Posts

Hip pain

What is causing my hip pain? A look at top causes and how to treat them.

As the largest, and one of the strongest joints in the body, your hips can put up with a lot of repetitive motion and wear. Cartilage cushions the ball-and-socket to allow for smooth rotation as you walk, run and move.To keep your hip moving smoothly, a complex network of bones, cartilage, muscles, ligaments, and tendons must all work in harmony.

But as with all joints, the hip cannot withstand endless overuse,and the muscles, tendons and cartilage can wear down over time, or sustain damage from injury or disease. If you have hip pain, the first step is to understand what is causing it. There are numerous possibilities, depending on your medical and activity history. Seeing an orthopedic specialist is the best way to diagnose a hip injury, but understanding the most common causes of hip pain can be helpful.

Tendinitis

Tendinitis is inflammation or irritation of a tendonand canaffect tendons connected tothe muscles that control hip motion. The hip flexor, as the name implies, allows your hip to flex and rotate. It’s made up of two muscles known as the iliopsoas, which attach by a tendon to the upper thigh. The iliopsoasis called upon to help you walk and run, andalso to help other weaker muscles that aren’t pulling their weight leaving it susceptible to overuse and tightness. Translation – if you have weak gluteal or core muscles, your iliopsoas are probably doing more than their share and can becomeswollen and tender when put under repeated stress. This can certainly cause lingering hip pain.

Another common cause of hip joint tendinitis, particularly in runners, involves the thick span of tissue that goes from the outer rim of the pelvis to the outside of the knee known as the iliotibial or “IT” band. Also susceptible to overuse injury, it causes pain that can radiate along the entire length of the IT band from the knee all the way up to the outer side of the thigh to the hip. In fact, many people with IT band overuse present only with complaints pain to the outside of the knee.

Bursitis

Bursitis has many causes and can be intensely painful. Bursae are the fluid-filled sacs that cushion skin or muscle against the bone, allowing muscles and tendons to move smoothly. The most common hip related bursitis is on the outside of the hip socket near the “point” of the hip. Often triggered by repetitive motion and – you guessed it – overuse, this type of bursitis can also be brought on by things as simple as lying on the affected side for too long.

Labrum Tear 

Hip labral tears are actually not painful for many patients. When symptoms do occur, they generally take the form of deep groin pain, gluteal pain, clicking, catching, locking, or giving out. Limited range of motion or stiffness can also be indicators of a hip labral tear, which is why physicians test range-of-motion as part of an examination. Physical activities like golf, ballet, tennis and softball that repetitive twisting, pivoting and hip rotation cause strain on the joint that can lead to deterioration and ultimately a hip labral tear. Tears can also be caused by a collision (typically in contact sports) or structural abnormality.

Sciatica

When a herniated disc in the spine presses on the sciatic nerve, or if a tight muscle in the pelvis pinches around the nerve, it tends to cause pain that runs along the nerve from the lower back, down the hip and into one or both legs and feet. The pain is typically sharp or burning, and is often triggered by movement – even by a cough or sneeze –that can last for weeks. With sciatica, it’s uncommon for people to have hip pain alone.  Lower back pain is sometimes present, and patients often report a tingling, burning or feeling of numbness running down their leg.

Treatment

For most types of hip pain, there are multiple treatment options,available that typically begin with conservative, non-invasive options like a short course of NSAIDs (e.g. Advil or naproxen), periods of rest, yoga and stretching, physical therapy to increase hip strength, stability and range of motion.

If conservative options do not resolve hip pain, injections, surgery or hip replacement may be considered. Options can include:

Injections can both help to diagnose and treat some hip injuries. Orthopedic specialists can use an injection to numb the hip joint to determine if the joint is the source of hip pain, and then make treatment recommendations accordingly. Cortisone injections are also used to reduce inflammation and provide pain relief which may be done using ultrasound or fluoroscopy.

Hip Arthroscopy is a minimally invasive procedure that allows doctors to see the hip joint without making a large incision. It can be used to diagnose and treat a wide range of hip problems.

Hip Joint Replacement or Total Hip Replacement also known as Total Hip Arthroplasty (THA)to replace all or part of the hip joint with an artificial device to restore joint movement (prosthesis) when the cause of pain is significant arthritis of the joint.

The anterior hip approach allows your surgeon to access the hip from the front of the body and avoid cutting any major tendons or muscle groups, significantly reducing pain and recovery time. Many people back to an active lifestyle as soon as six weeks after the procedure, with far fewer post-procedure restrictions.

Revision total hip replacement is performed when the original primary total hip replacement has worn out or loosened in the bone. Revisions are also carried out if the primary hip replacement fails due to recurrent dislocation, infection, fracture or very rarely, ongoing pain and significant leg length discrepancy.

