Hip bones. Image by Stephen Woods
Training > Injuries

Hip pain: diagnosis and causes

Sore hips, while common among triathletes, are difficult to diagnose and treat. Luckily 220 physio Emma Deakin knows the signs, symptoms and solutions for hip problems and injuries

Due to the demands of the sport, hip pain is a common occurrence in triathletes. It can be difficult to correctly diagnose and treat, as pain can come from structures within the hip joint itself, or from structures surrounding the hip joint. It may be felt in front of the hip as groin pain, on the outside of the hip, or at the back in the buttock.

The hip is the largest ball-and-socket joint in the body, connecting the thigh bone (femoral head) snugly into a cup-shaped socket (acetabulum) in the pelvis. It bears our body’s weight (up to six times in running) and the force of the muscles of the hip and leg. In addition the hip joint is also one of our most flexible joints and allows a large range of movement. Muscles, tendons and ligaments all support the hip, as well as several fluid-filled sacks or bursea. In short, there’s a lot to go wrong!

Most hip issues are simple and involve overuse or tendonopathies of the muscles that attach into the hip such as the hip flexors and hamstrings. Illio tibial band and piriformis syndrome are also common in running sports and need to be ruled out by assessment from a physiotherapist. If these common ailments have been ruled out, then a number of deeper structures may be responsible for your pain. Here we’ll look at three such injuries and the common signs and symptoms associated with them.

Labral tears

What is it? The labrum is a band of cartilage surrounding the hip, providing additional stability of the joint. The labrum can be torn or injured as a result of trauma, such as a fall or bike crash, but is most commonly caused
by repetitive trauma to the hip joint. Running with poor biomechanics or with ineffective muscle balance and function around the hip can be responsible. A labral tear results when a part of the labrum separates or is pulled away from the socket. 

What causes it? Hip labral tears may result from a combination of several different variables, including: bony abnormalities in the hip joint (hip impingement); hip muscle tightness; hip muscle weakness; poor technique or biomechanics with repetitive activities; and high volumes of running.

The signs and symptoms include: a deep ache in the front of your hip or groin; painful clicking or ‘catching’ with hip movements; increased pain with prolonged sitting; a sharp pain in the hip with end-range hip flexion.

Stress fractures

What is it? During running the hip joint has to absorb a lot of load. Repeated load and overuse can result in a stress fracture of the hip, most commonly the neck of the femur. A stress fracture is a small break in the bone in an area that is repetitively put under stress where the bone can’t recover. 

What causes it? Sudden increases in training load and volume; training when fatigued; poor run mechanics causing overload; unsuitable footwear; nutritional factors; low vitamin D levels; poor lower limb muscular conditioning. 

The signs and symptoms include: gradual onset; pain in the front of the hip or groin; pain when running (weight bearing activities); ache at rest; night pain.

Trochanteric hip bursitis

What is it? Bursas are small sacks of fluid, found between bones and soft tissues, particularly tendons. They protect the soft tissue from rubbing against the underlying bone, reducing friction. If the overlying tissues are too tight or biomechanically ineffective the bursa itself can sometimes become inflamed and irritated. 

There are lots of bursas around the hip joint, but the most commonly injured is the trochanteric bursa. It sits on the outside of the hip, over a bony protrusion of the femur (the greater trochanter), and separates the bone from the ilio tibial band.

What causes it? Overuse/repeated friction; large increases in run volume; muscle tightness (ITB); faulty lower limb biomechanics; weak glutes, causing overload through the hips; direct trauma
to the area. 

The signs and symptoms include: pain on the outside of the hip; pain worse after running; pain radiating down the side of the thigh; pain lying on the injured side; pain on palpation directly over the site of the bursea; swelling over the lateral side of the hip.

So as you can see, the hip is a complicated joint. It’s important to see a doctor or physiotherapist to get any issue correctly diagnosed, so that any investigations and treatment are effective. 

Go to page two of our guide to hip pain to see 5 hip specific stretching and strengthening exercises (2/2)

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