Hip joints are made up of a ball at the end of the thighbone (femur), which fits into a socket in the pelvis. Both the socket and the head of the femur are coated with cartilage, to ensure they move smoothly together. The whole joint is covered in a fibrous capsule, which supports and lubricates the joint.
The hip is subject to a range of conditions that can cause chronic (persistent, ongoing) pain and difficulties performing sports, gentle exercising or even walking.
Hip pain can often be treated successfully if properly diagnosed. Prompt diagnosis can reduce the impact of the problem and to prevent long-term instability in the joint.
Sports associated with hip injuries:
- Contact sports such as football and hockey, particularly ice hockey
- Running
- Sports that involve jumping
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Diagnosis
Sports related hip injuries are generally diagnosed by an orthopaedic specialist.
Modern technology is extensively employed to enable accurate diagnostic techniques, which can usually establish the cause of chronic hip pain, enabling prompt and relevant treatment. These diagnostic technologies include X-ray, ultrasound, CT scans, and MRI scans.
Hip fracture: If you suspect a hip fracture, you need to go to hospital. A doctor will assess you by initially asking how you injured yourself and enquire about any medical conditions. They will take your temperature, check for dehydration and assess your mental state. You may be given painkilling medication, a local anaesthetic and/or intravenous fluid. It is likely you will be referred for an X-ray, MRI scan or CT scan to confirm whether your hip is fractured.
Osteoarthritis: You should see your GP if you have persistent symptoms of osteoarthritis. As well as pain and stiffness, you may also notice:
- Joint tenderness
- Joints appearing knobbly or larger than usual, or making a crackling or grating sound
- Limited movement in the joint
- Muscle wasting
Causes & Symptoms
Sports related hip pain is typically the result of a fall, where the hip joint is subject to hard impact. It can also be caused from repetitive motion, or from an isolated event involving too much stress or strain on the hip joint.
More often than not, hip related injuries are caused from either improper care prior to performance, or increasing the sports activity too quickly, or too rigorously.
There are a number of conditions, which can cause hip pain, including:
Muscle strains or Tendinitis, including iliopsoas and proximal hip quadriceps strains
Overuse of muscles and tendons in the hip and groin can lead to injury. Symptoms may include stiffness, aches and pains in the hip area when flexing whilst performing a running or kicking action.
Iliotibial (IT) band syndrome
The Iliotibial band is the name for the fibrous tissue running between the outside of the hip down to the knee. Sometimes this tissue becomes tight and rigid and rubs against the edge of the hip causing a pain outside the hip and often along the knee. This is common with walking and running.
Muscle tendon bursitis
Muscle tendon bursitis is common with excessive walking and running. It is caused when the bursa sacs, that surrounds the hip become inflamed, causing pain, which is often worse when lying on the side of the body that is affected.
Labral tears of cartilage – a tear in the cartilage surrounding the hip socket
The hip labrum is cartilage that stabilises the head of the femur (thighbone) and the acatabulum (hip socket). A tear of the labrum is rare but can cause pain in the hip, often accompanied with a clicking sound when moving. Symptoms can be difficult to diagnose, although an athlete would notice they would not be able to perform to the same standard as usual.
Contusion – bruise, commonly called a hip “pointer”
A hip pointer occurs as result of internal bleeding in the pelvis and may be visibly swollen or bruised as well as painful on the side of the hip. Football, hockey and skating are examples of sports where this could occur.
Hip bone fractures
Hip fractures are cracks or breaks in the top of the thigh bone (femur) close to the hip joint. They are normally the result of a fall or injury to the side of the hip, or from car accidents.
Falls are common in older people who may have impaired mobility and balance problems and also in women who are susceptible to osteoporosis (weak bones).
However, they can be a consequence of vigorous sporting activity causing injury.
Hip fractures can also be caused by a condition like cancer, which weakens the hip bone.
