The Most Common Hip Injuries in Athletes

June 13, 2018

Fortunately, it takes a considerable amount of force to seriously damage a healthy hip. The large muscles of the thighs, lower back, and buttocks all help protect the hip from injuries. So, when a hip injury does occur, it is more likely to be caused by chronic overuse of the joint and its associated muscles rather than a direct, traumatic injury.

Hip inflammation and injury is very common in athletes such as cyclists, runners, swimmers, baseball players, and golfers. High-performance athletes, especially those who compete in professional and college sports, must take extra precaution to avoid injuries. In the most severe instances, a hip injury can lead to debilitating pain, loss of hip function, and—for athletes, in particular—the end of an athletic career.

This article contains a list of common hip injuries in athletes. If you experience the signs and symptoms of any of the conditions listed below, it is recommended that you talk to a hip specialist.

Sprains and Strains

A sprain is a stretching or a tear in ligaments. By contrast, a strain is a stretching or a tear in muscles. Sprains and strains are classified into three grades depending on their severity:

• Grade I – Mild stretching or microscopic tears accompanied by mild pain. The joint functions normally.
• Grade II – Moderate stretching or tears accompanied by pain. The hip may periodically give out while standing or walking.
• Grade III – The ligament, muscle, or tendon is completely torn. The hip can no longer bear weight.

Signs and symptoms of a hip sprain or strain include:

• Hip pain, tenderness, and weakness, especially when walking or climbing stairs
• Hip swelling, inflammation, and bruising
• Muscle spasms in the hip
• A limp while walking
• A visible muscle deformity (in severe sprains or strains)

The symptoms of hip sprains and strains will vary based on their severity.

The majority of sprains and strains start as microscopic tears. Chronic overuse of the hip causes these tears to gradually increase in size until the ligament, muscle, or tendon ruptures, or completely tears from the bone. Hip sprains and strains are common in sports that require repetitive use of the lower body, such as cycling, running, swimming, baseball, and golf.

Low-grade sprains and strains are often so mild that they don’t require treatment from an orthopaedist. In these instances, simply taking a break from activities that stress your hips for a few weeks may be all you need. Cold therapy can also help relieve symptoms and speed up the recovery process. However, if your pain and swelling doesn’t subside after a few weeks, or if your hip interferes with your ability to complete everyday activities, schedule an appointment with a hip specialist.

Tendonitis and Tendinosis

Hip tendonitis is inflammation of any of the hip tendons, or the strong fibrous tissue that attaches muscle to a bone. Tendonitis occurs when the body’s immune system increases the flow of blood to an injured tendon, causing inflammation in the joint.

Hip tendinosis is the non-inflammatory degeneration of a tendon. Tendinosis degrades the tendon, causing changes in the structure or composition of the tendon.

Similar to strains and sprains, tendonitis and tendinosis are frequently caused by overuse of the hip. Both conditions can also be caused by acute physical trauma, although this is less common. Long-distance runners, swimmers, baseball players, tennis players, and golfers have a higher than average risk of these conditions.

Signs and symptoms of hip tendonitis and tendinosis include:

• Pain in the hip, back, or leg
• Hip pain that gradually develops over time
• Hip stiffness, swelling, and inflammation
• Heat and redness around the tendon
• Visible lumps along the tendon

Both tendonitis and tendinosis can be treated with RICE (rest, ice, compression, and elevation) and physical therapy. You can also lower your risk of recurrent injuries by adequately stretching before exercise and strengthening the muscles in your hips, legs, and lower back.

It is important to note that NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen and naproxen, as well as cortisone injections, are suitable treatments for tendonitis but not for tendinosis. This is because tendinosis is non-inflammatory and NSAIDs will not help tendons heal. In fact, some experts advise against using NSAIDs to treat tendinosis because they inhibit the growth of callogen, which is necessary for tendon healing.

It should also be stressed that tendonitis and tendinosis heal at different rates. Tendonitis typically heals in about 6 weeks with proper treatment. Tendonosis typically heals after 3-6 months. If you experience the signs and symptoms of these conditions, schedule an appointment with an orthopaedist. A hip expert will ensure that your condition is accurately diagnosed and that you receive the appropriate treatment.

Bursitis

Hip bursitis is inflammation of bursae, which are fluid-filled sacs that cushion muscles, tendons, and ligaments against bone. Similar to other inflammatory conditions, bursitis is commonly caused by chronic overuse of a joint. Although less likely, bursitis can also occur from acute trauma or infection.

The trochanteric bursa and the iliopsoas bursa are the two major bursae located in the hip. The trochanteric bursa is located on the bony tip of the hip called the greater trochanter. The iliopsoas bursa is located on the inside, or groin side, of the hip. This is why bursitis pain is felt in the hip or thigh, outside the hip or thigh, or on one side of the groin.

Signs and symptoms of hip bursitis include:

• Hip pain and stiffness that becomes worse with repetitive motions
• Pain when pressing on the hip or groin
• Pain when lying on one’s side
• Pain when walking up stairs
• Pain when rising from a deep sitting position

The symptoms of bursitis only last for a few weeks if the hip is allowed to rest. Similar to the treatment of tendonitis, RICE can help manage symptoms while the body heals itself. Strengthening your hip, leg, and back muscles can also help prevent future episodes of bursitis.

Iliopsoas Tendinitis

The iliopsoas muscle, which consists of the psoas major muscle and the iliacus muscle, are the primary hip flexor. The psoas major originates in the lumbar (lower) region of the back and attaches to the femur (thigh bone). The iliacus originates in the pelvis and also attaches to the femur. Because both muscles function together, they are collectively referred to as the iliopsoas muscle. The iliopsoas muscle allows you to walk, sit up straight, and rotate your thigh laterally.

Iliopsoas tendonitis, is caused by repetitive use of the hip. It causes inflammation of the iliopsoas muscles and leads to the gradual development of hip pain. Iliopsoas tendonitis is common among long-distance runners, bicyclists, and athletes who regularly squat.

Talk to a Specialist

Hip injuries are a reality of sports. Fortunately, many hip injuries can be prevented by simply reducing the amount of stress placed on the joint. Strengthening the muscles surrounding your hips, adequately stretching before exercise, and maintaining proper body mechanics both during your workouts and on the field can also help reduce your risk of an injury.

Dr. Steve Hamilton is a board-certified hip specialist at Beacon Orthopaedics and Sports Medicine who can treat you for any of these common conditions. Dr. Hamilton can also diagnose and treat labral tears, osteoarthritis, post-traumatic arthritis, and fractures. Schedule an appointment to meet with Dr. Hamilton for an evaluation and treatment plan that is personalized to you.