The hip is a large joint that connects the leg to the rest of the body. Although the hip is tough and can withstand intense pressure and outside impact, it is at risk of injury during activity. The Sports Medicine doctors at Sauk Prairie Healthcare are experienced in evaluating and treating hip injuries caused by playing sports.

Anatomy of the Hip

The hip joint consists of two bones: the pelvis and the femur, or thighbone. The pelvis is a large bone that is central to the body and acts as a platform for the spine. The pelvis has two sockets, left and right, called the acetabulum that receives the ball-like head of the thigh bone or femur. The hip’s ball-and-socket shape allows the leg to move in all kinds of directions. Aside from the shoulder, the hip joint has the second greatest range of motion among the joints in our body. 

On the rim of the socket of the hip joint, there is a ring of cartilage called the labrum that follows the outer edge of the socket. The labrum acts as a cushion to protect the hip joint, and form a protective seal to keep the top of the femur in place. 

There are several sets of hip joint ligaments connecting the pelvic bone to the bones in the legs. Similarly, the tendons around the hip connect the muscles around the hip to the femur and pelvic bones. 

Outside the hip joint, there are multiple fluid-filled sacs called bursae. Each bursa protects tendons and ligaments from friction during movement. 

Hip Tendonitis

The hip has many tendons that can be injured either due to trauma or repetitive overuse. Tendons are the dense fibrous ropes that connect muscles to bone. Hip tendonitis is a painful inflammation or irritation of the tendon near where it attaches to the bone. The tendon usually gets inflamed because it has been overused for a long time or it has been overused too quickly. Sometimes tendonitis starts out of the blue, because just getting older causes tendonitis to happen more easily. 

The range of tendonitis injuries that can occur throughout the body, resulting from overuse, are often referred to as tendinopathy. 

Tendonitis is very common. Some tendons around the hip that are affected by tendonitis are: 

  • Iliopsoas Tendon (pain in the groin)
  • Hip External Rotator Tendons (pain over the side of the hip and pelvis)
  • Hamstring Tendon (pain in the buttock or sit-bone) 

Most tendonitis can be treated at home with rest and avoiding movements that hurt. Ice and heat can also provide relief of pain. If the pain is severe or is not going away after a week or two of home treatment, you should consider seeing your Sports Medicine specialist for evaluation to confirm that it is tendonitis. Your Sports Medicine specialist may use an ultrasound machine to look at the tendon to confirm tendonitis or sometimes to reveal a tear of the tendon.  

A majority of tendonitis can be treated non-surgically. Non-surgical treatments options include: 

  • Modified physical activities and avoiding movements that strain inflamed tendons 
  • Physical therapy
  • Manual therapies like ASTYM® and Graston Technique® 
  • Dry needing 
  • Therapeutic ultrasound 
  • Non-prescription pain relievers like ibuprofen or naproxen or prescription topical diclofenac gel
  • Prolotherapy injections 
  • Platelet Rich Plasma injections 
  • Occasionally corticosteroid injections into the bursa next to the tendon

Scientific studies have shown physical therapy to be the best treatment for the majority of tendonitis cases, although many of the most effective exercises recommended by physical therapists can result in temporary soreness.

Greater Trochanteric Pain Syndrome

Lateral hip pain is very common, affecting 10 to 25% of the general population. “Hip Bursitis” is a diagnosis that is often given to pain and tenderness over the bony part of the side of the hip known as the greater trochanter. Sports Medicine doctors have discovered that the pain over the greater trochanter is not always caused by an inflammation of a bursa sac but most often is due to tendonitis of the muscles that attach to the greater trochanter such as the gluteus medius or gluteus minimus tendons. Sometimes the pain is due to a thickened Iliotibial (IT) band.

Like other tendonitis, greater trochanteric pain symptoms happen with overuse activities such as running, sports or fitness classes that involve a lot of jumping or bicycling. Sometimes a fall or bump to the side of the hip can cause the hip to become inflamed. 

Sharp, intense pain and tenderness of the side of the hip that extends to the side of the thigh is one of the most common symptoms. Other common symptoms of greater trochanteric pain syndrome or include:

  • A dull ache over the side of the hip with sharp pains with certain movements
  • Trouble sleeping on the painful side
  • Swelling and redness
  • Pain with prolonged standing, sitting or walking and especially up or down stairs

Many people with greater trochanteric pain syndrome find pain relief through non-surgical treatments such as physical therapy and injections to reduce inflammation and soft tissue irritation.

Surgery is rarely necessary, but treatment usually takes a very long time. Recovery from most types of greater trochanteric pain syndrome take between several weeks and several months. If in the course of treatment, a tear of a tendon is discovered and non-surgical options have been exhausted, your Sports Medicine doctor may recommend surgery and refer you to an Orthopedic surgeon.

Hip Bursitis

The bursae are small fluid-filled sacs that help protect joints including the hip. Appearing like a deflated plastic bag sealed with just a tiny amount of liquid inside, the bursae help reduce friction between the bones of the hip joint and the tissue surrounding them. 

If a bursa becomes irritated and inflamed, it can result in hip bursitis, often felt as achiness and stiffness of the joint, along with pain if there is pressure on the area. Often tendonitis of the hip, particularly greater trochanteric pain, can be mistaken for bursitis. A genuine flare of bursitis is less common in the hip than in the shoulder or elbow. 

Similar to tendonitis, bursitis can usually be treated with non-invasive options such as changes in activity, anti-inflammatory medication, steroid injection or physical therapy. In rare cases in which bursitis continues to be a problem despite other treatment attempts, surgical treatment may be recommended, in which the inflamed bursitis is removed.  

Osteoarthritis of the Hip

Osteoarthritis is the most common joint disorder in the United Sates, estimated to affect more than 27 million Americans. 

