11 Common Hip Pain and Injuries in Athletes

Hip pain is a common cause of discomfort in athletes and can be a frustrating problem to treat. In the past, just about any hip pain symptom was attributed to a “muscle strain”-type injury. While this can be a very common cause of hip pain in athletes, there are many other conditions that can sideline a player as well.

Muscle Strain

Muscle strain, or pulled muscle, occurs when a muscle is overstretched or torn. In athletes, this type of injury is common in the hip and groin area due to fatigue, overuse, or the improper use of a muscle. The failure to warm up before exercise also contributes to the problem.

Muscles around the hip joint are especially prone to strain because of the tremendous force they can generate. Groin pulls and hamstring strains are two examples of this.

Lower back strains often occur due to sudden, forceful, and sometimes unexpected movements such as flexion, extension, and rotation.

Contusion (Hip Pointer)

A contusion, simply known as a bruise, is a region of injured tissue in which blood capillaries have ruptured. When a contusion is caused by blunt force impact, swelling and pain will accompany the characteristic black-and-blue discoloration of the skin.

A direct blow to the outside or front of the hip can cause a contusion to the iliac crest of the ilium, the largest bone of the pelvic girdle. In athletes, this type of injury is commonly referred to as a hip pointer. Treatment of a hip pointer injury typically involves RICE and NSAIDs followed by range of motion and active resistance exercises.

Osteitis Pubis

Osteitis pubis is the inflammation of the pubic symphysis, the joint of the two major pelvic bones at the front of the pelvis. Osteitis pubis is thought to be due to the repetitive pull of muscles over the front of the hip joint. The condition is often seen in long-distance runners, soccer players, and hockey players who take long strides over prolonged periods of time.

RICE, NSAIDs, and physical therapy are usually considered appropriate for the treatment of osteitis pubis. Steroid injections may be suggested to reduce pain and inflammation. Walking aids may be necessary.

Hip Bursitis

Bursitis is the inflammation of the fluid-filled sacs throughout the body, called bursae, that help reduce friction between bone, muscles, and tendons.

Inflammation of the bursa located on the outside of the hip joint, called trochanteric bursitis, can cause latera hip pain made worse by movement. Without the cushioning effect of the bursa, any movement of the hip joint can be painful.

While hip bursitis can be effectively treated with ice, NSAIDs, steroid injections, and physical therapy, the condition has a tendency of coming back and becoming chronic.

Snapping Hip Syndrome

Snapping hip syndrome is a term used to describe audible or palpable snapping sensations that occur with hip movement. Two main categories classify causes of snapping hip syndrome:

• External: Is typically due to the iliotibial (IT) band moving over the lateral hip (greater trochanter of the femur) with flexion, extension, and rotation of the hip.
• Internal: Most commonly occurs when the hip flexor (iliopsoas) moves over underlying bony prominences.

When there is no pain present, treatment is not necessary. Painful snapping hip syndrome responds well to conservative treatment:

• Rest
• Mobility work
• Steroid injections
• NSAIDs
• Physical therapy
• Activity modifications

Hip Labral Tear

The labrum of the hip is a cuff of thick tissue that surrounds the hip socket which helps 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 with movement.

Hip labral tears can often be treated conservatively with RICE, NSAIDs, physical therapy, and steroid injections. Significant tears will require surgical consultation and possible hip arthroscopy.

Femoroacetabular Impingement

Femoroacetablar impingement (FAI) is a condition where a bone spur or anatomical abnormality is present along the edge of the ball-and-socket hip joint causing friction in the joint. This can cause the loss of mobility of the joint and damage to surrounding soft tissues, including the labrum. FAI is thought by many surgeons to be a precursor to arthritis of the hip joint.

FAI is typically treated non-surgically with RICE, NSAIDs, and physical therapy. For those who fail to respond to conservative measures, hip arthroscopy may be recommended. While the surgery can improve symptoms, it has not been proven if it can do anything to prevent hip arthritis.

Stress Fracture

Stress fractures of the hip typically occur in the upper neck of the femur (thigh bone). These are often seen in long-distance runners who place repetitive stress on the hip, causing compression and the development of microfractures. These injuries are especially common in athletes with nutritional deficiencies or eating disorders.

Doctors will most often recommend non-surgical treatment of compression-type stress fractures. Athletes will be instructed to stay off the affected leg for a period of time, using crutches if necessary. Pain can be treated with hot and cold treatments and NSAIDs.

Sports Hernia

Sports hernias, also known as athletic pubalgia, is a painful soft tissue injury that occurs in the groin area. It is a problem commonly seen in hockey players but can occur in other sports that require repetitive twisting and turning at high speeds. A common cause of a sports hernia is an imbalance between the muscles of the hips and abdominals.

RICE and NSAIDs are generally recommended for the first 7 to 10 days of treatment, after which physical therapy may bring the athlete back to sports readiness within 4 to 6 weeks. If the condition is severe, surgery may be needed, performed either as an open surgery or laparoscopically.

Hip Arthritis

Arthritis of the hips is increasingly seen in older athletes who may have already endured injuries during their sports career. The type most commonly seen in older athletes is osteoarthritis, also known as wear-and-tear arthritis.

Hip arthritis in athletes is treated the same as anyone else. In most cases, the condition is treated non-surgically with activity modification, NSAIDs, physical therapy, and possibly steroid injections. Lifestyle modifications that help manage and treat hip arthritis include weight reduction, proper footwear, and assistive devices.

Severe cases may require surgery, including hip arthroscopy, hip osteotomy, hip resurfacing, arthrodesis (joint fusion), or hip replacement.

Traumatic Subluxation and Dislocation

Complete dislocation of the hip joint is a very rare hip injury; most commonly seen 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 the joint, are being recognized as a possible cause of hip pain in athletes.

These are seen more commonly in football players or soccer players who are frequently tackled or hit with blunt force.

Hip subluxation and dislocation are considered serious injuries. Treatment involves closed reduction (in which the joint is put back into its correct position), followed by prolonged rest, pain medications, traction (if necessary), and physical therapy. Surgery is typically recommended if there is recurrence or if nearby nerves, blood vessels, or ligaments are damaged.