Hip injury: 7 common causes of hip pain in active people

If you battle hip pain, you know it can limit your ability to exercise or play sports as well as you want. There are many causes of hip pain. Sometimes a hip injury results from a traumatic event. Others develop over weeks and months with continued activity.

Hip injury #1 – Femoroacetabular impingement (FAI)

This is a more common cause of hip pain that we probably realized years ago. You might notice pain that you feel deep in the groin. Prominent areas of bone on the femoral neck below the head (ball of the ball-and-socket joint) or on the acetabulum (socket) catch with motion and cause pain. Physical therapy and activity modification can occasionally provide pain relief. If your symptoms persist, arthroscopic surgery of the hip to remove the excess bone can relieve pain and improve hip motion.

Femoroacetabular impingement, a common hip injury
This x-ray of a left hip shows bony prominence (white arrow) of the femoral head and neck consistent with cam-type femoroacetabular impingement.

Hip injury #2 – Labral tear

The labrum is a cartilage bumper within the acetabulum of the hip joint. You might experience pain, catching, or clicking in the groin with activities. Hip labral tears are often seen on MRIs performed in patients with no pain. Therefore, orthopaedic surgeons must correlate the MRI findings with your symptoms and physical examination to decide the cause of your pain and plan treatment. Often surgeons can arthroscopically trim or repair the labrum if your symptoms persist.

Hip injury #3 – Athletic pubalgia

This is a term for pain in the lower abdominal or groin area of athletes. It replaced the older term “sports hernia.” The injury affects the lower abdominal wall or adductor tendons. Hockey, soccer, and football players seem to develop athletic pubalgia more than other athletes. Nonoperative treatments, such as rest and physical therapy, are usually the first treatments tried. Occasionally athletes and active people need surgery.

Hip injury #4 – Hip flexor strain

The hip flexors are the muscles along the anterior (front) aspect of the hip. They flex the lower extremity towards the head. A traumatic event often causes a hip flexor strain. Frequently these muscles and tendons do not rupture completely. Nonoperative treatment is often effective. Rest, activity modification, and physical therapy are also good starting treatments.

Hip injury #5 – Adductor strain

The adductor muscles are muscles located on the medial (side closest to the midline) side of the thigh. They pull the lower extremity across the body. Athletes who play sports requiring quick changes of direction can injure these muscles or tendons. Usually an adductor strain involves a stretch or possibly a small partial tear of the muscle or tendon. Active people rarely need surgery. It can be painful while it heals. Rest, activity modification, and physical therapy can all help decrease pain and speed return to activity.

Hip injury #6 – Osteitis pubis

This is an overuse condition marked by inflammation of the symphysis pubis, or the junction between the pubic bones. Athletes who play sports involving rapid change of direction or bringing the lower extremity across the body occasionally develop this injury. You might feel pain deep in the groin, especially with these activities. You rarely require surgery for osteitis pubis. Rest, anti-inflammatory medications, and physical therapy often relive the pain and allow return to activity.

Hip injury #7 – Hip pointer

This is a contusion (bruise) of the iliac crest, which is the bony prominence on the outside of the pelvis. You likely landed on that bony prominence on the anterior and lateral (front and side) of your hip. Or another player hit you in that spot. This injury can be very painful. You could have significant bruising along the front of your hip and outside of your body. Rest and avoiding painful activities usually help your pain, but this injury can often take several weeks to resolve.

Location of pain from a hip pointer

Each of these injuries can limit activities and exercise. You can overcome some of them without surgery. If you have hip pain or other symptoms in or around your hip, consider seeing an orthopedic surgeon who specializes in sports medicine or hip surgery. Also consider working with a physical therapist. He or she can help you overcome some of these injuries and speed your return to sports and exercise.