From the Guidelines
Hip pain in an athletic adult is most commonly caused by femoroacetabular impingement (FAI) syndrome, dysplasia, and intra-articular pathology, including labral tears, chondral damage, and ligamentum teres tears. According to the study by Reiman et al, 2019, as cited in 1, these conditions are the primary causes of hip-related pain in young and middle-aged active adults. The study highlights the importance of early detection and effective management of hip-related pain, which can have a significant impact on quality of life, function, work capacity, and family life.
Some of the key causes of hip pain in athletic adults include:
- Femoroacetabular impingement (FAI) syndrome
- Dysplasia
- Intra-articular pathology, such as:
- Labral tears
- Chondral damage
- Ligamentum teres tears These conditions can result in significant disability and economic burden, emphasizing the need for standardized measurement methods to identify impairments and functional limitations, inform progression of rehabilitation, and evaluate the efficacy of evidence-based interventions 1.
The International Hip-related Pain Research Network (IHiPRN) was established to collaborate across research groups and disciplines, and to disseminate knowledge of hip pain to clinicians, with a focus on hip-related pain in young and middle-aged active adults 1. The network aims to provide recommendations for clinical practice and research on standardized measurement methods of physical capacity in this population. Therefore, it is essential to prioritize early detection and effective management of hip-related pain in athletic adults to prevent long-term damage and improve quality of life.
From the Research
Causes of Hip Pain in Athletic Adults
- Hip pain in athletic adults can be caused by various factors, including overuse injuries, labral and cartilaginous injuries, surrounding soft tissue derangement involving muscles or tendons, and osseous abnormalities 2.
- The differential diagnosis in adults is diverse and includes common entities such as stress fracture, avulsive injuries, snapping-hip syndrome, iliopsoas bursitis, femoroacetabular impingement syndrome, tendinosis, and tears of the gluteal musculature 2.
- Hip pain can be located anteriorly, laterally, or posteriorly, with different causes for each location, such as hip flexor injuries, labral tears, femoroacetabular impingement, greater trochanteric pain syndrome, and lumbar spinal pathology 3.
Specific Causes of Hip Pain
- Anterior hip pain can be caused by referred pain from intra-abdominal or intrapelvic causes, extra-articular etiologies, such as hip flexor injuries, and intra-articular etiologies, such as labral tears or femoroacetabular impingement 3.
- Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction 3.
- Posterior hip pain can be caused by referred pain, such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy 3.
Athletic Hip Injuries
- Athletic hip injuries, including adductor strains, osteitis pubis, athletic pubalgia, or core muscle injury, often with underlying range-of-motion limitations secondary to femoroacetabular impingement, can be debilitating and require timely diagnosis 4.
- Hip labral tears are found in 22-55% of individuals with hip pain, but labral tears without cysts are usually not responsible for hip pain, which originates mostly from other structures than the torn labrum 5.
Diagnosis and Management
- Diagnosis of hip pain requires a combination of history, physical examination, and imaging tests, such as radiography, ultrasonography, or magnetic resonance imaging 3.
- Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain, and advanced imaging and/or early referral may improve patient outcomes 3.
- Overuse injuries of the hip and pelvis can be managed with adequate rehabilitative management, including the correction of intrinsic and extrinsic risk factors and controlling abusive force loads that may have contributed to injury 6.