Hip Pain

Hip pain

Hip pain in sportsmen and women often occurs in conjunction with or is related to chronic groin pain. Here we explain the common causes of hip pain in sport.

Hip pain in children is often diagnosed as Perthe’s disease and it is very important that hip pain in children should be examined by a Doctor.

Pain at the front of the hip

Labral tear

Labral Tear - Hip

A labral tear of the hip is a tear to the cartilage lining of the joint, called the acetabulum. Symptoms of a labral tear include:

  • Pain in the hip and/or groin.
  • A clicking or locking of your joint may occur.
  • You may have stiffness and/or restricted mobility in your hip joint.
  • Symptoms may come on suddenly following an impact or trauma. But can also develop gradually if your joint progressively degenerates.

Read more on labral tears.


Synovitis of the hip

Synovitis often occurs in sports people alongside another hip joint injury. Symptoms include:

  • Difficulty walking.
  • Pain in your hip joint at night, which sometimes radiates further down your leg.
  • This condition can also affect young children and be linked to the presence of a virus.
  • Diagnosing and treating the original cause or co-existing condition is the key to recovering from hip synovitis.

Read more on Hip synovitis.


Osteoarthritis of the hip

Osteoarthritis is ‘wear and tear’ (degeneration) of the hip joint. The hard cartilage on the ends of bone wears away and eventually, the bone starts to wear away also. Symptoms include:

  • Hip pain
  • Reduced joint mobility
  • Joint inflammation. Your hip joint will feel hot and inflamed.

It is common in older people over the age of 50, especially women. Although there is no cure, osteoarthritis can be managed with various treatment options.

Read more on Osteoarthritis.


Ligament teres tear

Ligamentum teres

The ligamentum teres is a ligament that joins the acetabulum (pelvis) to the head of the femur (thigh bone). Symptoms are similar to a number of other hip injuries:

  • Deep aching pain in the hip joint
  • Reduced range of motion
  • Hip pain at night
  • Pain may radiate into the groin.

There are no specific tests or imaging methods to help diagnose a Ligamentum teres tear. They are usually picked up during arthroscopic surgery. A complete rupture of the ligament can be serious as this stops the blood supply to the head of the femur causing necrosis.


Rectus femoris tendon injury

The rectus femoris is one of the powerful quadriceps muscles at the front of the thigh. A strain or tear in the tendon can occur at its origin at the front of the hip. Symptoms include:

  • A sudden sharp pain at the front of the hip or groin.
  • Pain usually occurs whilst doing explosive type activity such as sprinting or jumping.
  • Swelling and bruising may occur with pain when lifting the knee up against resistance.
  • Tenderness will be felt when pressing in where the muscle attaches at the front of the hip.

Read more on Rectus femoris tendon injury.


Hip pointer/contusion

A hip pointer occurs following a direct impact or trauma to the front of your hip. It is common in contact sports like Rugby or American football. There will often be bruising and pain at the point of impact which can be eased by ice and compression.

  • Symptoms of a hip pointer include pain and tenderness over the front of your hip.
  • Pressing in on the point of injury will be painful.
  • There is usually some obvious bruising or swelling.
  • A full assessment should be undertaken to rule out the possibility of damage to intra-abdominal organs.

Read more on Hip pointers.


Pelvic stress fracture

A pelvic stress fracture is a hairline type fracture in the large pelvis bone. This is due to repetitive impacts or forces, rather than one sudden impact or accident. They are more common in women and normally occur in the pubic rami, where the hamstring and groin muscles attach. Read more on the causes, symptoms, and treatment of this injury.

Pelvic stress fracture symptoms include tenderness over the inferior pubic ramus at the bottom of the pelvis. Pain is felt in the groin or hip which increases with exercise but eases or gets better with rest. The athlete will experience reduced strength and movement in the pelvic area.

Causes: Pelvic stress fractures occur most often in female runners and military recruits. They are more common in females due to reducing bone density after the age of 30.

Stress fractures of the pelvis occur most frequently in the pubic rami. This is the lowest part of the pelvic girdle, where the hamstring and groin muscles attach. Fractures may also occur at the pubic symphysis – the front joint between the two pelvic bones. These fractures may be due to repetitive muscular forces, or through impact and stress transferred up from the foot.

What can the patient do? Rest from activities which cause pain. Try to stay off the feet as much as possible for the first 2 weeks. Apply cold therapy or ice to the painful area to ease the pain, swelling and inflammation Seek medical attention.

What can a sports injury specialist do? Refer for investigations such as X-rays, bone scans or MRI’s to confirm the diagnosis. Prescribe anti-inflammatory medication to help ease pain and inflammation. Assess the patient for potential causes of the stress fracture. These may be biomechanical, such as oversupination, or may be factors such as low bone density or amenorrhea. Advise on a gradual return to sports programme after 4-6 weeks, when the bone has fully healed.

