Hip Pain Part 1 – Your Hips Do Lie

Some basic anatomy of the hips and some common injuries that occur.

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The hip is a fickle beast. When it works well and without pain, it can be used to control nearly the entire body. But, when there is discomfort within the hip, it can be caused by nearly anything in the entire body. With so much potential for disaster and success, today’s post is the first of a two-part series. In this, the first post of the series, we will be going over some basic anatomy of the hips and some common injuries that occur. Next week we will be going over how to avoid injuries and some exercises to help you recover from hip pain. So let’s get these hips shaking!
All Roads Lead To The Hips
The hips are difficult to describe. The hips control 6 motions of the legs, and there are at least 4 other motions that can be produced within the hip itself. There are at least 24 muscles and 4 ligaments that need to be considered when talking about hip motion. Not to mention the complex array of nerves, cartilage, and other tissues that need to be taken into account. Instead of boring you with the specifics, I’ll just say that there are no black and white answers when it comes to your hip pain. But we do have a lot of opportunities to find clues to the answer for your problems.
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Endless Possibilities
Hip problems are so complex that they may not even have symptoms that appear anywhere close to the hip! So let’s dive head first into some of the most common issues.
Femoroacetabular impingement (FAI) – FAI is the new kid on the block because we have only recently recognized it as a true issue. FAI can cause symptoms such as pain that you feel deep in the groin which may be mistaken as a groin strain (1). Overgrowth of the bones of the ball and socket joint of the hip cause tearing of cartilage in the joint (2). This problem can lead to early arthritis and affects about 10-15% of young adults (3). There is not a deep understanding of how this occurs yet, but we are learning more about it every day.
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Labral Tear – The labrum is a cartilage bumper within the socket of the hip. This problem can cause pain, catching, or clicking in the groin with activities. Labral tears can be caused by issues such as FAI, but they require an MRI to be diagnosed (4).
Athletic Pubalgia – AKA sports hernia. This issue can cause pain in the lower abdominal or groin area of athletes. The injury affects the lower abdominal wall, or adductor tendons, and is generally related to sport-specific movements (e.g. slap shot). This injury may require an MRI to diagnose (5).
Hip Flexor Strain – The hip flexors are the muscles along the anterior (front) aspect of the hip. Pain in the front of the hip when lifting the leg up will be experienced with this injury. 
Adductor Strain – Also known as a groin strain, this issue is tough to differentiate from other injuries of the hip (2). Usually, an adductor strain involves a stretch or possibly a small partial tear of the muscle or tendon. These injuries can have a gradual onset with diminished performance, and warms up, or, an acute onset that worsens during exercise (5).
Osteitis Pubis – This is an overuse condition causing inflammation of the junction between the pubic bones.You might feel pain deep in the groin when playing sports involving a rapid change of direction or bringing the lower extremity across the body. You might also experience pain radiating to the thigh or bone tenderness (5).
Piriformis Syndrome – This issue is described as a neuromuscular disorder that is presumed to occur when the sciatic nerve is compressed or involved at the level of the piriformis muscle (6). You may experience sciatica-type symptoms, pain when sitting, and/or pain with hip flexion, adduction, and internal rotation.
Inline image 3
Trochanteric Bursitis/Snapping Hip – Pain at the top of the hip is common especially among runners. Sometimes associated with IT band syndrome, these issues can often be caused by friction, overuse, trauma or too much pressure. You may experience symptoms such as pain getting up off your bed or pain while lying on the floor and sharp burning pain over the lateral thigh that worsens with exercise for bursitis and snapping hip respectively (7).
Sciatica – Sciatica is the result of a neurological problem in the back or an entrapped nerve in the pelvis or buttock. You might experience a pain in the butt (not spouse related), numbness, weakness, leg pain, or a host of other symptoms (8)
 
Summary
The problems listed above are just the tip of the iceberg. There are loads of other injuries that I would love to get into, but I will save my nerdiness for another day. What you need to know is that your groin pain may not be a simple groin strain. The sciatica you have been complaining about all these years may not actually be sciatica at all. And no matter what the issue is, there is going to be a solution to your problem. So be sure to read my next post to find out how to resolve your rear end issues!
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References
1. Sansone, M., Ahldén, M., Jonasson, P., Thomeé, R., Falk, A., Swärd, L., . . . Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation. (2014). Can hip impingement be mistaken for tendon pain in the groin? A long-term follow-up of tenotomy for groin pain in athletes. Knee Surgery, Sports Traumatology, Arthroscopy, 22(4), 786-792. doi:10.1007/s00167-013-2738-y
2. Chakraverty, J. K., Sullivan, C., Gan, C., Narayanaswamy, S., & Kamath, S. (2013). Cam and pincer femoroacetabular impingement: CT findings of features resembling femoroacetabular impingement in a young population without symptoms. AJR. American Journal of Roentgenology, 200(2), 389.
3. Leunig M, Ganz R. Femoroacetabular impingement: a common cause of hip complaints leading to arthrosis [in German]. Unfallchirurg 2005; 108:9–10, 12–17
4. Falvey, E. C., Franklyn-Miller, A., & McCrory, P. R. (2009). The greater trochanter triangle; a pathoanatomic approach to the diagnosis of chronic, proximal,lateral, lower limb [corrected] pain in athletes. British Journal of Sports Medicine, 43(2), 146.
5. Falvey, E. C., Franklyn-Miller, A., & McCrory, P. R. (2009). The groin triangle: A patho-anatomical approach to the diagnosis of chronic groin pain in athletes. British Journal of Sports Medicine, 43(3), 213-220. doi:10.1136/bjsm.2007.042259
6. Miller, T. A., White, K. P., & Ross, D. C. (2012). The diagnosis and management of piriformis syndrome: Myths and facts. The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques, 39(5), 577.
7. Franklyn-Miller, A., Falvey, E., & McCrory, P. (2009;2008;). The gluteal triangle: A clinical patho-anatomical approach to the diagnosis of gluteal pain in athletes. British Journal of Sports Medicine, 43(6), 460. doi:10.1136/bjsm.2007.042317
8. Koes, B. W., M. W. van Tulder, & Peul, W. C. (2007). Diagnosis and treatment of sciatica. BMJ: British Medical Journal, 334(7607), 1313-1317. doi:10.1136/bmj.39223.428495.BE

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