Common Hip Pain and Injuries in Athletes

Hip pain in athletes is a common cause of discomfort and can be a frustrating problem to treat. In the past, just about any hip pain symptom was attributed to a "muscle strain" type of injury. While this is a common cause of hip pain in athletes, we are learning more and more about other causes of hip pain that can sideline a player from the action.

Muscle Strains: The most common injuries of the hip and groin region in athletes are muscle strain injuries. Muscles around the hip joint are especially prone to this type of injury because they are subject to eccentric contraction. Eccentric contractions cause tremendous forces in the muscle and can lead to a muscle strain. Muscle strains around the hip include groin pulls and hamstring strains.
Hip Bursitis: Inflammation of the bursa over the outside of the hip joint, so-called trochanteric bursitis, can cause pain with hip movement. Treatment of hip bursitis is often effective, but the condition has a problem of coming back and sometimes becoming a persistent problem.
Contusions (Hip Pointer): A direct blow to the outside of the hip causes an injury to one of the large bones of the pelvis, the ileum. When a contusion is sustained in an athlete over the outside of the hip, the injury is called a hip pointer.

Stress Fractures: Stress fractures of the hip are usually seen in long distance runners, and much more commonly in women than in men. These injuries are usually seen in endurance athletes with deficient nutrition or eating disorders.
Hip Labral Tear: The labrum of the hip is a cuff of thick tissue that surrounds the hip socket. The labrum helps to support the hip joint. When a labral tear of the hip occurs, a piece of this tissue can become pinched in the joint causing pain and catching sensations. Much more has been learned about hip labral tears, to the point that some orthopedic surgeons are concerned these injuries are overdiagnosed. However, some patients with hip labral tears can find improvement with treatment of this condition.

Femoroacetabular Impingement: Femoroacetablar impingement, often referred to as FAI, is a condition where bone spurs form along the edges of the ball-and-socket hip joint and cause limited mobility of the joint and damage to soft tissues including the labrum. FAI is thought by many surgeons to be a precursor to arthritis of the hip joint.
Osteitis Pubis: Osteitis pubis is thought to be due to the repetitive pull of muscles over the front of the hip joint. Usually, pain is activity related and often seen in runners, soccer players and hockey players. The x-rays may show signs causing concern for infection, but osteitis pubis usually resolves with rest and anti-inflammatory medications.
Sports Hernias: Sports hernias are a problem seen most commonly in hockey players, but can be seen in other sports that require repetitive twisting and turning at high speeds. The problem is thought to be due to an imbalance of the strong muscles of the thigh and the relatively weaker muscles of the abdomen.
Snapping Hip Syndrome: Snapping hip syndrome is a word used to describe three distinct hip problems. The first is when the IT band snaps over the outside of the thigh. The second occurs when the deep hip flexor snaps over the front of the hip joint. Finally, tears of the cartilage, or labrum, around the hip socket can cause a snapping sensation.

Traumatic Hip Subluxation & Dislocation: Complete dislocation of the hip joint is a very unusual hip injury--most commonly hip dislocations occur in high-speed car crashes. However, hip subluxations, an injury where the ball of the ball-and-socket hip joint is pushed part of the way out of joint, are being recognized as a possible cause of hip pain in athletes. A hip subluxation is the type of injury that is thought to have ended Bo Jackson's athletic career.
Hip Arthritis: Arthritis of the hips is increasingly seen in athletes as the age in which we participate in sports increases. Older athletes can experience joint stiffness and pain as a result of hip arthritis.

Low Back Strain: While not a problem in the hip region, low back problems can often cause pain around the buttock and hips.

Evaluating Hip Pain

Evaluation of hip pain and an athlete should begin with a careful history and examination of the patient. By understanding the onset of symptoms, your physician can gather clues as to the possible diagnoses that may be causing your symptoms. Different conditions occur for different reasons, and understanding how symptoms began and have evolved can help guide an understanding of the diagnosis. A careful examination can help to locate the source of the discomfort. Often hip problems and be puzzling because the hip joint itself is located deep within the pelvis. Hip joint problems have different symptoms from problems with a source in the bursa or the lumbar spine. Determining the anatomic source of the discomfort can also be very helpful in guiding the diagnosis.

Often diagnostic testing can also be helpful in determining the source of hip pain. Knowing the right diagnostic test to order depends on the possible diagnoses being considered. Often x-rays can be very helpful in evaluating the bony anatomy of the hip joint. Other imaging studies include CAT scans, MRIs, ultrasound, and other tests that can be used to evaluate these different conditions.

It is critical that the proper diagnosis is obtained, as treatments can be different depending on the specific underlying diagnosis. Once the diagnosis has been established, treatment can progress to radiological series of steps targeted at the underlying condition.

A Word From Verywell

Hip pain is a common complaint of athletes in many different sports. Finding the best way to alleviate symptoms of pain requires an understanding of the underlying diagnosis, and then a logical regression of treatments. Working with her physician, they can help evaluate, diagnosed, and ultimately treat your hip condition.

Sources:

Lynch TS, Bedi A, Larson CM. "Athletic Hip Injuries" J Am Acad Orthop Surg. 2017 Apr;25(4):269-279.