Understanding Ankylosing Spondylitis Hip Pain

Ankylosing spondylitis (AS) is best known for the way it affects the spine and entheses, the areas where tendons and ligaments attach to bone, but AS can also affect other body parts, including the hips.

When AS affects one or both hips, it might limit a person's mobility. Fortunately, there are plenty of treatment options for managing AS inflammation and pain and reducing the potential for disability from hip involvement.

This article covers how ankylosing spondylitis affects the hips and your options for managing hip pain and other symptoms.

How Does Ankylosing Spondylitis Affect the Hips?

AS inflammation often starts in the sacroiliac (SI) joints, the areas where the lower spine is connected to the pelvis. It can also cause enthesitis (inflammation of the entheses) in SI joints, and it might affect other joints, including the ankles, feet, knees, ribs, and shoulders.

While it primarily affects the spine, hip involvement in AS is quite common. According to a 2017 report, the prevalence of clinical hip involvement in AS ranges from 24% to 36%. The prevalence of radiographic hip arthritis (evidenced in imaging) in people with AS ranges from 9% to 22%.

The report's authors also note that synovial (joint lining) inflammation might be to blame. This type of chronic inflammation will lead to bone erosion and joint space narrowing. The damage in the hips might be similar to what is seen in a different kind of inflammatory arthritis called rheumatoid arthritis.

According to a 2021 report, AS hip involvement is associated with a high degree of disability. But joint changes in AS might take many years to show up on X-rays.

While magnetic resonance imaging (MRI) scans are much more useful for detecting changes in AS early on, they are not always utilized because of their cost. That means that by the time hip changes show up on imaging, AS has already progressed and caused damage to the hips.

If you already have AS, your healthcare provider may recommend changes to help you better manage AS pain and slow down further damage. If you start to notice pain and stiffness in one or both of your hips, let your healthcare provider know right away.

How to Relieve Ankylosing Spondylitis Hip Pain

The main goals in managing AS hip pain and other symptoms are to relieve your pain, maintain mobility, improve your quality of life, and reduce the potential for further damage or disability.

Medications like disease-modifying antirheumatic drugs (DMARDs) and tumor necrosis factor (TNF) inhibitors are important for reducing pain and inflammation throughout the body. Additional treatments performed at home or with the help of a healthcare provider can help manage your symptoms. 

Heat or Cold Therapy

Both hot and cold therapy can be helpful for soothing sore hips. You can use whatever method gives you relief, or you can alternate back and forth between hot and cold.

Heat can be applied two to three times a day for 20 minutes at a time. You can use a heating pad or a hot pack or take a warm shower or bath.

For cold therapy, use ice or an ice pack on sore hips for about 20 minutes at a time to numb a painful area. You should place a thin cloth between the ice and your skin.

Foam Rolling

A foam roller is a cylindrical piece of foam that you can use for self-massage to target sore areas of your body, including your hips. Research on the use of foam rollers shows them to be an effective method for improving hip pain.

You can ask a physical therapist or personal trainer to show you to effectively and safely use a foam roller. They can recommend different types of foam rollers and the types of exercises that might help relieve your hip pain.

Stretching

Stretching can help to relieve both hip pain and stiffness, especially in the morning. Stretching can help you to get moving and start your day off in a positive way. A physical therapist can recommend some safe stretches for you to do with AS.

Exercise 

Exercise is good for everyone and it can keep you strong and flexible. It can also help you to maintain a healthy weight that keeps pressure off already inflamed joints, including the hips.

According to the Spondylitis Association of America (SAA), exercise is a vital part of your AS treatment plan. It can counteract some of the effects of AS and keep you mobile and flexible. It is also effective for managing AS pain and stiffness.

You should check with your healthcare provider to determine what exercises are safe to do with AS hip symptoms. In general, walking, swimming, cycling, yoga, and Pilates are safe for people with AS. Try to avoid high-impact activities, especially if they cause you pain.

Losing Weight If You’re Overweight 

Losing excess weight can help lessen the load on your hips and even reduce joint pain.

A 2018 study found the more weight a person loses, the less joint pain they experience. That study looked at older adults with osteoarthritis who were overweight. They concluded that a 10% to 20% weight loss improved pain, function, and overall quality of life better than a 5% weight loss.

Losing weight can also help to lessen inflammation. According to a 2018 report, obesity can trigger and sustain low-grade inflammation. The more inflammation you experience, the more pain you will have, and uncontrolled inflammation eventually leads to joint damage and disability.

Physical Therapy

Physical therapy can help people with AS maintain their physical function and learn to manage pain and other symptoms. A physical therapist can teach you exercises that increase joint strength and muscle flexibility. They can help you to improve your posture and movement habits.

A physical therapist can be a valuable resource for patient education on AS as well. Your rheumatologist or other treating healthcare provider can help you locate a physical therapist that understands AS.

Total Hip Replacement Surgery

Ongoing inflammation in AS will lead to the destruction of the hip joint, functional impairment, and disability. Around 5% of people with AS will need hip surgery. Hip replacement surgery is usually performed to reduce pain and restore function.

According to the American Academy of Orthopedic Surgeons, hip replacement surgeries are considered one of the most successful procedures in medicine. With this procedure, damaged bone and cartilage are removed and replaced with prosthetic parts.

A total hip arthroplasty (total hip replacement) is commonly done in instances where AS has severely limited hip function or has caused severe pain and mobility issues. It might also be done in cases in which there is joint ankylosis (fusion) to restore joint function even in the absence of pain.

According to a 2015 report in The Open Orthopaedics Journal, a total hip replacement can provide significant relief and generally improved range of motion in people with AS.

For some people with AS hip involvement, a total hip arthroplasty of one hip may not be enough to reduce pain and restore mobility. For people with bilateral (both sides) AS hip disease, bilateral total hip arthroplasty is generally recommended (both hips are replaced at the same time).

A 2019 systemic review (a summary of multiple sources of medical literature on a topic) in the journal EFORT Open Reviews looked at the outcome of bilateral hip arthroplasties done on people with AS. In all the reviewed studies, there was a significant improvement in hip function, mobility, and patient satisfaction from the bilateral procedure.

If you have AS in your hips and think you would benefit from a total hip replacement, you should reach out to your healthcare provider for more information. A primary care provider can refer you to an orthopedic doctor or surgeon who can best explain your options.

Summary

Ankylosing spondylitis is an inflammatory condition that primarily affects the spine and the areas where tendons and ligaments meet bone. AS can also affect other joints of the body, including the hips.

Hip pain in AS can be managed and treated with a combination of different therapies, including home remedies, exercise, weight loss, and surgery. If you have AS and experience hip pain and stiffness, you should let your doctor know.

A Word From Verywell

There is currently no cure for ankylosing spondylitis, but there are treatments available that can help to slow down disease progression and offer symptom and pain relief. By working with your healthcare provider to effectively manage AS, you can maintain your mobility and have a good quality of life.

If you experience pain or stiffness in one or both of your hips, reach out to your healthcare provider. They can request imaging and other tests to determine the source of your symptoms. Getting a timely diagnosis is the best way to prevent hip damage and disability and improve your outlook.