There could be many reasons why you are suffering from hip pain, the majority of which respond favourably to injection therapy and physiotherapy. Please click on the below links to find out more about each condition;
Frequently asked questions
When should you consider having an injection for hip pain?
The first port of call when treating hip pain is a combination of physiotherapy and rehabilitation and if this is not effective then an injection should be considered. The most common reason for injections around the hip joint are hip osteoarthritis, hip impingement (also known as femoral acetabular impingement or FAI) and trochanteric bursitis). An injection can provide rapid pain relief for all of these conditions.
If you are suffering from one or more of the below factors then an injection might be right for you:
- Substantial amounts of pain which has been present for 6 weeks or over or has been getting considerably worse.
- Pain and symptoms that stop you falling to sleep or wakes you at night
- Pain that is impeding your lifestyle whether that is undertaking simple activities of daily living, work or exercise/playing sport
For an injection to be both safe and effective it is vitally important that an accurate diagnosis is made. Diagnosing hip pain requires a combination of clinical testing and diagnostic imaging (ultrasound, X-ray and/or an MRI).
At Complete, we are uniquely placed to find out what is causing your pain. Our team of highly experienced clinicians are all senior physiotherapists and musculoskeletal sonographers. On your initial assessment you will be assessed using clinical testing and a diagnostic ultrasound imaging. In the vast majority of cases this will provide the relevant information needed to provide you with a diagnosis however, if further investigations are required (such as an Xray or MRI) then your clinician will be able to refer you.
Why should I choose to have an ultrasound guided hip injection over a non-guided hip injection?
Hip joint injections MUST be carried out with guidance. Unguided (also known as ‘blind’ injections) injections into the hip joint are not accurate and often do not result in adequate pan reduction. At Complete we use ultrasound guidance to ensure the needle placement, to avoid sensitive tissues and to ensure pain levels are kept to a minimum.
Many of the hip structures which require injecting are relatively deep and surrounded by lots of delicate and sensitive structures (such as the femoral nerve and artery as well as the sciatic nerve). It is therefore essential that the correct target is located and monitored throughout the injection process. The delicate structures which surround the hip joint can be observed and avoided during an ultrasound guided injection.
Using ultrasound guidance allows our clinicians to use the thinnest, shortest needle possible to reach the intended target. Using ultrasound guidance ensures minimal pain, avoids trauma to the tissues and avoids any accidental soft tissue trauma.
Every injection undertaken at Complete are performed under ultrasound guidance. If you would like to know more or would like to book an appointment, please feel free to contact Complete on 020 7482 3875 or email injections@complete-physio.co.uk.
Are hip injections painful?
Many people expect hip injections to be very painful however, our patients are normally surprised how well they tolerate the procedure and the low levels of pain they experience. Although pain thresholds can vary considerably between individuals the majority of patients report a hip injection to be no more uncomfortable than a blood test.
At Complete our ultrasound guided injections cause minimal pain because:
- We use local anaesthetic with all our hip injections A local anaesthetic allows for immediate comfort making the procedure more comfortable and can often last for up to two hours ensuring you get home in comfort.
- Our clinicians are highly experienced and perform hundreds of ultrasound guided injections every year.
- The target tissue can be observed and the easiest, most direct route selected to allow the needle to pass safely and unencumbered to the desired site.
- Sensitive structures including blood vessels and nerves can be avoided and therefore unnecessary trauma and discomfort can be avoided.
- The thinnest and shorted needles can be used and monitored on their approach to the intended injection site.
- We ensure you are in a relaxed, comfortable position with adequate support.
How long should I expect an ultrasound guided hip injection to last?
The effects of an injection can vary between individuals. Many patients find a single injection is enough to completely resolve the pain associated with their condition allowing them to undertake a physio program to address the root of the problem.
Outcomes are dependent on your diagnosis as well as the severity and chronicity of your symptoms i.e., how long you have had the pain. If you have had your pain for many years or have a degenerative condition such as osteoarthritis then you may find that your symptoms return and a second injection is required. For more chronic or long-term conditions an ultrasound guided injection plays an important role in your ongoing management plan. An injection can be repeated at intervals and to provide pain relief to allow you to stay fit and active.
If you would like to find out if an injection can help your pain or to book an appointment with one of our clinical specialists contact 020 7482 3875 or email injections@complete-physio.co.uk.
How many injections can I have in my hip?
At Complete we find a single injection is enough to treat the majority of patients however, as previously discussed, if you do require further injection therapy (for chronic conditions for example) then guidelines set out by the Arthritis Research Council (ARC) recommend no more than three injections in one area over a one year period. If you find that three injections within a one-year period is not enough to control your symptoms and you have been diligent with your rehabilitation program then it is strongly recommended that you seek an orthopaedic review to assess whether surgery is required.
