and tightness that interfere with normal movement.
Regardless of the diagnosis, it is recommended to perform basic exercises that help improve physical condition and positively influence the course of the condition. The exercises focus on:

• Eliminating trigger points — hardened or nodular areas where stiffness, spasm, and tenderness are felt upon contact. The best approach is to massage trigger points with a rubber ball or massager.
• Restoring fascial gliding. In various inflammatory bone conditions, fascial mobility is impaired, which can lead to restricted movement, discomfort during physical activity, and later even at rest, if the inflammatory process affects the fascia.
• Restoring the anatomical range of motion of muscle fibers, which becomes shortened due to a sedentary lifestyle, insufficient activity, or conditions accompanied by movement restrictions.

In conventional medicine, it is commonly accepted that hip pain should be treated by a rheumatologist (a joint specialist — however, rheumatologists typically focus on inflammatory pain), a manual therapist (who will "adjust" and "crack" the joints, even though joint blockages are actually a consequence of trigger points), or an orthopedic traumatologist.
Ideally, any of these specialists can effectively treat hip pain — the key is that they focus on treating the muscles and fascia first, rather than the joint itself.

The presence of coxarthrosis of the hip joint and the presence of pain do not always correlate. In other words, an X-ray may reveal coxarthrosis of the hip joint, but there may be no pain — and conversely, pain may be present while MRI or X-ray shows no abnormalities. This means there is no direct link between hip pain and the presence of degenerative-dystrophic changes.
It is commonly believed that pain is associated with wear of the articular surfaces of the hip joint, and that the more the cartilage has worn away, the more severe the pain. This is incorrect, because cartilage tissue contains no pain receptors — cartilage itself cannot hurt. What actually hurts are the soft tissues: muscles, fascia, periosteum, and ligaments — not the joint itself.
To relieve pain in coxarthrosis, myofascial therapy is required — specifically, compression, stroking, and massage of tense tissues. This helps regulate muscle tone and promote relaxation. Massage improves joint mobility and prevents atrophic processes and dystrophic changes.
How these techniques work:

• They improve the mobility of adhesions that form between muscle fibers as a result of inactivity due to illness or a sedentary lifestyle. Compression and squeezing techniques help separate connective tissue, restoring normal mobility of muscles and joints.
• They activate the sensitivity of nerve fibers, tone the structures, reduce signs of atrophy, and improve blood flow to affected areas. During exercise, muscles "warm up," which slows dystrophic changes and restores activity.
• Blood supply to tissues improves mechanically through the effect on damaged areas. Contact with the skin normalizes sensitivity, microcirculation, and trophism.
• They enhance the healing process and clinical course of conditions, and dilate blood vessels responsible for supplying blood and nutrients to important structures.

Regular self-massage helps reduce hip pain in coxarthrosis, alleviate signs of atrophy, slow degenerative-dystrophic processes, and improve tissue blood supply. Hip joint mobility improves, which in turn restores motor function of the limb, relieves stiffness, and eliminates discomfort.

Indeed, hip pain can radiate to the leg. In such cases, it is likely that several types of pain are combined at once.
If the pain in the leg feels deep, conducting, and shooting, this may indicate nerve involvement. Trigger points can contribute to the formation of intervertebral disc herniation, which leads to nerve involvement (nerve compression and inflammation). In other words, neuropathic pain in the leg is added to the myofascial pain in the hip area.
It is also important to understand that trigger points can "spread" and cause referred pain. Often, pain in the leg originates from the gluteus minimus muscle, but trigger points may also be present in the muscles of the leg itself. In any case, if there is hip pain radiating to the leg, it is necessary to assess the contribution of each pain component. Afterward, massage therapy for trigger points should be performed.
On average, massage of one segment takes up to 20 minutes. During the initial session, discomfort may occur, which later gives way to relief and relaxation.
Self-massage technique:

1. Sliding and gentle compression of trigger points in the joint area using the edge of the palm or a fitness ball. Pain may be felt during the process, which later subsides and is replaced by relief.
2. Compression and stroking in the lower back, buttocks, and sacrum.
3. Gentle pressure on the upper third of the thigh.
4. Special attention is given to areas where tension, spasm, or sensory disturbances are felt.

