What’s that pain in the front of my hip?

Hip pain is a common complaint amongst runners and triathletes. For the purposes of this article, we will focus on pain in the front (anterior) of the hip. It is also possible to develop pain on the side and rear of the hip in isolation, or in combination with the front of hip pain I will describe.

There are several common anterior hip injuries that runners are susceptible to:

1. Hip flexor impingement: this is similar to impingement pain that can develop in the shoulders. The impingement is typically the iliopsoas muscle (hip flexor) that gets ‘pinched’ on the underlying bony structures of the hip. The causation of such pain can be multifactorial but may include factors such as; muscle weaknesses around the pelvis, adverse muscle tightness of key hip muscles, sudden increases in training, inappropriate footwear, and changes in terrain. There can also be congenital or inherited ‘ball and socket’ configurations of the hip that can predispose some runners to the development of hip impingement injury. These bony configurations can be a thicker femoral neck than normal (CAM deformity) or an extra bit of bone extruding from the ‘socket’ of the hip (pincer deformity). Plain film imaging can detect these two configurations of hip joint shape.
2. Tendon problems: typically if left unattended hip flexor impingement can progress into tendon related problems of the hip flexor tendon (iliopsoas). This can include the onset of a degenerative hip flexor tendon (tendonopathy) whereby the tendon begins to weaken and in effect ‘break down’ producing pain.
3. Bony injuries: this can range from stress reactions of the femur through to frank stress fractures (ouch!). Typically it is the femoral neck that is the site of the bony injury for runners. Key factors in the development of bony hip pain are often similar to that described above for hip flexor impingement.  Sudden increases in training intensity or volume are often noted in the athlete who has a bony injury of their femoral neck.

If you are suffering from front of hip pain than consult with your local healthcare provider or physiotherapist. Unfortunately without treatment and correction of the causative factors front of hip pain will rarely disappear with just rest alone. Happy running and pain-free training!

Brad Beer (APAM)

POGO Guru Physio

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