Do steroid injections just hide or mask the pain?
In short, no, injections do not just hide the pain. A corticosteroid is a strong anti-inflammatory medication designed to reduce or control inflammation. By resolving the inflammation associated with a condition such as a bursitis or osteoarthritis will allow you to safely rehabilitate your condition with significantly less pain.
How quickly does an injection work?
The steroid normally takes 1-3 days to start working. In some cases, a steroid injection can even start working the same day.
All injections at Complete are accompanied by a short acting local anaesthetic and so immediately after an injection you should experience a short period of relief. This can last up to two hours after which you may feel some discomfort. There is a small chance there will be a short period of increased pain following an injection, this can last for a few days and is very normal. If this does happen then please do not worry. A short period of rest, some over the counter medication and an ice pack is usually enough to settle things down.
A hyaluronic acid injection and a platelet rich plasma (PRP) can take longer to start working (sometimes up to 4-5 weeks) and so a degree of patience is required. Your clinician will always be on hand to answer your questions.
How much does a hip injection cost?
Prices vary depending on what medication is used however, generally speaking a single ultrasound guided steroid injection costs £250. This fee includes your assessment and diagnostic scan and a post injection letter. For a full injection price list click here.
Are there different types of injections available for hip pain?
Steroid injections (also known as cortisone injection) are most common injection we carry out for hip pain. They are quick acting and provides rapid, pain relief. However, for hip osteoarthritis we also carry out Platelet rich plasma injections and Hyaluronic acid injections.
Choosing the right injection option can only be achieved after receiving an accurate diagnosis. A majority of times this can all be carried out in one appointment session.
The three injection options available for hip pain are;
What hip conditions can be treated with an injection?
Iliopsoas tendinopathy/bursitis
The iliopsoas tendon sits over the front of your hip and helps you bring your knee towards your chest (for example lifting your hip to put your socks on). The iliopsoas tendon is supported by a small fluid filled washer, called the iliopsoas bursa. Repetitive hip flexion during activities such as running and kicking a football can either irritate the tendon causing it to swell, known as an iliopsoas tendinitis or overtime can cause wear and tear of the tendon itself, known as an iliopsoas tendinopathy. Furthermore, the bursa can become inflamed, known as an iliopsoas bursitis. A combination of an iliopsoas tendinitis/tendinopathy and a bursitis can also occur. Irritation of the tendon and bursa is not uncommon if you have prolonged pain after a total hip replacement.
Signs and symptoms of an Iliopsoas tendinopathy/bursitis include:
- A deep aching type pain located around the crease of the hip/groin area
- Occasionally you may hear or feel and clicking/clunking sensation when flexing your hip
- Increased pain with sitting or standing for long periods of time
- Pain made worse with running
- The hip may well feel weak or unstable
Generally, Iliopsoas tendinopathy/bursitis respond well to physiotherapy and rehabilitation however if symptoms prevail even with physiotherapy input, then a steroid injection can be considered.
Trochanteric bursitis/greater trochanteric pain syndrome
Trochanteric Bursitis, also known as greater trochanteric pain syndrome refers to pain emanating around the outside of your hip. Many of the gluteal muscles (your buttock muscles) attach, via their tendons, to a bony bump (called the greater trochanter) situated at the outside of your hip (the bony bump you can feel when sleeping on your side).
These tendons are supported and protected by a small friction reducing structure called the trochanteric bursa. When subjected to prolonged periods of stress the tendons can become inflamed (tendinitis), worn (tendinopathy) or the trochanteric bursa can become irritated and inflamed (bursitis). Inflammation of the bursa called trochanteric bursitis. This condition can happen to anyone irrelevant of age or sex but is most common in aged women aged 40-60 years.
Signs and symptoms of trochanteric bursitis/greater trochanteric pain syndrome include;
- Pain over the bony bump over the outer aspect of the hip
- Pain when lying on your affected side
- Pain with crossing your legs, standing or sitting for prolonged periods of time or with exercise
- Pain accompanied by a feeling of weakness or instability when standing on one leg
Many patients suffering from trochanteric bursitis (greater trochanteric pain syndrome) respond very well to physiotherapy and a strength training program however, if symptoms will not settle with conservative management alone or is waking you up at night, then an injection should be considered.
Osteoarthritis of the hip
Osteoarthritis of the hip is a very common condition characterised by pain and stiffness felt predominantly over the front of the hip (in the crease of the hip/groin area) and mainly affects patients in their 50’s onwards.
