The hip joints are a key component to stabilization and ambulation of the human frame, so if you are experiencing problems with one or both of your hips, it is going to cause some loss of basic movements required by common activities of daily living, which translates to a reduction in quality of life.  It is therefore imperative that you be mindful of your hip health at all times:  take care not to place excessive shock trauma and repetitive stress to your hips; engage in exercises and stretches that condition your hip stabilizers.

The hip joint, or acetabulofemoral joint is a ball and socket type joint that supports the weight of the body in a static (standing) position and ambulatory position (running, walking).  Its two articulating parts are the femoral head of the femur (upper leg bone) and the acetabulum of the pelvis (coxae), a bowl-like depression lined with cartilage.

Your hips bear quite a bit of repetitious force every day, and if you run and/or play sports that involve jumping and landing such as basketball or gymnastics, then those hip joints are really taking a pounding.

The hip/pelvis complex, like a $10,000 mountain bike, is designed to absorb shock from multiple planes while simultaneously enabling movement.  A high-end mountain bike can be ridden over uneven ground and can withstand shock forces from bumpy terrain, drops and jumps thanks to a multiple- jointed frame outfitted with shock absorbers.  Like the mountain bike, the hip/pelvis complex enables the human body to absorb shock while ambulating.

The hip joints are balanced under the coxae, with the femoral heads partially inserted into the acetabulae and held in tightly by strong but stretchable capsular ligaments.  Smooth, nearly frictionless cartilage lines the femoral head and the acetabulum.  Comprised mainly of water molecules bound by proteins, cartilage is able to absorb shock and rebound, since water is incompressible.  In youth, cartilage is thicker, suppler and more resilient than in those past age 40 but as you age your cartilage thins and is less capable of absorbing repetitive shock; hence the difficulty of running for exercise as you age.

Rear view of the hip muscles.

The Ilia and ischia of the pelvis serve as broad attachment points for the hip stabilizer muscles:  gluteus maximus and minimus, psoas, adductor brevis and longus, and the deep hip rotator muscles (gamellus, piriformus).  These are the hip mobilizers and shock absorbers that give the hip joints their main function of propelling the body on flat and uneven ground, and stabilizing them when the upper body needs a stationary anchor such as during heavy lifting.

So what are the main types of hip problems?

The most common problem that affects the hips is osteoarthritis.  With so much pounding forces absorbed daily, the hips are prone to degenerative changes more so than other joints with the exception of the knees.  Tiny fissures appear in the cartilage and gradually expand over time, like a windshield crack that grows longer from the constant dips and bumps of driving.  The cracks turn into pits, and the hip joint starts to lose its smooth, fluid movement; giving way to clicking, stiffness, and limited range of motion.  Although osteoarthritis is often referred to as a “degenerative joint disease,” this term is not entirely accurate.  There is indeed a degenerative process involving progressive loss of articular cartilage, but there is also a reparative process in response to this degeneration that involves new bone formation, osteophyte growth, and remodelling.  The dynamic process of destruction and repair determines the final disease picture.

In advanced hip osteoarthritis, the pit erodes all the way down to the bone, and at that point you start getting pain in your hips, and where there is pain there usually is inflammation.  The hip capsule may fill up with inflammatory exudate, increasing the internal pressure of the hip joint and adding to the stiffness.

Risk factors, or things that will increase your chances of prematurely developing hip osteoarthritis are:

• Previous injuries to one or both of your hips – a fall, sports injury, car accident, etc.
• Participating in sports or other activities that involve high impact landings
• Being overweight for much of your adult life
• Smoking, as smoking restricts oxygen to tissues which is needed for maintenance and repair
• Genetic factors – having a parent who got premature hip osteoarthritis

The genetic factors likely involve protein mutations that render the cartilage’s ability to bind water less efficient, making it extra vulnerable to shocks.  They may also involve abnormal production of synovial fluid by the cells of the synovial tissue that surrounds the joint.  Synovial fluid is analagous to motor oil in a car’s cylinder– it minimizes friction between the moving parts, so if production of synovial fluid is low, you will get erosion of the articulating surfaces; i.e. the cartilage on the femoral head and the acetabulum, accelerating the disease process.

Another form of hip pain and stiffness may be from iliotibial (IT) band syndrome.  The IT band is a broad ligament that originates on the iliac crest of the hip bone; passes over the greater trochanter of the femur (that hard bump you can feel on the sides of your hips, right underneath the skin); and then inserts into the lateral epicondyle of the proximal tibia (lower leg bone).  This is a condition that some runners get, and involves strain to the ligament and tenderness at its insertions points.  It most often causes pain on the side of the knee, but can also cause diffuse, broad pain over the entire hip.  Tenderness and pain at ligament insertion points (into the bone) typically involve micro-tears from mechanical stress, and/or inflammation to the periosteum, the thin layer of tissue where the fibers attach to the bone.

