Lingering Hip Pain

author : AMSSM

comments : 3

I challenged myself to jog a mile...and I managed to conformably complete a two mile jog. However, the next day, I had a horrible tightness, pull type pain in my left hip area.

Member Question

I am in my late forties and am pretty physically active and fit for my age. I am not really a great runner, I prefer boot camp style workouts, etc. Last spring I felt good and strong and wanted to start running and I challenged myself to jog a mile...and I managed to conformably complete a two mile jog. I was so proud and felt good after the run. I was ready to start adding it to my workouts. However, the next day, I had a horrible tightness, pull-type pain in my left hip area. Like the hip was rusty. Definitely overused. I cooled off from the activity and maintained stretching until it went away. The pain no longer bothered me for a few weeks.

I then went out dancing with some girlfriends, no issues....but the next day I had the same problem I did after the running. Some days I feel nothing, other days its back again, just not so intensely. My doctor said it really appeared to be more in the pelvic area as I pointed  out that the pain occurs right over the big boney party of the pelvic bone on the front interior of the crest.  It is this weird pulling sensation on the front of the iliac crest - a very specific spot. It even hurts in the exact same spot sometimes when I cough. I then have a radiating ache to the crease of my leg on the front of the thigh, towards the outside...its seems to follow the curve of the pelvic crest (not the groin). I feel it the most as I try to get out of the car...stiffness, a dull ache pain. Once I start moving its fine. Movement makes it feel better. There is no tenderness when I press in the entire area. I can move my hip and legs with no reenactment of the pain.

I had an orthopedic go over it with me. He could not reproduce the pain in his manipulations. I have had an x-ray and an MRI. My MRI revealed a hip lesion on the opposite hip (my right) iliac crest. They did a bone scan of my pelvis and spine to rule out more lesions or active tumors.  The x-ray and bone scan came up negative. He thinks the lesion they found is likely a boney island. The problem is, the lesion was found on the other iliac crest...not the one that is bothersome. I was told if the other side hurts to come back and see him. In the meantime, my weird ache/pull pain on the other side is still there. It is intermittent, but none-the-less has never gone away. I have found nothing online that mimics my issue (most people have pain in low back or buttocks....mine is solely in the front to front side).  I'm frustrated and I'm back where I started with some hefty bills left to pay.  This pain never existed until after this run...so I must have injured something...they just cant figure it out.  Any suggestions? 

Answer from Stuart Lisle, MD
Member AMSSM

First off, it sounds like this has been a very frustrating problem to deal with! Clearly you have done your part in trying to figure out what is causing your pain. It is helpful to know that you have been to an Orthopedist and had an MRI performed. That probably makes scary things like tears and fractures highly unlikely. Also, if his maneuvers could not reproduce the pain, then another possible cause of this type of pain- Femoral Acetabular Impingement Syndrome, seems less likely as well. The most likely cause is tendonitis or inflammation of the muscle attachments near your iliac crest, where you are experiencing the pain. Another possibility could be iliopsoas bursitis, which is a small sac of fluid around this area that can also get inflamed in a similar manner.

This type of injury commonly happens with overuse or from problems with form or muscle imbalance. Since you did not seem to have an excessive increase in volume or intensity, I would guess it is more of a muscle imbalance issue. The anterior muscles of the leg (iliopsoas, rectus femoris, gracilis, and sartorius) function as the hip flexor. They connect the pelvic bone to the femur and help bring your leg up with your stride. Acutely, treatment is aimed at calming down the inflammation (ice, anti-inflammatory medications), however, the main treatment is physical therapy.

Physical therapy exercises should be aimed at stretching and strengthening the affected area. It sounds like you had success with stretching, and initially getting it to feel better, and now, hopefully adding in strengthening exercises will complete the recovery and help prevent reoccurrence.  Formal Physical Therapy is not completely necessary, but given how long you have struggled with this, I would recommend it. A PT can help show you good exercises for the hip area, such as eccentric exercises that will help strengthen while stretching the muscle. They will also be able to help out with any biomechanical issues, such as things like leg length discrepancies. Hopefully this helps, and I wish you luck in getting back out on the road!

Stuart Lisle, MD

(University of New Mexico Family Medicine Resident and Incumbent Sports Medicine Fellow)

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date: February 19, 2014