Hip pain linked to ankylosing spondylitis: 7 remedies to try

Ankylosing spondylitis (SA) is an inflammatory condition of the spine and entheses, the areas where tendons and ligaments attach to bone. AS can also affect other parts of the body, including the hips.

When AS affects one or both hips, it can limit a person’s mobility. Fortunately, there are many treatment options to manage the inflammation and pain of AS and reduce the risk of disability from hip damage.

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

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How does ankylosing spondylitis affect the hips?

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

Although 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 arthritis of the hip (demonstrated by imaging) in people with AS ranges from 9% to 22%.

The report authors also note that synovial (joint lining) inflammation might be to blame. This type of chronic inflammation will lead to bone erosion and narrowing of the joint space. Hip damage can be similar to that seen in another type 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 can take several years to show up on x-rays.

Although magnetic resonance imaging (MRI) scans are much more useful for detecting changes in AS early, they are not always used due to their cost. This means that by the time the hip changes show up on the imaging, the 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 further damage. If you start to feel pain and stiffness in one or both of your hips, tell your health care provider right away.

How to relieve hip pain from ankylosing spondylitis

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

You have various options for this, including home remedies for pain relief, exercise, weight loss, physical therapy, and surgery as a last resort.

Heat or cold therapy

Hot and cold therapy can be helpful in soothing sore hips. You can use any method that gives you relief, or you can alternate 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 hot compress or take a hot 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 sore area. You should place a thin cloth between the ice and your skin.

Use a foam roller

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

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

Stretch

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

Exercise

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

According to the Spondylitis Association of America (SAA), exercise is an essential 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 in managing AS pain and stiffness.

You should consult your health care provider to determine which exercises can be done safely 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.

Lose weight if you are overweight

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

A 2018 study found that the more weight a person loses, the less joint pain they experience. This study focused on overweight elderly people with osteoarthritis. They concluded that a 10-20% weight loss improved pain, function and overall quality of life better than a 5% weight loss.

Losing weight can also help reduce 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.

Consult a physiotherapist

Physical therapists can help people with AS maintain 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 improve your posture and movement habits.

A physical therapist can also be a valuable resource for educating patients about AS. Your rheumatologist or other treating health care provider can help you find a physical therapist who understands AS.

Total hip surgery

Continued inflammation in AS will lead to hip joint destruction, functional impairment, and disability. About 5% of people with AS will need hip surgery. Hip replacement surgery is usually done 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 pieces.

A total hip arthroplasty (total hip replacement) is commonly performed in cases where AS has severely limited hip function or has caused severe pain and mobility issues. It can also be done in cases where there is joint ankylosis (fusion) to restore joint function even when there is no pain.

According to a 2015 report in The Open Journal of Orthopedicsa 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 replacement may not be enough to reduce pain and restore mobility. For people with bilateral (both sides) AS hip disease, bilateral total hip replacement surgery is usually 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 review Reviews on EFORT Open reviewed the outcomes of bilateral hip replacements performed on people with AS. In all of the studies reviewed, there was a significant improvement in hip function, mobility and patient satisfaction with the bilateral procedure.

If you have AS in your hips and think you might benefit from total hip replacement surgery, you should contact your health care provider for more information. A primary care provider can refer you to an orthopedist or surgeon who can better explain your options.

Summary

Ankylosing spondylitis is an inflammatory condition that primarily affects the spine and areas where tendons and ligaments meet bone. AS can also affect other joints in 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 that can help slow the progression of the disease and relieve symptoms and pain. 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, contact your healthcare professional. They may order 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.

Frequently Asked Questions

  • What does ankylosing spondylitis pain feel like?

    People with ankylosing spondylitis often report pain that comes and goes. This pain may worsen with inactivity or by sitting for long periods of time. The pain may be dull and feel like it is coming from deep in the back or buttocks. Joint stiffness may also accompany the pain.

  • How is ankylosing spondylitis diagnosed?

    A diagnosis of ankylosing spondylitis begins with a physical exam where your healthcare professional tests the range of motion in your spine. They can also press areas of the pelvis to determine which parts of the pelvis might be inflamed. Your healthcare provider may order imaging and lab tests to help with the diagnosis.

  • Can you cure ankylosing spondylitis?

    There is no cure for ankylosing spondylitis. but treatment can help relieve symptoms and slow the inflammation that leads to damage to the spine, hip, or other joints. Your healthcare provider’s goal will be to get you into remission and keep you there for as long as possible. Remission is a period of time during which the symptoms of AS go away.

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