Aneurysmal bone cysts, a benign but potentially destructive bone tumor may occur in the femur near the hip.  It involves the growth of a tumor inside the bone, filled with fluid and blood.  Normal bone is replaced by the tumor, which deforms and weakens the bone, making it prone to fracture.   ABCs typically start in the first 20 years of life and can remain into adulthood if not dealt with.  Make sure to rule this out before doing any physical therapy for hip pain; aneurysmal bone cysts are easily identified on X-ray.

There are other pathological conditions that affect the hip that can cause pain and stiffness, such as slipped capital femoral epiphysis (another pathology common to youth), fibrous dysplasia and other bone disorders but won’t be discussed in this article.  Just know that these can be a long-shot cause of hip pain, and can be usually ruled out on X-ray.

Those with hip pain or discomfort due to progressive hip osteoarthritis know the consequences:

• Very stiff hips upon waking in the morning, that improves up to a point as the day goes on.
• Laborious walking; takes extra effort to move your legs
• Aggressive movements like jumping and running are out of the question
• For some, burning pain in the hips
• Can’t stand for very long; have to sit

For those who have medical insurance, it’s a matter of time before they elect to have an artificial hip inserted.

So what should you do if you have hip pain from osteoarthritis, and are years away from considering hip replacement?

Here’s what I recommend:

Change your Diet:  what you choose to eat day to day has the biggest influence on your health.  Make 80 percent of your diet plant-based; and of that amount, about half of it raw (uncooked).  Suggestions:  green leafy vegetables such as chard, collard greens and spinach for the cooked; red leaf and green leaf lettuce, red cabbage, and endive for the raw.  Basically, vegetables with purple and red hues are the best as they are rich in anti-oxidants.

Include protein, about 10 ounces per day.  Organic grass fed meat, deep water fish, sardines, and pastured eggs are good choices.  Whey protein and pea protein powder are also good.

Include fats high in Omega 3 fatty acids, and some saturated fat.  Fats are a component of cell membranes especially in nerves, and they are a needed energy source for your body.  Salmon, mackerel, eggs, nuts and seeds are good choices.

And of course, drink water throughout the day to stay hydrated.  We humans are almost 80% water, and you lose water from your body with every exhalation.

Reduce daily stress in your life:  if your life is stressful, make an effort to remove the stress.  Stress has an adverse effect on your health and well-being.  It can raise blood pressure, blood sugar, cholesterol and cortisol levels, which promote fat weight gain.

Get some negative ions:  negative ions are abundant in nature; i.e. the outdoors.  They can neutralize harmful positive ions that are plentiful where there is pollution and electronics; i.e. cities.  Take off your shoes and socks, and walk on grass in a nearby park.  This will “ground” your body, discharging some of your positive ions and equalizing your electrical charge with the Earth’s.

Do low-impact exercises for fitness:  you don’t have to go crazy to get a good workout.  Using your body’s own weight is sufficient. Planks, squats, pushups, crunches, and lunges are great.  For weights, use kettlebells.  Cycling can be a good exercise for those with early osteoarthritis of the hip, as the pedaling moves the hip in a non-weight bearing position.

Lastly, use a Pulsed EMF mat daily.  Pulsed EMF is considered “energy medicine.”  It is the external application of electromagnetic fields similar to those produced by your body, to augment the potential energy the body uses to help drive biological activity; i.e. molecular movement such as blood flow and nutrient transport.  This can improve blood circulation and cell membrane transport of nutrients, proteins and wastes; thus improving cell function.  In weak tissues, Pulsed EMF can stimulate healing by energizing reparative cells.  Can Pulsed EMF help cause worn cartilage to regenerate?  Several studies such as this one found that pulsed EMF can upregulate the expression of a gene that controls cartilage production in chondrocytes.  It’s definitely worth a try.

Some studies show that Pulsed EMF can help cartilage regenerate.

Go here for more info on Pulsed EMF.

To recap, your hip joints are essential to a high quality of life.  They serve to ambulate you, and enable your body to perform basic movements required of daily living such as lifting, carrying, and bending.  They are also prone to degeneration, so be mindful of the health of your hip joints – avoid repetitive, high-impact activities that may accelerate degeneration.  If you like running, change your running stride to one that more resembles fast walking, where there is minimal to no change in height of your head as you run and therefore minimal impact to your knees and hips upon heel strike when running.  In fact, if you run, focus the impact of your foot on the ball of your foot as it contacts the ground, not the heel.  Running can be good for health, and your bones, when done right – not too aggressively; with moderation.