The hip is one of the largest weight-bearing and most interconnected joints in the body so it’s understandable why hip pain is so challenging. Don’t let hip pain keep you from being active. Get a professional diagnosis and treatment plan so that you can maintain or improve your mobility and remain active. Schedule an appointment today with one of our orthopedic hip specialists to find the right solution for your hip pain.

Best Hip Surgeons

dr harold hunt denver co

Dr. Harold Hunt


Jared Michalson, MD

Dr. Jared Michalson



Dr. Justin Newman


Scott Resig, MD

Dr. Scott Resig


R. Presley Swann, MD

Dr. R. Presley Swann


hip pain

Colorado: Hip Pain Keeping You from Being Active?

3 Common Causes of Hip Pain and Answers about Treatment

Pain in any load-bearing joint, like your hip or knee, can be very debilitating and have a huge impact on day-to-day activities and quality of life. And while minor hip pain can often be resolved with conservative measures such as rest, pain relievers, and ice or heat, more severe hip pain typically indicates damage to the bone, cartilage or supporting muscle and needs proper diagnosis.

You may have experienced a nagging pain that developed over time, or pain accompanied by a popping sound resulting from a movement or impact, or the inability to bear your body weight or move your leg. Hip pain can also be accompanied by secondary discomfort in thigh, groin, back or buttocks. If you’ve been experiencing any of these symptoms, it’s time for a medical evaluation. Most patients usually feel like they have pulled a groin muscle and it just doesn’t get better with rest and time.

Common causes of serious hip pain are arthritis, injury, and specific hip conditions (disease) such as acetabular dysplasia. Although the hip’s design supports repetitive motion and ongoing wear and tear, the joint is still vulnerable to damage and breakdown over time. Arthritis and injury are examples of breakdowns or damage.

Hip Pain and Arthritis

Hip pain stemming from arthritis often presents in the front of your thigh or in the groin due to stiffness or swelling in the joint. Osteoarthritis – the most common type of arthritis – tends to occur as people age and causes cartilage tissue in the hip (or other joint) to break down over time. This breakdown is what causes pain and swelling.

Treatment for hip arthritis ranges from exercises that foster increased range of motion and strength, injections, medications, to surgical options that include arthroscopy, hip osteotomy, resurfacing and total hip replacement. Your orthopedic specialist will evaluate the severity of your arthritis, your overall health and other factors to determine the best treatment with mutual decision making to get you active and pain free.

Hip Injuries

Tendonitis, bursitis, dislocation, tendon tears, and hip fractures are common types of hip injuries that require treatment. Treatment varies from pain relief and therapy to surgical procedures depending on individual circumstances. Injuries like dislocation, fracture or strains often occur from some kind of trauma, such as a car accident, sports collision, overexertion or a fall. The pain is sudden and often severe.

Other injuries like strains and bursitis can also cause intense pain but may develop over time, caused by overuse, over-extending a muscle, or degenerative conditions, to name a few. Because the causes and symptoms of hip issues can vary widely, don’t ignore a nagging pain or a sudden change in your hip health – especially after a fall or other trauma event. See your orthopedic specialist to be properly diagnosed, so healing, or symptom management can begin.

Hip Conditions and Diseases

There are a number of diseases that can impact the hip joint, including various types of arthritis and other auto-immune diseases as well as types of hip dysplasia. While most people think of dysplasia occurring in infants or small children, undiagnosed dysplasia (known as acetabular dysplasia) follows patients into adulthood.

The condition is and is found with greater incidence in females, relatives with dysplasia, first born babies and babies born in the breech position. Developmental Dysplasia of the hip (DDH) is the second most common single cause of osteoarthritis of the hip in young and older adults. The most common procedure to treat adolescent hip dysplasia is a periacetabular osteotomy (PAO). In hip osteotomy, the head of the thighbone or the socket is cut and realigned to take pressure off the hip joint.

Address Hip Pain So You Can Be Active

The hip is one of the largest weight-bearing joints in the body so it’s understandable why hip pain is so challenging. Don’t let hip pain, keep you from being active. Get a professional diagnosis and treatment plan so that you can maintain or improve your mobility and remain active. Schedule an appointment today with one of our orthopedic hip specialists to find the right solution for your hip pain.

Summer Grow Issue featuring Dr. Justin Newman

Over the Top

Overuse injuries among young athletes and active adults are beginning to stack up, causing short-term injuries and upping the long-term of osteoarthritis.

Read the article published in the Parker Adventist Hospital’s Summer “Grow” Newsletter, featuring our very own Dr. Justin Newman. Released at the beginning of August and see on pages 4 & 5.