Hip osteoarthritis, or degenerative joint disease, is caused by a breakdown in the cartilage of the joint. The lack of cartilage results in greater friction, increased pain, and decreased mobility. As the condition progresses, night pain becomes more common, interfering with sleep. 

The Centers for Disease Control (CDC) and Prevention estimates the lifetime risk of developing hip osteoarthritis is about 18.5% for men and 28.6% for women.  

Osteoarthritis symptoms include:  

  • Limited motion and stiffness
  • Weight bearing or walking pain that gets better with sitting down or laying down
  • As hip arthritis progresses, a constant ache may develop
  • Crapitus, or the sensation of hearing or feeling grinding or clicking in the joint

So far there is no cure for osteoarthritis. There is not an effective way to rebuild or regenerate cartilage that has thinned, but there are options to lessen symptoms and prevent further damage. The safest but most difficult way to slow the progress of arthritis is to lose weight by focusing on your diet and nutrition. Often times, the recommendation of losing weight is discouraging because the osteoarthritis has made it hard for the patient to exercise. 

Following an initial examination, your Sports Medicine doctor may recommend a combination of modified activity, physical therapy and or a strength training regimen. It may sound counterintuitive, but keeping the arthritic joint moving is a good way to control the pain. Acetaminophen is often recommended as a first step in pain relief, but non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen may also be used to reduce pain and inflammation in the joint. Regular daily anti-inflammatory use should be monitored by your regular family doctor.

In more serious cases there are a number of surgical options available from less invasive methods to total joint replacement. Your Sports Medicine doctor may refer you to an Orthopedic surgeon to learn more about the options available.

Hip Labral Tear

A hip labral tear is a tear in the ring of cartilage lining the socket of your hip joint. Athletes that play sports involving harsh torqueing motions from cutting and changing directions, like hockey, soccer, football, and ballet are at a higher risk of suffering a hip labral tears. Hip labral tears can occur over time by repetitive strain, but this usually starts becoming painful after 50 years of age. 

Sometimes, hip labral tears display no signs or symptoms. However, when there are symptoms, they typically can include pain in the groin. Other hip labral tear symptoms include:

  • A locking, clicking or popping sensation
  • Stiffness
  • Limited mobility and range of motion
  • A sensation that the hip is weak or wants to give away when bearing weight
  • Groin pain and less often pain in the side of the hip or buttocks

When your doctor examines your hip for a torn labrum, he or she will move your hip joint to evaluate your pain and range of motion. Your doctor may order an X-ray or even an MRI to further evaluate your symptoms.

The treatment your doctor recommends depends on the severity of the tear. Sometimes, a person recovering from a hip labral tear without surgery can take several weeks to months, but many require surgery to remove the torn part of the labrum. Non-surgical hip labral tear treatment options include:

  • Modified physical activities and avoiding movements that cause the labrum to be pulled or pinched
  • Occasionally complete rest
  • Physical therapy with special torn labrum hip exercises
  • Non-prescription pain relievers like ibuprofen or naproxen or acetaminophen (Tylenol)
  • Corticosteroid injections

Hip labral tear surgery can be used to remove the torn piece of the labrum or to stitch the parts of the torn labrum back together. Your Orthopedic surgeon will discuss which surgical labral tear treatment is right for you. Physical therapy is necessary after surgery to re-strengthen your hip. 

Growth Plate Injuries

There are a number of growth plates around the hip or pelvis that can be injured in adolescent athletes between the ages of 14 and 17. A majority of growth plate injuries are due to overuse or playing too much of one sport without adequate rest. One potentially serious type of growth plate injury is an avulsion or a separation of the growth plate. This often occurs with explosive kicking, jumping or sprinting activities. Muscle tightness, muscle imbalance and lack of proper warmup can increase the risk of these types of injuries.

Symptoms of a growth plate irritation happen quickly over the course of a few days to a week or two before they are too painful to tolerate. Growth plate separations happen suddenly and are dramatic. 

  • Sharp, sudden pain in front of the hip or in the groin
  • Tenderness at the front of the hip
  • Swelling and bruising
  • Inability to contract the muscle or feeling weak in the affected muscle

When examining your hip or pelvis your Sports Medicine doctor may check for tenderness and bruising around your hip, plus any signs of swelling or muscle weakness. The doctor who is evaluating you may order an X-ray or use an ultrasound machine to look at your tendon and growth plate. In some instances, even an MRI is necessary to further evaluate the injury. 

If you think you or your child has a growth plate injury of the hip, you should rest and apply ice to it immediately. Other non-surgical treatments your doctor may recommend include:

  • Immobilization, crutches and very aggressive rest for up to 6 to 8 weeks
  • Physical therapy after the pain and swelling have subsided

Some complete growth plate separations require surgery and in this case your Sports Medicine doctor may refer you to an Orthopedic Surgeon. 

How Sauk Prairie Healthcare Treats Hip Sports Injuries

At Sauk Prairie Healthcare, we strive to treat every person’s hip injury as a unique case to make sure they can return to the activities they enjoy. 

Our Sports Medicine doctors in Sauk Prairie, Lodi and Spring Green prioritize an aggressive non-surgical approach to treatments for all kinds of sports injuries, including hip injuries. For injuries requiring surgery, our Orthopedic surgeons will work with you to help your hip completely recover after your procedure. Our team also includes physical therapists , radiologists and certified athletic trainers  for complete care until you’re ready to return to play. 

Your Sauk Prairie Healthcare team will follow up with you through every step of the process after you are injured, from the first appointment until you have recovered and can safely get back up to speed. 

Our Sports Medicine Physicians:
Masaru Furukawa, MD, MS
David Krey, DO
Mark Timmerman, MD

To schedule an appointment with a Sports Medicine physician, call 608-643-7677.

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