Symptoms may include:
- pain
- inability to stand or put weight on your leg
- inability to lift, move or rotate your leg
- bruising and swelling around the hip area
- a shorter leg on the injured side or your leg turning outwards on this side
Hip dysplasia
Hip dysplasia is where the hip joint is the wrong shape or the hip socket is incorrectly positioned. Whilst exercise and strengthening is recommended to maintain muscle, the type of exercise needs to ensure that it does not put too much weight onto the hip joint. To this extent, high impact sports, including running are not recommended if you suffer from this condition.
Osteoarthritis
Generally, the most common cause of hip pain is osteoarthritis. The condition is caused by:
- Inflammation of the tissues in and around the hip joint
- Damage to the cartilage that coats the moving parts of the joint
- Bony growths (osteophytes) around the edge of the joint
The symptoms of osteoarthritis are pain and stiffness in the hip. You may have problems putting on shoes or socks, or getting in or out of a car.
Chronic hip pain can sometimes be treated without major surgery, although this will only become apparent on more detailed examination.
Treatments range from non-operative or minimally invasive care through to complex joint reconstruction and replacement.
Treatment
Some sports related hip injuries could improve by reducing or stopping the activity that causes painful symptoms.
However, this can be frustrating if you enjoy sports and want to continue with your usual routine.
Many sports related injuries require proper treatment, following accurate diagnosis.
These may help in the short-term:
- Apply ice to inflammation
- Monitor pain and link it to associated activities
- Stop doing the activities that cause pain – this is important to prevent further damage
- Replace old sports equipment, such as footwear – a shoe with a thick sole may help absorb shock and protect the hip joint. Orthotics may be useful too.
- Ensure to adequately stretch following any exercise
- Consider a daily Vitamin D and Calcium supplement
Non-operative, diagnostic and minimally invasive hip treatments
Hip pain that is caused by minor muscular strains, worn cartilage, bursitis, excessive exercise or mild osteoarthritis could benefit from either non-operative treatment or minimally-invasive surgery. It is, however, important to have early and accurate diagnosis of the causes of chronic hip pain.
Operative treatments for the hip
Trauma resulting in hip fracture, severe bone infection, malformation of the joint, or conditions where non-invasive treatment may all need to be treated by an operation to replace some or all of the joint. Operations – known as revisions – are sometimes needed to upgrade or replace some or all of a hip replacement.
Risks
One main risk of sports related hip injuries is not seeking the correct treatment in a timely manner.
Complications can potentially arise from nerve damage or pulled tendons in the injured hip. Also, injuries that are not treated may lead to long-term hip arthritis or require hip resurfacing or replacement surgery at a later date.
All surgery carries risks and hip surgery is no exception. Find out about the associated risks of hip surgery.
Osteoarthritis: More research is needed into the long-term effects of viscosupplementation.
FAQ’s
Is it a good idea to exercise if I have hip pain?
If you are participate in regular sports activities and notice something isn’t quite right, the best thing to do is stop and seek guidance from a specialist.
Following diagnosis, gentle exercise is generally good as it builds muscle and strengthens your joints. However, too much exercise or exercising too hard can exacerbate the pain. It is essential to warm up thoroughly before exercising and stretch afterwards. Try low impact exercises like swimming or cycling rather than high impact activities like running.
When does pain in the hip need urgent medical attention?
You should seek urgent medical help if:
- you have had a fall or accident
- your leg is deformed, badly bruised or bleeding
- you’re unable to move your hip or put weight on your leg
- you have a temperature and feel unwell
Can taking supplements help with osteoarthritis of the hip?
There is some evidence to suggest that glucosamine sulphate and chondroitin sulphate may help to ease the symptoms of osteoarthritis to some degree and they do not cause side-effects.
Vitamin D and calcium may be recommended supplements for general bone health.
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If you are experiencing pain in your pelvis, hip, knee or ankle, or are suffering from a sports injury, seek specialist help to get you back to living your life. Contact can be made direct, or through your GP.
Email:
enquiries@carrothersorthopaedics.co.uk
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+ 44 (0) 1223 667 376.