Persistent Hip Pain: When to See a Specialist

Hip pain

Hello, Doctor! I would like to ask you about the pain I have been experiencing on both sides of my buttocks for almost six months now.
I haven't had any injuries; it just started hurting suddenly.
At first, the pain felt like soreness and numbness, but recently it has felt more like inflammatory pain.
I went to an orthopedic doctor and had an X-ray taken, and the doctor said there were no abnormalities in the bones.
They prescribed anti-inflammatory medication and muscle relaxants, but I feel that they haven't been effective, and the pain still comes and goes.
The key point is that when it hurts, it almost always affects only one side, and it's rare for both sides to hurt at the same time.
When the pain occurs, I cannot bend down to pick things up, as it increases the pain.

1.
Should I see a rehabilitation specialist or continue with orthopedics?
2.
Do I need to undergo any additional tests?
3.
The pain does not affect my daily activities except for bending down to pick things up, which increases the pain.
4.
Can buttock pain radiate to the genital area? I have a specific point on the left side of my glans that occasionally has sharp pain (though it has improved now).
I would like to know if this could be related to the buttock pain.
P.S.
I cannot pinpoint the exact area of the buttock pain.
I feel it is neither bone pain nor muscle pain, but it still hurts.
Please give me your advice, Doctor.
Thank you!

Fanrao Ren, 30~39 year old female. Ask Date: 2016/04/16

Dr. Jian Jincheng reply Rehabilitation

Hip pain has persisted for nearly six months.
It is recommended to start with some anti-inflammatory medication and apply ice packs.
For the sharp pain in the glans, you may consult a urologist to check for other underlying causes.
If there is no improvement, MRI and other examinations may be warranted.

Reply Date: 2016/04/16

More Info

Persistent hip pain can be a complex issue, especially when it arises without a clear injury or cause. Given your symptoms and the fact that you've already consulted with an orthopedic specialist, there are several considerations to keep in mind regarding your condition and the next steps you might take.

1. Understanding Your Symptoms
Your description of the pain evolving from a dull ache to a more inflammatory-like pain suggests that there may be underlying issues that are not immediately visible on X-rays. Conditions such as bursitis, tendinitis, or even issues related to the hip joint itself (like labral tears or impingement) may not always show up on standard imaging. The unilateral nature of your pain, where it predominantly affects one side, can also indicate localized issues rather than systemic problems.

2. When to See a Specialist
Since you have already seen an orthopedic doctor without satisfactory results, it may be beneficial to consult a physical medicine and rehabilitation specialist (physiatrist) or a sports medicine physician. These specialists can provide a more comprehensive evaluation of your functional movement patterns and may suggest additional diagnostic tests, such as an MRI or ultrasound, to assess soft tissue structures around the hip.

3. Additional Diagnostic Tests
Given that your pain is persistent and has not responded well to anti-inflammatory medications, further imaging might be warranted. An MRI can provide detailed images of soft tissues, including muscles, tendons, and ligaments, which may help identify issues like tears or inflammation that X-rays cannot show. Additionally, a thorough physical examination focusing on hip range of motion, strength, and functional movement can provide insights into potential causes of your pain.

4. Pain Management and Rehabilitation
In the meantime, consider engaging in physical therapy. A physical therapist can develop a tailored exercise program to strengthen the muscles around the hip, improve flexibility, and address any movement dysfunctions that may be contributing to your pain. Modalities such as ultrasound therapy, electrical stimulation, or manual therapy techniques may also be beneficial.

5. Connection Between Hip Pain and Reproductive Pain
Regarding your question about whether hip pain can refer to genital pain, it is indeed possible. The nerves that supply the hip region can also affect the pelvic area, leading to referred pain. This phenomenon is known as "referred pain," where discomfort in one area of the body is perceived in another. If you are experiencing pain in the left side of your genital area, it could potentially be related to the hip pain, especially if the nerves in that region are involved.

Conclusion
In summary, your persistent hip pain warrants further investigation, especially since it has not improved with initial treatments. Consulting a specialist in physical medicine or rehabilitation may provide you with a more comprehensive approach to diagnosis and treatment. Additionally, engaging in physical therapy could help alleviate your symptoms and improve your functional capacity. If the pain in your genital area persists or worsens, it would be prudent to discuss this with your healthcare provider as well, as it may require a separate evaluation. Remember, effective communication with your healthcare team is key to finding the right diagnosis and treatment plan.

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