Member Case Study: Hip Pain, Difficulty Staying Aero

author : AMSSM

comments : 0

At the age of 44, I am experiencing extreme pain in my hip. I have been trying simple stretching and have found no relief.

Member question from llshort3254

I've been training for two years in triathlon and competing for one year. I had been a competitive power lifter for many years before. This year, at the age of 44, I am experiencing extreme pain in my hip. I have been trying simple stretching and have found no relief. The pain is the front inside, and when I move through a squat, the pain it is right in the crease. I cannot come anywhere close to a deep squat position, and I am having difficulty holding an aero position on my bike. Any advice will be helpful.

Answer from Billy Haug, M.D.

Member AMSSM

Hip pain is a common malady in the athlete, regardless of age. The etiologies may be diverse, but pain usually results from these categories:

1. Soft tissue -bursitis, tendonitis, or sprains

2. Muscle – contusions and strains

3. Bone – arthritis, stress fractures, or tumors

Most of the above may result from either an acute injury or chronic overuse syndromes.

When athletes describe pain as near the groin or “in the crease” as you have stated, I am not only concerned about muscles, but am also concerned about bony etiologies such as a degenerative disorder or femoral neck stress fracture. Degenerative joint disease is often slow in onset and may continue to progress over the years. Femoral neck stress fractures are seen especially in those athletes involved in endurance sports, and may progress to a more serious problem (necrosis) if not found early enough.

Aging athletes are at much greater risk of developing degenerative arthritis in the hip joint. Several factors may predispose athletes to this condition, including previous acute or chronic injuries to the structures around the hip, obesity, and genetic factors. If the pain stems from degenerative joint disease, different treatment methods can be implemented to help reduce pain. Continued physical activity is an important part of keeping the pain in check. It can often be difficult, however, for patients to keep up with activity because of pain.

Physical therapy may assist with rehabilitating the low back, hips, and pelvis, and improving core strengthening. Finding a good pair of orthotics for your shoes may also prove helpful in certain cases. These may be purchased over the counter or they may also be customized to fit your feet. Finally, there are medications that may be taken to help control pain that you may discuss with your physician.

If a femoral stress fracture is present, then an altogether different treatment plan may be implemented. Usual treatment options for a stress fracture include rest and non-weight bearing activities. Surgery is sometimes necessary depending on the severity and progression of the fracture.

My advice at this stage would be to make an appointment with a primary care physician who is knowledgeable about sports related injuries. Give your doctor a thorough history explaining the quality, timing, severity, and nature of the pain. After a thorough exam, your physician may choose to perform x-rays which may lead you toward or away from certain etiologies discussed above. If more advanced imaging is required, an MRI may be able to better assess both bone and soft tissues (such as the labrum) deep inside the hip.

The sooner the correct diagnosis is made, the sooner you’ll be back out there training hard for the swim, the bike, and the run!

Billy Haug, M.D.
Primary Care Sports Medicine, Altru Clinic, Grand Forks, North Dakota.

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date: January 14, 2008