Denver back pain specialists

Does your golf buddy have the solution to your knee or hip pain?

Knee or hip pain can be excruciating and when you are in pain, you want relief – pure and simple. And there is no shortage of advice on how to fix your joint problem, right? If your pain is keeping you from being active, you’ve probably had plenty of advice from well-meaning friends, fellow sports enthusiasts or family members – “you need surgery!” says one, “avoid surgery at all costs!” says another.

Knee and hip pain is very common, so it’s highly relatable, and everyone wants to empathize and help. But understanding what your pain means and determining your best treatment requires a partnership between you and your orthopedic physician.

We take great care to understand the story that your pain is telling and provide the care that is right for your personal situation. Sometimes, surgical procedures are the best solutions. But, sometimes, a non-surgical solution is the better course of action.

How can non-surgical solutions be better? Let’s start with the understanding the mechanics of both joints, knowing that both solutions have the potential to provide great relief and meaningful quality of life improvements.

Hips

The hip is one of the largest weight-bearing joints in the body. When it’s working properly, it lets you walk, sit, bend, and turn without pain. Unlike the shoulder, the hip sacrifices degree of movement for additional stability. To keep it moving smoothly, a complex network of bones, cartilage, muscles, ligaments, and tendons must all work in harmony.

Knees

The knee joint is very complex and consists of the femur (thigh bone), tibia (lower leg bone) and patella (the kneecap). The knee relies on the surface cartilage of these three bones as well as the menisci to serve as shock absorbers and stabilizers that allow for a smooth, low friction surface for the knee to move on. The knee is further stabilized by ligaments inside and outside the joint and is surrounded by a capsule (envelope) that produces a small amount of lubricating fluid to help with smooth motion. We tend to ignore our knees until something happens to them that causes pain.

Understanding Your Options

As physicians, we’re committed to looking at all options in the priority that best fits what your body is telling us. Both knee and hip pain can occur for many reasons, and common causes include injury to or damage within the joint, arthritis, or from the incremental burden that excess weight puts on these weight-bearing joints. When pursuing non-surgical treatment, I often provide patients with a combination of solutions that best fits their situation, lifestyle and objectives. The following three solutions provide excellent outcomes for many patients.

Physical Therapy:

Our in-house physical therapist partners create custom therapy regimens to build strength, increase range of motion, and ultimately, reduce pain. Therapy sessions are frequently paired with heat, ice or even nerve stimulation to reduce inflammation and increase circulation.

Injectables:

There are a number of treatments that involve injections into the joint site. Some, like lidocane are designed to control pain by masking the sensation. Others, such as steroids reduce inflammation and pain. Another category of injections involve gel-like fluids, such as hyaluronic acid (known as viscosupplementation). Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. It can act as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads. People with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints. For some patients, adding hyaluronic acid to the arthritic joint can facilitate movement and reduce pain. Every patient’s circumstances and outcomes are different, but all of these non-surgical solutions have the potential to play a different role in helping to enable mobility and decrease pain.

Move More

It may sound counter intuitive, but we often find that the solution for some patents with chronic knee or hip pain is to move more. Paired with improvements in nutrition, exercise generates a dramatic reduction in pain through weight loss and enhanced mobility. Increasing movement – even if gradually over several weeks or months – significant increases many patient’s range of motion, strength, and flexibility. And the impact can be exponential: for every 10 pounds of weight loss, there’s a decrease in joint pressure equivalent to 50 pounds!

We work with patients to identify plans that can alter the body’s weight or muscle strength to relieve joint pain without ever requiring surgery. In tandem, pain management can reduce inflammation, and allow your body the time to recover, repair, and rebuild the strength to better support your body and relieve the condition.

Patients want to know their options and, too often, they are not aware of non-surgical options that can greatly improve their daily life. We are able to collaborate with a patient to achieve results without ever undergoing surgery. Physical therapy and treatments such as acupuncture and other non-surgical therapy options are also viable options. It’s all about your situation and what’s best for you.
Sometimes surgery is required. When it is, wouldn’t you prefer to have the peace of mind that your physician has educated you about all of your options and helped you determine whether non-surgical or surgical treatment is best for you?

HIP CHECK: Preventing and Recovering from Hip Injuries

Fall sports are already in full swing and preparation for winter sports is gearing up. At Advanced Ortho, our goal is to provide our community with the guidance, resources, and services you need to keep you active and enjoying all the seasons that Colorado has to offer. Sports are as diverse as the seasons, but several fall and winter sports – football, ice hockey, gymnastics, soccer, skiing and figure skating – share body movements that can place extra strain on your hip and increase the risk for a labral tear. As the leaves begin to fall, we’re taking a look at common symptoms and causes of hip injury, tips for prevention and how to get you back in the game.

