Hip Joint Pain

author : AMSSM

comments : 0

Deep in the right hip joint, there's dull pain. It only hurts when I stretch or try to cross my right leg. Sometimes on long runs, it will begin to throb. What can I do to rid the pain in the hip?

Member question

Deep in the right hip joint, there's dull pain.  It only hurts when I stretch or try to cross my right leg.  Sometimes on long runs, it will begin to throb.  I have also developed runners knee on the right knee.

Some background: 2011 (Sept) I was hit by a car on my left side.  I have gone through therapy for a torn PCL (no surgery).  Can the runners knee and hip be from some type of compensation on the right leg from the accident?

What can I do to rid the pain in the hip?

Answer by Sam Schimelpfenig, MD, FAAP
Member AMSSM

The treatment of hip and pelvis-related problems continues to evolve as we develop better diagnostic and treatment modalities.  Based on what you have told me, I would be concerned about an underlying issue in your hip joint.

A few of the less serious problems involve strains of the various muscles or tendons in the hip region.  A strain of the hamstring muscle (a hip extensor as well as a knee flexor), the adductors (i.e. a pulled groin), a rectus femoris strain (a proximal injury near the muscle’s origin at the hip is more likely to result in chronic symptoms), or rarely a strain of the iliopsoas muscle (another hip flexor that can result in lingering symptoms when injured) can cause pain in the hip region.  Muscle strains usually result from a specific event, but they can be more insidious in onset and result in lingering, non-specific symptoms over time.  Pain from a muscle strain is usually associated with certain movements or activities, as it seems to be in your case.

Bursitis is another possibility.  A bursa is a small, fluid-filled sack that acts as a cushion between bones and overlying muscles and tendons; they occasionally become inflamed and painful.  Iliopsoas bursitis, in particular, causes pain in the anterior hip region and can accompany an injury of the iliopsoas muscle or tendon.

The most concerning cause of your symptoms would be problems involving the bones of the hip joint.  A stress fracture of the neck of the femur usually results in hip pain that worsens with weight-bearing activity; typically this injury is associated with a change in the one’s activity such as significantly increasing intensity or duration of training.  Osteitis pubis is a process affecting the symphysis pubis and can result in vague hip symptoms.  Intra-articular disorders would include tears of the labrum of the hip, femoral-acetabular impingement, or arthritis – all of which could cause lingering hip pain.

You are not describing any symptoms specific to a nerve injury (i.e. numbness, tingling, or weakness), but some nerves when they are compressed can cause non-specific discomfort.  Another rarer possibility would be an injury elsewhere that is having referred pain in the hip region.  Hernias and problems from the abdomen itself such as gastrointestinal, genitourinary, or gynecologic systems all can have pain that is sometimes felt in the hip region.  Often these possibilities are pursued after evaluation for more common diagnoses fails to identify the source of the pain.

As you have postulated, it is possible that your biomechanics have become altered following your history of a motor vehicle accident and PCL injury and that one of the above injury patterns has been the result. Depending on the actual cause of your symptoms, treatment can involve simple stretching/strengthening exercises, formal physical therapy, or even surgery.  I would recommend that you see a physician to discuss your symptoms in greater detail and conduct a thorough physical exam; imaging studies such as an X-ray or an MRI may also be needed to help identify the problem.

I hope that helps, and wish you all the best!

Sam Schimelpfenig, MD, FAAP
CAQ Sports Medicine
Avera McGreevy Clinic, Sioux Falls SD

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date: July 18, 2012