Osteoarthritis is a progressive degenerative condition starting with intermittent pain and stiffness which slowly progresses to become more consistent. Over time the cartilage within the hip joint becomes thinner and more fragile, revealing the underlaying bone surfaces which when come into contact with one another cause pain, swelling and stiffness. One of the hallmark symptoms of hip osteoarthritis is morning pain and stiffness.
Signs and symptoms of osteoarthritis of the hip include:
- Pain over the front of the hip (often in the groin) but does also cause pain in the buttock, on the outside of the hip and down the leg to the knee.
- Pain with prolonged sitting
- Pain with standing after sitting
- Progressive hip stiffness (difficulty putting socks on for instance)
- Early morning stiffness and pain which slowly reduces with gentle activity and movement
Hip osteoarthritis requires a long-term management plan involving physiotherapy and a rehabilitation program designed to keep the joint strong and flexible. Due to the intermittent periods of flare ups associated with hip osteoarthritis it is not uncommon to need periodic injections. Injections are designed to relieve your symptoms and allow you to return to your rehabilitation program.
Proximal hamstring tendinopathy
The hamstring muscles of the back of the thigh attach, via their tendons, to the sitting bones (known as the ischial tuberosity). This attachment is known as the proximal insertion of the hamstrings. The hamstring tendons, as they attach to the ischial tuberosity, are susceptible to compression and strain when subjected to prolonged periods of stress. This results in the tendon swelling and becoming painful.
Pain located at the proximal hamstring tendon insertion is called a proximal hamstring tendinopathy. A proximal hamstring tendinopathy is most commonly seen in sporty patients and in particular runners.
Signs and symptoms of a as a proximal hamstring tendinopathy include;
- Deep, achy pain over the sitting bones which can travel down the back of the thigh
- Pain with sitting, especially on hard surfaces and when driving
- Pain with walking and running – especially uphill
- Pain when trying to stretch your hamstrings
- Pain that starts slowly after starting a new exercise or increasing your running
A proximal hamstring tendinopathy can be very challenging to treat and is often stubborn to conservative management options (physiotherapy, rehabilitation exercises and shockwave).
If you have tried conservative treatments but are still struggling then an injection maybe of benefit to settle your pain.
Femoral acetabular impingement (FAI)
Femoral acetabular impingement (FAI) can develop due to either a bony variation in structure of the hip or due to a labral tear (the labrum is a layer of cartilage which encapsulates the hip joint socket). It is very common for a combination of these two factors to be present at the same time. A femoral acetabular impingement is most commonly seen in patients between 20 and 40 years old and often starts gradually without trauma.
Signs and symptoms of a femoral acetabular impingement include;
- A deep achy pain at the front of the hip (in the hip crease/grain area). This pain can radiate into the buttock.
- Pain with walking, prolonged sitting or standing and exercise
- Pain made worse with twisting movements of the hip
- A feeling of weakness in the hip
- A clicking or clunking sensation with hip movements
- Occasionally the hip may give way with sharp twisting movements
Piriformis Syndrome
The piriformis muscle sits deep to the gluteal muscles (located in the buttock) and is responsible for turning the hip outwards (lateral rotation) and is important in strength around the hip joint.
Piriformis Syndrome refers to pain in the buttock and pain that travels down the back of the leg. It can also be associated with pins and needle and occasional numbness. Piriformis syndrome is an uncommon condition and can be hard to diagnose as typically MRI and ultrasound imaging appear normal.
Discogenic back pain (pain coming from the intervertebral discs of the lower back) and ‘sciatica’ is an incredibly common cause of buttock and leg pain and pins and needles down the back of the leg. Therefore, it is essential that the lower back has been assessed and cleared for a diagnosis of piriformis syndrome can be made. In a small number of cases, the sciatic nerve runs through the piriformis muscle. This also cannot be proven on any imaging test such as an MRI or ultrasound.
Signs and symptoms of piriformis syndrome include;
- Pain in the buttock on the affected side
- Pain running down the back of the leg
- Pins and needles in the leg that continues into the foot
- No Lower back pain or symptoms and a clear set of lower back pain imaging i.e., it has been proven that your symptoms are not coming from your lower back.
Although piriformis syndrome is uncommon patients suffering from this condition respond well to physiotherapy and a rehabilitation program of stretching and strengthening exercises is enough to resolve the situation. If your symptoms continue and conservative management has not been effective then an injection should be considered.
If you would like to book an appointment to see one of our expert clinicians call 020 7482 3875 or email injections@complete-physio.co.uk.