What is a hip labral tear?
Advanced imaging and in-depth studies have made game-changing advances in isolating sources of hip pain. Identification and treatment of labral tears are perfect examples of the fusion of science and technology to improve recovery and performance in sports. The labrum is a ring of cartilage that extends out from the bone of the hip socket to seal around the head or ball the hip joint. Injuries, deformities or repetition of twisting, pivoting and cutting motions can cause a tear in the labrum. When the labrum is torn, the hip seal is broken and the result is pain, and loss of stability.

How do I avoid it? Given the nature of its socket seal, tears to the labrum can result from both trauma and repetitive motions that involve pivoting or twisting. Since many sports motions – from golf, to ballet, to gymnastics – incorporate these twisting motions, eliminating them from your activity is usually not practical. Instead, the best prevention comes from developing strength and flexibility. Your core, leg and gluteal muscles can support your hips through the highest pressure points. You are most at risk when your hip is supporting your full body weight while your legs are pushing the limits of what would be considered your hips’ standard range of motion.

Diagnosis: How do you know you have a torn labrum? Many times, a decline in performance can be the first indicator, as symptoms are not always immediately apparent. Other common indicators are pain (in your hip, deep groin or the front part of your leg) and a locking/catching feeling in your hip as you walk or move from a seated position to standing.

Treatment: How can I fix it? Treatments for hip pain range from activity modification and therapy, to surgical corrections. With advanced imaging, a sports medicine specialist can determine if a physical therapy regimen can empower your supportive muscle groups (core, glutes) to improve your condition; or if a surgical repair is necessary to restore you to full activity. Both options have the potential to relieve pain, restore stability, and return you to form. Technological advancements in treatment have taken the focus off of anxiety about hip surgery and put it exactly where it belongs – on your full recovery.

We may soon feel a change of the seasons in our bones, but bone discomfort – chill or other – should never come from your sports’ motions and movements. Enjoy Colorado and enjoy fall sports, but, along the way, be informed, be prepared and Be Active!

MAKOplasty: Advanced Orthopedic’s less-invasive option for knee osteoarthritis.

Are you sitting on the decision to relieve your knee pain? As we age, countless adults fight through knee pain or stiffness that occurs while standing, walking short distances or starting from a sitting position.

Colorado has one of the nation’s fastest-growing aging populations and in six years, there will be more than 1.3 million Coloradans age 60 or older. But an active life after 60 isn’t for sitting, it’s for doing – embracing your interests and doing all of the things that you finally have the time to do.

Osteoarthritis is a degenerative disease that affects many active adults, but today’s treatments options can relieve your pain and extend the life of your knee into the next decade. For patients who have not experienced relief from anti-inflammatories and non-surgical treatments, MAKOplasty offers a convenient and viable option to undergoing complete knee replacement.

The consistency and precision of MAKOplasty’s proprietary computer navigated, robotic assisted procedure allows the surgeon to resurface only the diseased portion of your knee (sparing the healthy portion of the bone and surrounding tissue), ensuring that your implants are optimally positioned to maximize function of your existing knee.

You can’t turn back the clock on osteoarthritis, but MAKOplasty’s bone and function preserving partial knee replacement procedure can delay more invasive surgeries for as much as decade or more – allowing your retirement years to be active years rather than sitting out on the fun.

As Colorado’s first MAKOplasty surgeon, Dr. Harold Hunt has pioneered the use of this computer navigated, robotic assisted treatment and has made less-invasive treatments a truly viable option for Coloradans with partial knee osteoarthritis. “I see the real difference that MAKOplasty makes in my patients’ pain and mobility every day,” said Advanced Orthopedic surgeon Dr. Harold Hunt. “For patients with early to mid-stage osteoarthritis, MAKOplasty is a game-changer.”

In fact, success stories include one patient, who after the MAKOplasty procedure at the age of 70 has since placed second in two international duathalons, and another patient who was skiing within just a few weeks of his procedure. Many others report the thrill of getting back to tennis, biking, hiking and all the activities they love.

Makoplasty keeps active adults active, with rapid pain relief and recovery. In most cases, patients are permitted to walk the day of surgery, drive a car within two weeks and return to normal activities shortly thereafter. For patients with limited osteoarthritis, MAKOplasty is the go-to tool for relief.

Knee pain doesn’t need to impact your ability to line up a putt or enjoy a brisk morning walk. In Colorado, we enjoy our active lives, so don’t sit on your pain problem. MAKOplasty offers active adults a less-invasive solution to knee osteoarthritis. AdvancedOrtho keeps active lives active.