The hip joint is a ball-and-socket joint formed between the hip bone (pelvis) and the thigh bone (femur). After the shoulder, the hip displays the greatest range of motion of any joint in the body. Alongside this, it is hugely weight-bearing and so is pulled on by many strong opposing muscles during walking, running, jumping etc.
Normal hip joint
Source: Basic anatomical knowledge
Similar to groin pain, when we examine people with hip pain, the area that is painful or tender isn’t necessarily the area that is causing the problem. There may be pain referring from other structures; areas creating compensations which overload other tissues, making the hip area the victim, or symptom. Also, there is often more than one pathology at play – the groin/hip/lower back area is incredibly complex anatomically and biomechanically, with nothing working in isolation.
There is also a huge amount of confusion about hip/groin/lower back pathologies.
Gluteal Tendinopathy usually causes pain towards the outside of the hip. Also attributed to this condition are muscular stiffness, and/or loss of strength in the hip musculature. Click on link for more information.
Iliopsoas Bursitis (or Iliopsoas tendon inflammation) is – despite the iliopsoas being a deep hip muscle complex – often felt as deep groin pain. A bursa is a small sack of fluid which reduces friction between tendon and bone. Symptoms can include a snapping/clicking/catching sensation may be felt in the hip. Pain and stiffness ( which can be front of the hip, groin, gluteal or even knee) may be worse in the morning, and sometimes eases as the body gets warmed up, but then worsens as activity increases.
Tronchanteric Bursitis is another lateral (outer) hip pathology, where inflammation of a “sac filled with lubricating fluid, located between tissues such as bone, muscle, tendons, and skin, that decreases rubbing, friction, and irritation”. Often, but not always, associated with an acute incident such as a fall. It is considered a compression issue, and so traditional stretches may be antagonistic.
Femoroacetabular impingement (F.A.I.) is a hip condition that will often give you pain deep in the hip socket, and it’s typically made achy after activity. It is caused by a bony deformity of the hip socket, such as a Cam or Pincer (see image). It often reports fairly non-specific – it can cause pain in the groin, front of thigh/hip, and gluteal area. You might also feel a pinching/clicking sensation in your groin, and it can be uncomfortable getting up from a seat – anecdotally, an almost ever-present complaint seems to be moving the leg out of a car. These – and labral tears, see below – are very often misdiagnosed, or missed, with the average time of successful diagnosis being nearly 3 years (1), which is surprising as there are a range of specific, and sensitive, tests.
Hip Labral Tear. The acetabular labrum is cartilage that runs around the rim of your hip joint socket. Its purpose is to make the hip socket deeper and more stable. The labrum can be torn from its attachment, or irritated, and cause pain, clicking or catching. Often, but not always, associated with an F.A.I.
Osteoarthritis (OA) Arthritis is “joint inflammation.” Osteoarthritis occurs when inflammation and injury to a joint cause a breaking down of cartilage tissue. Pain can appear in different locations, making it another difficult diagnosis – it is not unusual to have groin, thigh, gluteal, or knee pain. The pain can be stabbing and sharp or it can be a dull ache, and there is often stiffness. It was previously though that running was causal for OA, but research shows that actually, the opposite is true – “no evidence that running increases the risk of OA, including participation in marathon races, and, in fact, subjects that ran ≥1.8 METhr/d (≥12.4 km/wk) were at significantly lower risk for both OA and hip replacement”.
Osteoporosis is a the weakening of bones, making them more fragile and so more likely to break. It develops slowly – over several years – and is often only diagnosed when a minor fall or acute incident causes a bone fracture.
So as you can see, lots of cross-overs and symptoms which are very similar in a number of pathologies.
As always, when in doubt, seek professional assistance.
- Time and Cost of Diagnosis for Symptomatic Femoroacetabular Impingement | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555566/
- Effects of Running and Walking on Osteoarthritic and Hip Replacement Risk | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3756679/
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.
For more information please visit www.dc-injuryclinic.co.uk