Frozen Hip: Symptoms and Treatment

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Frozen hip, also called adhesive capsulitis (AC) of the hip, is a painful condition that causes restriction of motion in the hip joint. The connective tissues surrounding and within the hip joint become inflamed and scar tissue forms inside the capsule, causing extreme pain and stiffness in the buttocks and groin.

Little is known about why or how frozen hip occurs, although trauma to the hip and prior surgery are two scenarios that have been associated with the disease. Frozen hip occurs more commonly in women than men and generally affects those who are age 30 to 55.

woman with frozen hip

Igor Vershinsky / Getty Images

Symptoms of Frozen Hip

Frozen hip is characterized by its spontaneous onset, usually without overt injury. Typically, there are four distinct stages of frozen hip with either a complete or substantive resolution within one to three years.

Stages

Stage 1: "Prefreezing"

It may be difficult to identify your problem as frozen hip during stage 1. During stage one, you may:

  • Have had symptoms for one to three months, and they're getting worse
  • Experience pain when you move your hip
  • Experience achiness when you're not using your hip
  • Begin to limit hip motion by not walking or standing as much
  • Notice that movement loss is most noticeable in "external rotation"—as you rotate your leg away from your body

Stage 2: "Freezing"

By this stage, you've had symptoms for three to nine months. During stage two, you may:

  • Experience a progressive loss of hip movement
  • Experience an increase in pain (especially at night)
  • Still have some range of movement, but it is limited by both pain and stiffness
  • Find yourself protecting your hip by bypassing activities that may involve certain hip movements altogether

Stage 3: "Frozen"

Your symptoms have persisted for nine to 14 months. During stage three, you may:

  • Have a greatly decreased range of hip movement
  • Experience a substantial amount of pain (during the beginning of this stage)
  • Notice the pain decrease (toward the end of this stage), with the pain usually occurring only when you move your hip as far you can move it

Stage 4: "Thawing"

You've had symptoms for 12 to 15 months. During stage four, you may:

  • Notice there is a big decrease in pain, especially at night
  • Still have a limited range of movement, but your ability to complete your daily activities has increased dramatically

Causes

The cause for frozen hip is unknown. Most cases occur in women who have had no previous history of infection or injury. Frozen hip may be confused for other conditions that cause hip stiffness. In addition to taking a detailed clinical history, proper imaging and performing a thorough physical examination are key.

Other Conditions that Cause Hip Stiffness

Hip stiffness is caused by any condition that causes damage to the ball and hip socket capsule, thereby limiting one's range of motion. 

 Chronic conditions associated with hip stiffness include:

Diagnosis

The diagnosis of frozen hip is a diagnosis of exclusion, meaning all other conditions must be ruled out before calling your hip pain frozen hip. The diagnosis is made mainly on clinical grounds—noting the history of pain which is generally:

  • Constant and present at night
  • Not relieved by rest
  • Associated with restricted movement in all directions (flexion, extension, internal and external rotation)
  • Detectable on clinical examination

You may be asked to take an X-ray to help rule out any other causes of your hip pain. In frozen hip, the X-ray will be normal. Your doctor may ask you to get an MRI scan which can be helpful in some cases of frozen hip—particularly those which follow previous surgery—but these scans are often clean as well. 

Treatment

There is no ‘gold standard’ treatment for frozen hip. Using the R.I.C.E method of rest, ice, compression and elevation is usually the first line of treatment, especially when you are experiencing hip pain but are unsure why.

There are many potential treatment options for frozen hip, including:

  • Manual manipulation by a DO or physical therapist 
  • Pressure dilation
  • Use of non-steroidal anti-inflammatory medications (NSAIDs)
  • Physical therapy
  • Corticosteroid injection
  • Synovectomy
  • Arthroscopic surgery
  • Sapsulectomy

However, most cases resolve on their own or after conservative treatment. 

Is Surgery an Option?

Surgery is not often considered until after repeated failures of conservative therapy or refractory pain and stiffness. Surgery is usually not performed except for severe cases that involve hip capsule contracture.

Medication

Over-the-counter (OTC) anti-inflammatories like ibuprofen (Motrin and Advil), Naproxen (Aleve), or high-dose aspirin are commonly used to treat pain and inflammation. In some cases, your doctor may prescribe stronger pain-relieving and anti-inflammatory drugs.

Physical Therapy

A physical therapist may start an exercise program focused on increasing your range of motion to preserve as much mobility of the hip as possible. Common exercises include stretching and core strengthening.

Massage is also used as a pain-relieving technique during the acute stages of frozen hip and throughout your time in physical therapy.

If your condition progresses to the chronic stages, your intervention will focus on decreasing the progression of fibrotic changes in the hip and regaining range of motion through more aggressive physical therapy tactics like pressure dilation and gentle stretching. 

If exercises or stretches during physical therapy are too painful to complete tell your physical therapist so they can modify or create a plan that works best for you.

Prevention and Coping

There aren't any hard and fast rules that you can follow to prevent frozen hips, but healthy eating, exercise, and stretching may help. Frozen hip is more common in people with diabetes and hypothyroidism, possibly because those conditions involve abnormalities of the endocrine system, which work to regulate inflammation in the body.

Frozen hip can be an extremely painful and debilitating condition. To help alleviate pain:

  • Use OTC anti-inflammatory medication
  • Eat an anti-inflammatory diet
  • Attend physical therapy

Some people even say that a warm shower and gentle stretching in the morning has helped them to cope physically and mentally. No matter what stage of the disease you are in, know that most cases resolve within 18 months.

A Word From VeryWell

If you are diagnosed with frozen hip, know that resolution of your symptoms is possible. If you are experiencing additional symptoms—such as fever or joint pain—your hip pain your diagnosis is unlikely to be frozen hip, and you should seek immediate medical attention.

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