Hip pain in athletes not easy to diagnose

Hip pain is a frequent injury in athletes who participate in sports requiring running and jumping. The variability of presenting symptoms and pathology make correct diagnosis and treatment a challenge. 

The hip joint is a ball and socket joint between the femur (thigh) and the pelvis. The head of the femur articulates with the acetabulum of the pelvis.

The pelvis is made up of three bones: the ilium, ischium and pubis. These bones come together in the acetabulum. A cartilaginous rim around the acetabulum called the labrum holds the femur in place.

A complex network of ligaments, nerves and blood vessels holds this joint together. Injury to any of these structures can result in pain that is often difficult to localize.

Athletes typically suffer from a variety of overuse syndromes of the hip. The pain in these syndromes is the result of inflammation, arthritis and fractures. Hip pain in young athletes is often related to overuse and can lead to lifetime difficulties unless activities are restricted.

Direct trauma to the pelvis can result in hip and pelvic fractures. A “hip pointer injury” is often seen in high-velocity collision sports like football and hockey when a blow to the rim of the pelvis results in hemorrhage.

Hip pain can also be referred to the low back and be mistaken for a spine injury. Only after careful examination by a qualified physician can the differential be clarified.

“The treatment of hip injuries in elite and recreational athletes is finally beginning to catch up to the treatments we know are routinely successful for shoulder and knee injuries,” reports Dr. Michael Joyce, Co-Director Connecticut Sports Medicine Institute. “Minimally invasive arthroscopic procedures allow athletes the potential to come back from injuries that were once considered career-ending.”

Early diagnosis and treatment are critical to resolving hip pain in athletes.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu