Hip Pain: 3 Most Common Causes (How To Tell What Is Causing It)
Unexplained Hip Pain
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About five years ago I had orthotics made because of bad heel spurs. Well, the spurs went away but now I have had hip pain in my right hip for at least two years and now my left hip is starting to hurt too. I am a 35 year old who loves to run. I try to run three to four miles four to five times a week. Well I haven't been running the past three days and still have pain. Could I have hip fractures and not know it? Or could it be my orthotics?
— Kat, Colorado
I doubt very much that your orthotics are causing hip pain, especially since you used them for three years before you experienced hip pain. I am more inclined to think of an athletic injury as the cause of your ongoing pain.
It would be good to know your height, weight, the exact location of your pain, and — if you are a woman — your menstrual history. Very often, patients refer to buttock pain as "hip pain." Pain originating in the hip joint is felt in the groin, and may radiate to the thigh and knee.
There are several pelvic and hip injuries that can occur in athletes:
- Muscle strains
- Iliotibial band syndrome
- Stress fractures
- Snapping hip syndrome
- Acetabular labral tears
- Hip osteoarthritis
- Sports hernias
- Nerve entrapment syndromes
I'll say a few words about each of these.
When a muscle is strained or pulled it typically causes pain and/or cramps. As a seasoned runner, I hope you are protecting your muscles by warming up and progressively increasing your running efforts.
Tendonitis is inflammation of the tendon sheath often due to microtrauma due to repetitive injury. A good example is finger tendonitis in garment industry workers (cutters), and patellar tendonitis in runners.
Bursitis (inflammation of a bursa sac) is either due to repetitive activity or acute trauma. In the pelvis and hip area, it may affect the trochanteric, ischial or iliopectineal bursa.
Tendonitis and bursitis can also be due to inflammatory joint diseases (rheumatoid arthritis, gout, reactive arthritis, infectious arthritis) or infections.
The trochanteric bursa is located at the outer aspect of the hip, the ischial is located on the buttock where we sit, and the iliopectineal is in the groin.
Iliotibial band syndrome causes sharp or burning pain at the outside of the hip and knee, which typically worsens with activity.
The previously mentioned problems can be improved with rest, temporary avoidance of the activity or motion that brought on the symptoms, cool compresses and nonsteroidal antiinflammatory drugs (ibuprofen, naproxen, indomethacin, diclofenac, celecoxib and others).
Stress fractures are probably the most serious of athletic injuries and are twice as common in collegiate women as in male athletes. A stress fracture is an overuse injury caused by repeated stress that is less than the stress needed to fracture the bone in a single loading. Stress fractures are common in runners, and occur especially in the leg bones (tibia and fibula) and in the metatarsal bones of the feet. Stress fractures of the hip and of the sacral bone can occur but are less common. Several factors contribute to the development of stress fractures: eating disorders; lack of ovarian function with menstrual disturbances or even no periods; and osteoporosis. These three factors are interrelated: if a woman's body has less that 20% fatty tissue, the ovaries do not function well and loss of bone occurs (osteoporosis). If the woman's diet is relatively deficient in vitamin D, which is essential for bone and immune system health, stress fractures are even more likely.
The best diagnostic test for stress fractures is MRI (magnetic resonance imaging). Treatment should include injury prevention and comprehensive rehabilitation. Return to running has to be gradual and can often be accomplished in six to eight weeks. Prevention is essential, because previous hip injuries increase the risk of recurrence. The ideal physician to consult is a sports medicine specialist, usually an orthopedic surgeon, or a rheumatologist. The coaches, trainers and physicians caring for runners should advise appropriate running regimens, shoes, surfaces, and techniques that minimize the risk of initial or subsequent hip injuries. Often training and conditioning programs should be individualized. Attention should be focused on the completeness of the diet with vitamin D and calcium supplementation.
The acetabular labrum is a piece of cartilage that completes the socket of the hip joint and at times may be torn.
You are too young for hip osteoarthritis, unless you were born with a congenital hip deformity, or had prior trauma to the hip joint. The MRI can detect osteoarthritis as well.
Your symptoms do not suggest a hernia or a nerve entrapment (pinched nerve).
At this point I suggest you try to find a good sports medicine clinic and suspend running until you get diagnosed and have a well-planned treatment and rehabilitation program.
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