Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.

Oluseun Olufade, MD, is a board-certified orthopedist. He teaches as an Assistant Professor of Orthopedics at Emory School of Medicine in Atlanta, Georgia.

Ankylosing spondylitis is an inflammatory, autoimmune disorder that causes joint inflammation, pain, and stiffness. It usually affects the spine but can also affect the hips and joints in the area where the spine connects to the pelvis. This causes deep pain that worsens with inactivity, such as prolonged sitting or bed rest. 

This article will discuss how ankylosing spondylitis causes hip pain and ways to treat your symptoms. 

Ankylosing spondylitis predominantly causes joint pain, inflammation, and stiffness in the spine, but these symptoms can also occur in the hips. About one-third of patients with ankylosing spondylitis experience hip pain, joint damage, and difficulty walking.

Ankylosing spondylitis causes inflammation when the body produces antibodies that attack the hip joints. This inflammation irritates surrounding nerves in the hips, leading to cartilage breakdown and bone spurs, causing further pain.

Hip pain in patients with ankylosing spondylitis is more likely to develop in younger patients between the ages of 15 and 25 than in older adults and tends to be associated with increased disease severity.

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. 

Before trying any at-home treatment, consult with your healthcare provider to make sure that it is safe for you to try.

Heat and cold therapy are beneficial for relieving pain, but each is appropriate for different conditions.  

Cold therapy helps decrease inflammation, swelling, and pain and can reduce hip pain with ankylosing spondylitis. Depending on where you feel pain, you can apply a bag of ice or a cold pack to your groin or back of your pelvis.

Heat therapy can help loosen and relax tight muscles and stiff joints. Heat can be applied to your hips with either a heating pad or a hot bath. Limit the time you use heat or cold therapy to 10–20 minutes.

Gentle stretching of stiff, painful hips can help improve your flexibility, decrease joint stiffness, and improve your ability to move and function throughout the day.

To improve hip mobility, stretch the hip flexors, hamstrings, and piriformis (muscle in the buttocks at the top of the hip joint).

Aerobic exercise, including low-impact activities like walking and bicycling, decreases pain and stiffness. To reduce irritation within your hips, try resistance exercises and strength training. These exercises also help strengthen surrounding muscles, especially your glutes, to support and stabilize your hip joints.

Increased body weight places more pressure on your joints, especially weight-bearing joints like your hips and knees. Losing extra body weight can help decrease hip pain from ankylosing spondylitis by reducing the pressure through the hip joints and slowing down inflammation.

Physical therapy can help relieve hip pain from ankylosing spondylitis by improving hip joint mobility, range of motion, balance, and strength. This will help with everyday tasks like sitting, standing, and walking.

A physical therapist will evaluate your legs and examine your gait pattern (how you walk) to check for muscle imbalances. They will also give you exercises and treatments to help address limited mobility.

When chronic inflammation causes significant damage to the hips, a total hip replacement (also called total hip arthroplasty) surgery may be needed to decrease pain and improve functioning. A total hip replacement is also often required if chronic hip pain is left untreated and worsens over time.

These metal pieces used in a hip replacement help the joint move more smoothly, decreasing pain and avoiding direct bone-on-bone contact that results from joint damage.

Approximately 50% to 90% of patients who experience hip pain from ankylosing spondylitis complain of symptoms on both sides of the body, so in these cases, hip replacements for both sides of the body may be considered.

Ankylosing spondylitis is an inflammatory, autoimmune disorder that causes joint inflammation, pain, and stiffness that can affect the hips. In addition to medications to decrease widespread inflammation throughout the body, heat and cold therapy, hip muscle stretching, strengthening exercises, and physical therapy can help alleviate hip pain and stiffness from ankylosing spondylitis.

Managing your hip pain from ankylosing spondylitis is important for maintaining your overall health and quality of life. You can help manage your condition through medication, regular exercise, and physical therapy.

Pain from ankylosing spondylitis typically feels like a deep ache and stiffness within joints that worsens with lack of movement.

Ankylosing spondylitis is diagnosed through a physical examination, medical history, blood tests, and imaging like X-rays and magnetic resonance imaging (MRI) scans.

There is no cure for ankylosing spondylitis, but medications like DMARDs can help suppress the autoimmune inflammatory reaction to help manage symptoms.

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By Kristen Gasnick, PT, DPT Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.

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