Nonsurgical hip pain treatment in Raleigh & Cary, NC​

Common Causes of Hip Pain

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Hip pain can come from several different structures, and determining the actual source of the pain is an important first step in choosing treatment.

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Pain coming from the hip joint is often felt in the groin or front of the hip. Common causes include hip arthritis, labral injuries and femoroacetabular impingement.

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Pain along the outside of the hip may be related to gluteal tendinopathy, gluteal tendon tears, greater trochanteric pain syndrome or irritation of the tissues surrounding the hip.

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Pain toward the back of the hip or buttock may sometimes originate from the hamstring tendons, sacroiliac region, muscles surrounding the hip or the lumbar spine.

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Because several conditions can produce similar symptoms, the location of pain alone does not always establish the diagnosis.

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Hip Arthritis

Hip osteoarthritis is a common cause of hip pain, particularly as we get older.

Patients may experience groin pain, stiffness, loss of motion and difficulty with activities such as walking, climbing stairs, exercising, putting on shoes and socks, or getting in and out of a car.

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Symptoms do not always correlate perfectly with the appearance of arthritis on an X-ray. Some people have significant arthritis on imaging but relatively manageable symptoms, while others experience substantial limitations.

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Treatment decisions should therefore be based on the entire clinical picture rather than an X-ray alone.

For patients who are not ready for hip replacement, nonsurgical treatment options may be considered depending on the severity of arthritis, symptoms and individual goals.

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Hip Labral Tears and Hip Impingement

The labrum is a ring of cartilage surrounding the hip socket that contributes to stability and joint function.

Hip labral tears can occur after an injury but may also develop gradually, particularly in association with abnormal contact between the ball and socket of the hip known as femoroacetabular impingement (FAI).

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Patients may experience groin pain, clicking, catching, stiffness or discomfort with prolonged sitting, exercise or movements involving hip rotation.

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Finding a labral tear on an MRI does not automatically mean surgery is necessary. Imaging findings should be interpreted together with the patient's symptoms and physical examination.

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Some patients can be managed with activity modification, rehabilitation and other nonsurgical treatments, while others with significant structural abnormalities or persistent mechanical symptoms may require evaluation by a hip surgeon.

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Pain on the Outside of the Hip

Not all hip pain comes from inside the hip joint.

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Pain along the outside of the hip is frequently associated with the gluteus medius and gluteus minimus tendons and surrounding structures.

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This is sometimes broadly referred to as greater trochanteric pain syndrome or incorrectly assumed to be simply “hip bursitis.”

Patients may experience pain when walking, climbing stairs, exercising or lying on the affected side. Symptoms can sometimes become chronic and interfere with sleep and physical activity.

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Treatment depends on the underlying problem and may include rehabilitation, activity modification and selected image-guided procedures. For certain chronic tendon conditions, PRP or shockwave therapy may also be considered.

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Is Your Hip Pain Actually Coming From Your Back?

Pain around the hip and buttock does not always originate from the hip.

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Problems involving the lumbar spine can produce pain that travels into the buttock, hip or leg. Sacroiliac joint problems, nerve irritation and certain tendon conditions can also mimic hip-joint pain.

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A careful examination can help determine whether symptoms are more likely coming from the hip joint, surrounding tendons and muscles, or another area.

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This distinction matters because treating the wrong structure is unlikely to provide the desired result.

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Do You Need an MRI for Hip Pain?

Not every patient with hip pain needs an MRI.

Depending on the symptoms and examination, evaluation may begin with X-rays to assess the hip joint for arthritis and other structural abnormalities.

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Diagnostic musculoskeletal ultrasound can also be useful for evaluating many of the tendons, muscles, bursae and soft tissues surrounding the hip.

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MRI may be appropriate when more detailed evaluation of the hip joint or surrounding structures is needed, when a labral injury is suspected, or when the diagnosis remains uncertain.

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Imaging should ideally be used to answer a clinical question rather than simply being ordered because the hip hurts.

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Can Hip Arthritis Be Treated Without Surgery?

Hip replacement can be an excellent treatment for appropriately selected patients with severe arthritis, but not every patient with hip osteoarthritis requires immediate surgery.

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Depending on the severity of arthritis and symptoms, nonsurgical management may include exercise and rehabilitation, weight management when appropriate, activity modification, medications and image-guided injections.

