Your hip hurts worse than your MRI is saying it should and your doctor doesn’t believe you

Ross Hauser MD

Ross Hauser, MD

This is a fascinating article that will show you that you have to believe your hip when it is talking to you and not an MRI.

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 for the people we see who have more hip pain than his/her MRI is showing and more pain than his/her doctors will believe they are having.

Where is all this hip pain coming from that your doctors are not seeing on 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, where the hip is eroding and degenerating every second of every day, 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 hip needs treatment – the hip labrum sends an SOS for help – doctors do not understand the message – they don’t believe your pain.

Nature designed our body to talk and communicate when there is a problem. Sometimes doctors do not understand the message. Medical University researchers in Greece sought to explain these 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 by converting the hips energy into sending these messages to the brain.(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:

Hip Labrum Your hip hurts worse than your MRI is saying it shouldThe 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 an 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 because the hip is crying out for treatment

The hip does cry. The hip does panic. The hip cries and panics when it knows that it is being threatened with hip replacement. This is not some colorful explanation. It does happen. Here is how:

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

  • In other words, the hip was rebuilding its pain reporting system to match the urgency of the situation. The hip is panicking because it sees its survival is threatened. To get more messages out, the mechanoreceptors covert themselves into free nerve endings so more pain messages can be sent to the brain. But there is a price to pay for this new communication system. The conversion of the hip’s energy to sending pain messages reduces the hip’s ability to heal.

Your hip hurts worse than your MRI is saying it should

The SOS of a sinking hip

Let’s pretend that you are on that ship to the left. Let’s pretend that ship is your hip.

The ship has struck an iceberg. It is now damaged beyond its crew’s ability to repair it. The ship/hip needs help or it will sink.

Your hip is now sending SOS messages to the brain in an attempt to get the brain to send help to prevent the ship from sinking. What type of help? Inflammation to create swelling to keep the hip stable (or afloat). Immune cell crews that get rid of the damaged tissue to make way for repair and immune cell crews that bring new material to the site of damage and start repairing damaged tissue.

Your hip is in a state of panic. This is why you have more pain than your MRI is showing.

Your hip is panicking because it wants to survive, it does not want to be replaced. It is gambling its resources away from trying to fix more damage than it can to its ability to send more SOS messages of pain. The gamble is, to send more SOS messages that pain is getting worse and extreme pain is coming., the hip has to take resources away from healing itself. So the hip is doing the minimal repair because it knows if not enough help arrives – the minimal repair will not keep the hip afloat, the hip will sink and die.

  • This is why you have more pain than your MRI is showing. Your hip knows it is sinking, an MRI picture of the hip may not show this. This is a situation where a lot of pictures only confuses the situation and prevents you and your doctor from understanding what is happening in your hip.

The hip in accelerated panic. It is trying to survive “rapidly destructive osteoarthritis” and trying not to be  replaced

Clearly, your hip does not want to be replaced. Your hip is panicking because it wants to survive. Here is a study from 2014 that will tie this all together and show you that the hip labrum is your hip’s early warning signal that rapidly destructive osteoarthritis is coming and doctors should believe the hip labrum before they believe an MRI.

In the Journal of Arthroplasty, a medical journal dedicated to joint replacement, a team of doctors at Kanazawa Medical University in Japan wanted to know what turned the slow, degenerative, eroding processes of the hip into rapidly destructive osteoarthritis. Where was the switch that created accelerated destruction? The switch was in the hip labrum. Just like the Greek researchers above, the Japanese team was able to understand that the hip labrum was at the center of rapid hip destruction.

This is what this study revealed:

  • The pathophysiology (the conditions that cause) rapidly destructive osteoarthritis of the hip is unknown but it may be coming from the hip labrum
  • This study documented cases of inversion (collapsing on itself, turning inward) of the hip acetabular labrum. This is a typical condition if the labrum in initial-stage rapidly destructive hip osteoarthritis.
  • Subchondral (cartilage and bone) insufficiency fractures of the femoral heads were seen just under the inverted labrum in 8 of the 9 patients of the study.
  • Therefore, inversion of the acetabular labrum may be involved in rapid joint-space narrowing and subchondral insufficiency fracture in rapidly destructive hip osteoarthritis.(2)

What does this mean? The labrum is recognizing before anything else, rapidly destructive hip osteoarthritis is coming. It sees it before the MRI, it sees it before many of your doctors. The Labrum sees it coming and is trying to tell you it is coming by making your hip more painful.

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

Prolotherapy Specialists Your hip hurts worse than your MRI is saying it should and your doctor doesn't believe you

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. [Google Scholar]

2 Fukui K, Kaneuji A, Fukushima M, Matsumoto T. Inversion of the acetabular labrum triggers rapidly destructive osteoarthritis of the hip: representative case report and proposed etiology. The Journal of arthroplasty. 2014 Dec 1;29(12):2468-72. [Google Scholar]

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