Disclaimer: Hip pain is complex but rarely harmful. However, the following section is meant for educational purposes only and not to diagnose any conditions. You should always consult a medical professional before attempting any treatments when experiencing pain.
Our goal is to simplify your understanding of why your hip hurts. Here are a few common causes of painful hips:
FAI (Femoroacetabular Impingement) happens when there's too much bone in the hip joint, causing it to rub and affect the integrity of the cartilage in and around the hip joint. FAIS (Femoroacetabular Impingement Syndrome) includes not only the bone issue but also the pain and movement problems that come with it.
People with FAIS usually feel groin pain and have trouble moving their hip fully, especially when bending or twisting. Tests can show weak hip muscles, particularly the hip abductors (moving your thigh away from your midline) and rotators. FAIS can be confused with other hip problems, like arthritis or stress fractures, so doctors need to do careful tests to figure out the right issue.
Treating FAIS with physical therapy involves modifying activities that cause pain, educating patients about their condition, and focusing on strengthening and flexibility exercises that avoid painful movements. Joint mobilization techniques can reduce pain and improve hip movement, while motor control exercises ensure proper form. For those with athletic goals, specific return-to-play tests, including jumping and sprinting, assess readiness. A comprehensive program includes exercises for pelvic stability and endurance, with gradual increases in the range of motion as tolerated.
A potential source of anterior hip pain is the iliopsoas tendon or the iliopectineal bursa, which reduces friction between the tendon, the pubic bone, and hip joint capsule. Internal snapping hip syndrome occurs when the iliopsoas tendon snaps over the hip capsule and femoral head (the ball of your thigh bone), often described as a snapping or popping sound during hip movements.
This condition is common in athletes and is usually a non-contact overuse injury caused by repetitive movements like running and kicking. Excessive friction can lead to inflammation and structural changes, and pain is a clinical challenge during rehabilitation, especially after hip surgeries. Diagnosis involves a detailed history, symptom description, and physical examination, including palpation and tests to identify muscle tightness.
Patients with iliopsoas complex injuries, such as internal snapping hip, should modify activities that cause pain, especially those involving repetitive hip flexion and extension. This might reduce overall activity, so athletes should try alternative exercises like cycling, elliptical training, or aquatic exercises to prevent deconditioning.
Addressing deficits in range of motion and muscle flexibility is important and can be done through stretching, soft tissue mobilization, and proprioceptive neuromuscular facilitation techniques. Strengthening the lumbopelvic, hip, and lower extremity muscles should be gradual to avoid exacerbating symptoms.
Return to sport should only occur when the patient can perform all exercises without pain and has no significant strength asymmetries.
Lateral hip pain typically involves the greater trochanter bursa, iliotibial band, gluteus medius, and gluteus minimus tendons, where they attach to the greater trochanter (a structure on the outside portion of your upper thigh bone). This condition, known as greater trochanteric pain syndrome (GTPS), affects women and individuals aged 40 to 65 more commonly but can also occur in younger, athletic populations.
GTPS arises from movement dysfunctions, such as excessive adduction (bringing the thigh bone inward) and internal rotation during weight-bearing tasks, leading to stress on the gluteal tendons. Symptoms include lateral hip pain and pain during activities like lying on the affected side, standing, walking, climbing stairs, and sitting.
Repetitive motions like running or kicking can be problematic in athletes. Diagnosis involves assessing hip abductors, external rotators, and lumbopelvic muscle strength and endurance.
Key treatment goals for GTPS include reducing pain, protecting tissues, and strengthening gluteal muscles to manage the load on the greater trochanter. Activity modification is important, such as avoiding movements that trigger pain, like repetitive hip flexion and extension.
Alternative exercises like cycling or swimming can prevent deconditioning for athletes. It is crucial to address hip flexibility and strength, especially in the hip abductors and lumbopelvic muscles. Stretching and strengthening exercises should be tailored to avoid excessive compression of the gluteal tendons. Motor control exercises focusing on hip stability and proper movement patterns are also beneficial.
Piriformis syndrome is characterized by buttock pain, which may or may not include sciatica, caused by the entrapment of the sciatic nerve. This nerve typically exits the pelvis below the piriformis muscle. Causes of piriformis syndrome can include anatomical variations, direct trauma, overuse, muscle hypertrophy, shortening, or prolonged compression.
Common symptoms are buttock pain, pain when sitting, and pain during movements that stretch the piriformis. Due to the muscle's deep location, diagnosing piriformis syndrome can be challenging, but palpation techniques and specific tests are useful.
