My Hip Hurts: Where’s the Pain?
Previous articles have discussed problems in the pelvis, including piriformis syndrome, sports hernia, osteitis pubis and sacroiliac (SI) dysfunction. This article will review problems in the hip joint and surrounding tissues.
Hip flexors are a group of muscles that move the thigh forward and up. Strains (pulls) are caused by backwards slippage of the foot. This may occur with one big slip or repetitive small slips while running on a slick surface, such as snow. Stretching the hip flexors is difficult. Lie on your back on the edge of a table or high bed and drop the outside leg off the edge. Lunging with the back leg fully extended will also stretch the hip flexors. An easy way to strengthen the hip flexors is to perform leg lifts. Leg weights or use of a sports cord will add resistance. To maximize strength throughout the hip, work leg raises in each direction — back, forward, in and out.
Tendinitis is usually due to increased training — increased mileage, speed work or hill work. Treatment includes decreasing training, ice, strengthening and stretching. How much decrease is based on the severity of the symptoms. If there is pain with walking, cross-train in a pool. Cycling, rowing machines, stairmasters and elliptical trainers may be used if they do not cause pain. In less severe cases, cut back on mileage by 25-50 percent and eliminate speed and hill work.
Strains and tendinitis of the top of the hamstrings cause pain in the lower buttocks (the bone that you sit on) and the top of the back of the thigh. Treatment is the same as that used for hip flexor problems. Hamstring stretching and strengthening, especially backwards leg raises, are important. Deep tissue massage may be beneficial. This is a difficult problem that takes a long time to resolve.
Pain on the outside of the hip is most commonly due to greater trochanteric bursitis. The thigh bone juts outward at the base of the neck (connects ball to the femur; site of hip stress fractures); this protrusion is the greater trochanter. A lubricating sac (bursa) overlies the boney protrusion, so that the surrounding muscles do not rub directly on the bone. The top region of the iliotibial (IT) band, known as the tensor fascia lata, is commonly involved in greater trochanteric bursitis.
Treatment includes stretching and strengthening the IT band, hip abductors and gluteal muscles (see exercises for the IT band and piriformis syndrome). Apply ice to the painful area for 15 minutes three to four times per day. Avoid running on banked surfaces. A cortisone injection may be beneficial. Severe or worsening pain should raise suspicion for a stress fracture.
Pain along the inside of the hip may be due tendinitis or strain of the adductor muscles. Adductors pull the leg inward as it is moving forward; the faster the movement, the greater the degree of adduction (footprints of a runner are almost single file as opposed to the side-by-side footprints of a walker). Side lunges will stretch these muscles and inward leg raises will strengthen the adductors. Treatment is otherwise the same as the other muscle injuries.
Pain in the inner and sometimes the front of the hip can be caused by osteitis pubis, sports hernias, infections and hernias (discussed in previous articles), or by pubic stress fractures and osteoarthritis (to be discussed in future articles).
Persistent or worsening hip pain warrants a visit to your health care provider and possibly a sports medicine specialist. Some problems, particularly hip stress fractures, are commonly misdiagnosed due to the confusing presentation of symptoms. A thorough evaluation is necessary and often includes X-rays and other studies (MRI, bone scan). As with all injuries, the absence of pain does not mean that all is well. Strength and flexibility deficits must be addressed to allow a healthy return to running.