Traction apophysitis/ilium apophysitis

Ilium apophysitis is an overuse injury which occurs in children and adolescents at the front of the pelvis. An apophysis is an area of growth of a bone which also acts as a point for muscles to attach to. This injury can particularly affect those who participate in sport and those with tight hip muscles. The hip pain usually intensifies with activity.

Symptoms: Apophysitis of the Ilium typically results in dull pain at the front of the hip. There will be tenderness at a specific point on the front of the hip. Pain usually gets worse with activity and there may be some mild swelling.

Causes: A growth plate is an area of bone from which growth occurs. This is the last area of bone to fully harden from cartilage and so is still relatively soft in children and adolescents.

Those involved in sporting activities in particular or those with very tight hip muscles may suffer from this injury. The repetitive pulling of the muscles on the growth plate can result in irritation and inflammation of the area. This most frequently occurs at either the AIIS (anterior inferior iliac spine) or the ASIS (anterior superior iliac spine) at the front of the pelvis.

Treatment for Ilium apophysitis: Rest from aggravating activities until pain and tenderness ease. Apply ice or cold therapy products to ease pain and inflammation. A doctor may recommend anti-inflammatory medication. Once-daily activities are pain-free, stretches for the hip muscles can be performed. Sports massage therapy may be able to help relax really tight muscles such as the hip flexors.

Once pain has gone, a gradual return to sport can be initiated. Ensure a full warm-up is performed and stop if any pain is felt. The condition will ease on its own once growth is finished and the bone is fully matured.

Slipped capital femoral epiphysis

This injury occurs when there is a fracture at the neck or top of the thigh bone. The injury happens to the epiphysis which is where the bone grows as children grow older. It is more common in boys aged 11 to 16 years old and occurs gradually over a period of time. Hip pain and groin pain are major symptoms which can cause the injured person to walk with a limp.

Symptoms of a slipped capital femoral epiphysis include pain in the hip and groin which can radiate into the knee. The patient may walk with a limp. When examined they may find one leg is shorter than the other and rotated outwards slightly. Moving the leg out to the side known as abduction and rotating the hip outwards is often limited compared to the uninjured side.

The epiphysis is the area of the bone that does the growing in children and adolescents. This area is sometimes called the growth plates. It is often brought on by sports activity.

This is an uncommon condition which typically affects boys aged eleven to sixteen years old. It is more common in those who are considered overweight and may sometimes be present in both hips.

A slipped capital femoral epiphysis can cause problems with a decrease in blood flow to the head of the Femur, resulting in avascular necrosis (bone death) and so should be addressed as soon as possible.

Treatment of a slipped capital femoral epiphysis:

  • Due to the potential for death of the femoral head, medical attention should be sought as early as possible.
  • If this injury is suspected X-rays should be taken to confirm the diagnosis.
  • If positive, orthopedic assessment is required and surgery may be performed.
  • Surgery involves fixing the head of the femur with pins or a screw.
  • After a period of immobilization, a full rehabilitation programme is required to return to full weight-bearing and then to regain full strength and movement in the hip.

Pain on the outside of the hip

Trochanteric bursitis/Hip bursitis

Hip bursitis, also known as Trochanteric bursitis is inflammation of a bursa or small sack of fluid between the tendon and bone. A bursa prevents friction and helps movement in the joint so when it becomes inflamed, it causes hip pain. Most cases of hip bursitis are caused by overuse and poor biomechanics, although a direct impact like a fall could also cause it. Read more on the causes, symptoms, and treatment of this condition.

Read more on hip bursitis.

Important do not miss:

  • Avascular necrosis of the head of the femur
  • Slipped capital epiphysis
  • Perthes’ disease
  • Tumor
  • Fracture of the neck of femur
  • Nerve root compression

Perthes’ disease

Perthes’ disease affects children, most commonly boys aged between four and ten years old, but can also occasionally occur in younger children and teenagers. Tiredness and groin pain are two common symptoms, and they may have a noticeable limp. Medical help is needed to diagnose this condition as early as possible to try to prevent and limit any future problems.

Read more on Perthes’ disease.

When should I see a doctor?

  • Severe pain in or around the hip or groin area, especially during walking.
  • A “giving way” feeling in the hip during walking or going up/downstairs.
  • Altered sensation in the leg – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anaesthesia).
  • Unable to complete your normal daily activities after the initial 72 hours.

Further medical assistance can be sought through either your local GP or a private clinician such as a physiotherapist, sports therapist, osteopath or chiropractor.

In the first instance, if you have followed the P.R.I.C.E. principles (see below) and are still unable to walk after 72 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment. Another warning sign is if your hip “gives way” whilst walking and once again, you should consult your doctor or visit A&E.

Secondly, if you have applied for P.R.I.C.E. principles and still have weakness that lasts a long time (more than 2 weeks) or have ongoing discomfort in your knee, you are highly recommended to seek advice from a specialist expert – such as a physiotherapist, sports therapist, osteopath, or chiropractor – who can provide you with advice and an appropriate and effective recovery and rehabilitation program.

This article has been written with reference to the bibliography.