The primary goal in treating piriformis syndrome is to reduce muscle irritation and alleviate sciatic nerve compression. Helpful tips include postural modifications to avoid positions that worsen symptoms, such as sitting with legs crossed, lying with the leg crossing the midline, or sitting on a wallet for long periods.
Soft tissue mobilization techniques can help reduce muscle tightness and pain but should be discontinued if they increase symptoms. Stretching exercises should be introduced gradually, avoiding aggressive stretching, especially if the muscle is highly irritated.
Strengthening the gluteal muscles is also important to prevent overuse of the piriformis. Lumbopelvic strength and endurance exercises are recommended if there is a history of related dysfunction.
IFI is a condition defined by decreased space between the back side of the thigh bone and the sitting bone, known as the ischiofemoral space. This causes movement-related pain in the region below or around the glutes. IFI occurs when the hip's movement results in bony impingement, irritating the quadratus femoris muscle.
Common symptoms include deep buttock pain, worsened by activities like walking, running, or kicking, and sometimes associated with groin discomfort.
Treating IFI involves activity modifications to reduce symptoms, such as avoiding movements that cause impingement. Early rehabilitation may include soft tissue mobilization and stretching exercises to address muscle tightness and joint stiffness, especially focusing on the hip abductors and external rotators for stability.
Motor control exercises should be progressively introduced to ensure proper movement quality.
Adductor muscle injuries are common in athletes, particularly those in sports like soccer and ice hockey. These injuries typically cause pain in the inner upper thigh region, with the adductor longus being the most frequently injured muscle. Injuries can be acute, overuse, or acute-on-chronic, often occurring during rapid transitions from hip extension to flexion or due to repetitive loading in activities like skating.
Diagnosis involves assessing pain characteristics, mechanism of onset, and risk factors. Strength and flexibility tests are used to evaluate the injury. Concurrent lower abdominal muscle involvement, known as athletic pubalgia is possible, so careful evaluation is needed.
For acute injuries, treatment begins with a focus on protecting the tissue and controlling symptoms, including a gentle range of motion and stabilization exercises. Strengthening should progress from isometric to isotonic exercises, focusing on hip abductors and external rotators.
Stretching can be added once symptoms are stable. Rehabilitation aims to balance adductor and abductor muscle strength, ideally achieving an 80% strength ratio to prevent further injury.
For athletes, return-to-sport criteria should include strength, endurance, and sport-specific training.
Experiencing hip pain after running can be a sign of underlying musculoskeletal issues, and understanding the stages of severity can help you address the problem early. In the beginning, you might notice mild discomfort that only appears after intense running sessions. This early stage suggests that the condition is still manageable and hasn't significantly affected your hip function.
However, if the pain starts to appear during your runs and not just afterward, it indicates a progression to a more moderate stage. At this point, it's important to pay attention and consider interventions to prevent further deterioration. As the condition worsens, the pain may persist throughout your run and continue afterward, severely impacting your performance and daily activities. Conditions such as Ischiofemoral Impingement (IFI), piriformis syndrome, and Greater Trochanteric Pain Syndrome (GTPS) can all contribute to hip pain after running, each with its own specific symptoms and treatment approaches.
Addressing hip pain early, when it's only noticeable post-activity, can prevent it from escalating to a stage where it interferes with your running and overall quality of life. Consult a healthcare professional to evaluate your symptoms, and consider incorporating targeted exercises and modifications to your running routine to manage and mitigate hip pain effectively.
For more detailed information, read the sections above on IFI, piriformis syndrome, and GTPS.
Hip pain when sitting can be a troubling symptom, often indicating underlying musculoskeletal conditions. Initially, you might feel mild discomfort only after sitting for long periods, suggesting the condition is still in its early stages and hasn't yet significantly impacted your mobility or daily activities.
As the pain becomes more frequent or severe, it may indicate a more advanced stage of a condition. Key contributors to hip pain when sitting include Femoroacetabular Impingement Syndrome (FAIS), piriformis syndrome, and Greater Trochanteric Pain Syndrome (GTPS). Each of these conditions has unique symptoms and requires specific treatment approaches.
Early intervention is crucial to prevent the progression of hip pain. By consulting a healthcare professional, you can accurately diagnose the cause of your pain and implement targeted exercises, posture adjustments, and other strategies to manage and alleviate your symptoms. For further details on these conditions and how to address them, read the sections on FAIS, piriformis syndrome, and GTPS.
To be able to tell with more certainty what is causing your hip pain, we recommend an assessment from a licensed medical professional or book a call with one of our licensed Doctors of Physical Therapy.
