When you have more hip pain than your MRI is saying you should have

Ross Hauser MD

Ross Hauser, MD

In our practice we see many skeptical patients. Some of them come into our office angry because they have a lot of pain and there are seemingly no answers. This is the case of people we see who have more hip pain than his/her MRI is showing and more pain than his/her doctors will believe.

Before you read on, if you have questions about your hip pain, you can get help and information from our Caring Medical Staff.

Where is all this hip pain coming from that your doctors are not seeing in the MRI?

Obviously if there is degenerative elements in the hip, loss of cartilage, bone on bone destruction, hip instability causing soft tissue structural damage, there will be pain. But in a degenerative hip disease environment, this pain can be greatly magnified beyond anything an MRI is showing Why? Because nature designed us to walk. When degenerative hip disease is threatening our ability to walk, our pain mechanisms are sending out a warning signal that something needs to be done, the hip needs treatment.

The science of magnified hip pain – the hip labrum sends an SOS

Medical University researchers in Greece sought to explain this phenomena of our bodies creating more pain sensation than what MRI revealed structural damage would indicate. In this research the doctors focused on the acetabular labrum of the hip. They speculated that in Grade III and Grade IV hip osteoarthritis, the labrum sends more pain signals to the brain and possibly the hip labrum itself is orchestrating an accelerated degenerative process.(1)

First, what is the hip labrum and what does it do?

In our article Doctors question Hip Labrum SurgeryDanielle R. Steilen-Matias, MMS, PA-C writes that:

The hip labrum is an important ring of cartilage that holds the femoral head, or top of the thigh bone, securely within the hip anatomy. It also serves as a cushion and shock absorber to protect the hip and thigh bones. Damage or  degeneration to the labrum causes pain and joint instability and bone overgrowth in attempt to stabilize the area.

The hip labrum makes some patients have more arthritis pain than they should

Writing in the Journal of orthopaedic surgery, the Greek doctors looked at the normal acetabular labrum of the hip and the relationship between free nerve endings (pain detectors) and mechanoreceptors (sensors that detect pressure and other things that may cause pain). Then they looked at the free nerve endings and mechanoreceptors in the hip labrum of patients with hip osteoarthritis.

The purpose was to see why some patients had more pain than they should.

A remarkable finding: More pain messages are being sent – the hip is crying out for treatment

A finding that the researchers found so remarkable was that the hip’s pain signalling mechanism changed during the progression of hip disease. The free nerve endings localized themselves to the central part of the hip labrum and the mechanoreceptors localized themselves to the out edges of the hip labrum.

The mechanoreceptors then began a “conversion” to turning themselves into free nerve endings so more pain messages can be stimulated to the brain.

The conversion of the hip’s energy to sending pain messages, reduces the hip’s ability to heal

Perhaps the best way to explain this is that the hip is a sinking ship and the hip pain messaging center is converting the remaining ship’s energy into sending more and repeated frantic SOS calls to the brain. It could be possibly thought that the conversion of the hip’s energy to sending pain messages, reduces the hip’s ability to heal.

This is truly a fascinating subject, and while the Greek team suggests more research into their hypothesis, one can clearly see that what we are discussing is a whole hip joint failure and that the hip is crying out for treatment.

Our website is filled with other articles on hip pain: These are the observations of 25 years of practice.

Prolotherapy for Hip Pain
Comprehensive Prolotherapy offers non-surgical hope to hip pain patients, as well as to those seeking an alternative to hip surgery or hip replacement. We have successfully treated patients who were told surgery was their only option.

When your hip is dying, there are alternatives to Hip Replacement
This is a discussion of whole hip disease and the suggestion of hip replacement surgery

Options and alternatives to hip preserving arthroscopic surgery
In this article we discuss Hip joint-preserving surgery includes a number of procedures including arthroscopy to avoid hip replacement.

Hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis
In this article Danielle Steilen-Matias, MMS, PA-C discusses Hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis.

Exercise and physical therapy fail to restore muscle strength in hip osteoarthritis patients
In this article we will discuss why exercise and physical therapy fail to restore muscle strength in hip osteoarthritis patients.

Mini-seminar with Ross Hauser, MD on Youtube

If you have questions about your hip pain, you can get help and information from our Caring Medical Staff

1 Kapetanakis S, Dermon A, Gkantsinikoudis N, Kommata V, Soukakos P, Dermon CR. Acetabular labrum of hip joint in osteoarthritis: A qualitative original study and short review of the literature. Journal of Orthopaedic Surgery. 2017 Oct 10;25(3):2309499017734444.

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