During the massage, the actions are aimed at improving the mobility of the iliacus, psoas major and minor muscles, as well as nearby ligaments and joints. These techniques help relieve tension, alleviate trigger point symptoms, and improve fascial mobility.

Hip pain when walking can occur primarily due to overload of the gluteal muscle groups and the subsequent activation of trigger points, which become the source of pain.
The gluteal muscles are the largest muscle group responsible for normal mobility of the lower extremities. They interact with the biceps, quadriceps, and calf muscles. Due to a sedentary lifestyle, insufficient physical activity, and illness, these tissues undergo atrophic changes. As a result, blood circulation and lymphatic drainage deteriorate, and overall well-being worsens.
Exercises are aimed primarily at improving tissue mobility and mechanically relaxing muscle fibers. If there is hip pain when walking or significant discomfort, it is recommended to perform dynamic training, gradually increasing the duration and intensity.
Technique specifics:

• Using fitness equipment, massage large muscle groups where significant tension or discomfort is felt.
• Gentle pressure is applied in a dynamic manner, with gradually increasing compression force.
• The direction of movement is from the front of the thigh to the sacrum. Special attention is given to the piriformis, obturator, gluteus minimus, gluteus medius, and gluteus maximus muscles.
• During point pressure, both muscle fibers and trigger points — the cause of discomfort — are massaged.

The duration of exercises depends directly on how the patient feels, overall condition, and the severity of the condition. It is important to pay attention to sensitivity in the affected area. In some cases, a session may last up to 10 minutes, after which relaxation sets in. In advanced pathological processes, the procedure may take more than 20 minutes, and relief may be only minor.

Treatment Approaches
Self-massage accounts for a large part of the success and good results in treating disorders, inflammatory processes of the fascia, bones, and joints. The methods described above can be supplemented with other types of therapy. What can be used additionally for pain in the hip joint area:

• Shockwave therapy — a physiotherapy technique in which acoustic waves act on tissues, eliminating inflammation and relaxing areas of spasm. Depending on the frequency, the therapy can break down bone growths, positively influence the course of degenerative processes, and restore tissue metabolism.
• Trigger point injections using medications. During the injection, a medication or anesthetic is introduced into the tense point that causes discomfort. The procedure helps restore activity, improve well-being, relieve spasms, and promote the breakdown of trigger points.
• Post-isometric relaxation — a gentle manual technique. The effect on muscle groups is performed in two stages: tension of fibers while holding the breath, followed by passive stretching during exhalation.
• Therapeutic massage, myofascial massage, myopressure — performed by a specialist with a medical education. Before scheduling these procedures, it is advisable to consult a doctor to determine which treatments are recommended and which are best avoided.

Pain in the legs, hip joint, and lower back can occur due to overstrain and spasm of fibers located not only in the lumbar region but also in the iliac region. 40% of hip joint conditions are caused by a syndrome involving prolonged overstrain and spasm of tissues near the ilium.
The situation is complicated by the lack of research focused on analyzing the iliopsoas muscle group. Often, during diagnostics, this area is ignored, which means that after treatment for other pathologies, discomfort may return with worsening symptoms.
For pain in the left hip joint, lie on a flat surface on your back, bend your knees, and locate the point in the middle of the ilium.
How to perform the exercise:

1. Gently press with your thumb, palpating the group of tense fibers.
2. While pressing, gently compress the skin inward, toward the bone. Pay attention to trigger point pain. If sharp discomfort occurs, it is recommended to stop the procedure and assess how you feel.
3. With your fingers, gently press on the tissues in the direction of the groin.
4. Gently massage the iliac area with your palm.

Compression and pressure force are increased gradually. The duration of the exercises depends directly on how you feel and the type of condition. These exercises help manage pain that occurs in the sacral region and radiates to the groin and front of the thigh.
Often, spasm in the lower abdomen can lead to narrowing of the spaces between the vertebrae, affecting nerve roots. When such symptoms appear, it is important not only to examine the intervertebral discs but also to pay attention to the iliopsoas muscle group.