Maybe it’s just me but whenever I’m talking about hips I can’t stop Shakira’s “Hips Don’t Lie” from playing on repeat in my head. Hopefully it’s currently in your head now as you read all about hips– if you have no idea what I’m talking about go on and google it.
I see a ton of hip complaints in practice. Hip injuries show up in all sorts of people of all shapes and size but many patients are, or were, runners and cyclists.
The hip joint is comprised of the femur (thigh bone) which articulates with the acetabulum (hip socket) to form a ball-in-socket joint. For a relatively straightforward bony joint you wouldn’t think there’d be a ton that could go wrong. But since the hips are the drivers in forward motion there are a ton of muscular attachments that need to be strong, stable but also be mobile. Tricky.
So what could your hip pain be stemming from? Let’s discuss.
The most common injury I see in my practice are previously undiagnosed labral tears. The labrum is a cartilaginous ring that sits between the head of the femur and the acetabulum within the hip joint to help hold it in place and absorb shock. Many people have bony anomalies of either the femur or an over growth of the acetabulum causing an impingement of the joint. When this happens the labrum is caught and repeatedly ‘jammed,’ eventually causing fraying and tearing. Since the labrum is pure cartilage and doesn’t have pain receptors you’re typically not catching any real issues until the damage has been done. Individuals with labral injuries will typically report a vague groin pain or hamstring pain that moves around. Generally, our focused history and physical exam gives us a very solid working diagnosis, but the only way to definitively confirm labral involvement is with an MRI where contrast is injected into the hip. At that point surgery or aggressive rehab are the best options. Many, but not all, cases are surgical to get a person back to the activity level they desire without pain.
The piriformis muscle runs from the sacrum (tail bone) to the outside of the hip, helping with internal rotation. It’s actually a pretty small muscle in the scheme of things but the mack daddy of all nerves, the sciatic, typically runs really close if not through the muscle. So if the piriformis is not happy, typically the sciatic nerve is not happy and that’s when the issues arise. Stretching and rehab specific exercises generally calm the muscle down, but with all things- it may take some time. Checking out bio-mechanics and why the issue arose in the first place is key to help minimize episodes of re-occurrence.
The ‘hamstring’ is comprised of 3 muscles that run from the ischium (“sit bone”) to the tibia. They are the main knee flexors of the body and the nemesis of all middle aged softball playing men (amongst others). When one, or all, of the hamstrings are injured there is typically pain in the back of the leg and people are generally correct in assuming it’s a straightforward hamstring injury. Hip involvement comes into play when the hamstrings are damaged at the origin site. Often times a tendinitis or more advanced tendinopathy will refer into the hip and might be a bit misleading in where the pain is originating from.
The iliopsoas runs from the lower lumbar vertebrae to the front of the hip. This is often referred to the ‘hip flexor’ and does just that, flexes the hip by bringing the knee up and off the ground. When this guy gets inflamed there is typically pain experienced in the front of the hip worse with, you guessed it, flexion. The tendon also may snap or click over the bony prominences of the hip joint. This injury is commonly an overuse injury from increasing activity too quickly. Stretching, releasing and modifying activity until the issue is under control is key to a quick(er) recovery.
The bursa are like these small water balloons that sit under tendons to them help glide smoothly and aid in hip range of motion. They, like everything else, can become overused and irritated. Bursas are everywhere but the most commonly aggravated one sits on the outside of the hip.
HOWEVER, in my opinion, a diagnosis of “bursitis” is a cop out diagnosis. Sure, it’s accurate but WHY did the bursitis develop? What muscle isn’t firing? What muscle is tight? Are your bio-mechanics totally skewed? Is there some other injury you’re compensating for? If anyone gives you a “bursitis” diagnosis and simply says “anti-inflammatories and rest” and provides you NO other insight -do yourself a huge favor and find someone that’s willing to dig deeper. *steps off soap box*
And finally, let’s chat stress fractures. These are typically thought of happening in the lower leg but they can and do happen in the hip. Stress fractures develop when everything else fails. Muscles and tendons are generally the shock absorbers of the body, when they are fatigued or not firing correctly force is transferred to the bones. Stress fractures are somewhat tricky in that they take time to develop and generally refer elsewhere (groin, low back). They’re also tricky in that they don’t typically show up on X-rays, and if they do it’s not until well after the process has begun. So people get an X-ray while they’re having pain, nothing shows up and they’re cleared for activity while the fracture is allowed to worsen. Therefore, an MRI is the best imaging to have done if a stress fracture is suspected.
Hopefully this quick overview of some common injuries contributing to hip pain has helped you out. Keep in mind there is still an extensive list of things that could be contributing to your hip pain. Getting checked out by a movement specialist and someone that really understands hip injuries is your best course of action.
Questions? Comments? Concerns? Let me know! And if you’re dealing with hip pain, get in to get it checked out today!
Dr. Katie Clare, DC, CCSP, ART
Dauntless Sport & Spine Clinic
4510 W. 77th St, Edina, MN 55435