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.
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 this stage, you may:
Have had symptoms for one to three months, and they’re getting worseExperience pain when you move your hipExperience achiness when you’re not using your hipBegin to limit hip motion by not walking or standing as muchNotice 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 2, you may:
Experience a progressive loss of hip movementExperience an increase in pain (especially at night)Still have some range of movement, but it is limited by both pain and stiffnessFind 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 3, you may:
Have a greatly decreased range of hip movementExperience 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 4, you may:
Notice there is a big decrease in pain, especially at nightStill have a limited range of movement, but your ability to complete your daily activities has increased dramatically
Causes
The cause of 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:
Ankylosing spondylitis Juvenile idiopathic arthritis Osteoarthritis Labral tear of the hip Tight hip flexor muscles Rheumatoid arthritis Hip bursitis Legg-Calvé-Perthes disease Lyme disease Tendinitis Avascular necrosis of the hip
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 nightNot relieved by restAssociated 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 healthcare provider may ask you to get an MRI scan, which can be helpful in some cases of frozen hip—particularly those that 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 doctor of osteopathic medicine or physical therapistPressure dilationUse of nonsteroidal anti-inflammatory medications (NSAIDs)Physical therapyCorticosteroid injectionSynovectomyArthroscopic surgeryCapsulectomy
However, most cases resolve on their own or after conservative treatment.
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 healthcare provider 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.
Prevention and Coping
There aren’t any hard and fast rules 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 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 diagnosis is unlikely to be frozen hip, and you should seek immediate medical attention.