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For selected patients, regenerative treatments such as platelet-rich plasma (PRP) or microfragmented adipose tissue (MFAT) may also be discussed.

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These treatments should not be presented as a way to regrow a severely arthritic hip or guarantee that hip replacement will never be necessary.

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The goal is more practical: reduce symptoms, improve function and help appropriately selected patients remain active while they still have reasonable nonsurgical options.

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PRP for Hip Pain and Hip Arthritis

Platelet-rich plasma is prepared from a patient's own blood and contains concentrated platelets and associated signaling proteins.

PRP may be considered for selected hip conditions, including certain patients with osteoarthritis and chronic tendon problems surrounding the hip.

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At Carolina Nonsurgical Orthopedics, PRP treatment begins with establishing the diagnosis rather than simply injecting the location where the patient reports pain.

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For example, PRP placed inside the hip joint would not necessarily be the appropriate treatment for pain originating from a gluteal tendon or proximal hamstring tendon.

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Identifying and precisely treating the appropriate structure is an important part of our approach.

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MFAT for Hip Arthritis

For selected patients with hip osteoarthritis, microfragmented adipose tissue (MFAT) may be another regenerative treatment option.

MFAT is obtained from the patient's own adipose tissue and processed before being used as part of an orthopedic procedure.

Whether PRP, MFAT or another treatment is appropriate depends on factors such as the patient's diagnosis, severity of arthritis, previous treatments, age, health and goals.

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Neither PRP nor MFAT should be viewed as a guaranteed substitute for hip replacement. Patients with severe arthritis and substantial functional limitations may ultimately be better served by surgery.

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Learn more about our dedicated hip arthritis treatment in Raleigh and Cary.

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Why Image Guidance Matters for Hip Injections

The hip is a deep joint surrounded by important muscles, blood vessels, nerves and other structures.

For this reason, precision is particularly important when performing hip procedures.

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Ultrasound allows the physician to visualize the hip and surrounding soft tissues in real time and guide the needle toward the intended target.

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Image guidance can also be valuable when treating structures around the hip, including certain tendons and bursae.

At Carolina Nonsurgical Orthopedics, we use image guidance for hip injections and other procedures when appropriate rather than relying exclusively on surface landmarks.

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How Painful Is a Hip Injection?

Patients are sometimes concerned that an injection into a deep joint such as the hip will be extremely painful.

Discomfort varies depending on the procedure being performed and the individual patient. Local anesthetic may be used when appropriate, and ultrasound guidance allows the physician to visualize the needle throughout the procedure.

Patients may experience temporary soreness afterward, particularly following certain regenerative procedures.

Your physician can explain what to expect before recommending a procedure.

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Can Regenerative Treatment Prevent Hip Replacement?

This is an important question, but it needs to be answered carefully.

No injection can guarantee that someone with hip arthritis will never need a hip replacement.

For appropriately selected patients, nonsurgical treatment may help improve symptoms and function and potentially allow them to remain active without immediately proceeding to surgery.

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That is different from claiming that PRP or MFAT can reverse advanced osteoarthritis.

Patients with severe joint destruction, significant loss of function and persistent pain despite appropriate conservative treatment may be better candidates for hip replacement.

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Our goal is to help determine whether reasonable nonsurgical options remain before surgery is pursued.

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Staying Active With Hip Pain

Hip pain can make patients reluctant to exercise, but complete inactivity is not always the best long-term solution.

The appropriate activity depends on the diagnosis.

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Some patients may temporarily tolerate walking, swimming, cycling or controlled strengthening better than running, jumping or repetitive high-impact exercise.

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Maintaining strength and mobility can be particularly important as we age.

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Rather than simply telling patients to stop exercising, our objective is to identify the source of the pain and develop a plan that allows them to remain as active as reasonably possible.

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When Is Hip Surgery Necessary?

Our practice focuses on nonsurgical orthopedics, but that does not mean surgery should always be avoided.

Certain fractures, significant structural abnormalities, advanced osteoarthritis and other hip conditions may require surgical treatment.

Hip replacement can be highly effective for patients with severe arthritis who have substantial pain and functional limitations despite appropriate nonsurgical treatment.

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Likewise, some patients with significant labral or structural hip abnormalities may benefit from evaluation by a hip surgeon.

The objective of nonsurgical orthopedics is not to keep every patient away from an operating room indefinitely.

It is to make sure that appropriate nonsurgical options have been considered and that surgery is pursued when it truly becomes the better option.