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EPISODE 40: Anterior Hip Pain - Causes & Treatment


Many people experience pain in the front of their hip but they do not know what it his or how it came about. Often times people just try to live with it or push through it within their daily activities until it stops them from participating in their hobbies or sports. There could be many reasons for pain in the front of the hip. In this blog post we will review the different types of anterior hip pain, symptoms, causes and some easy things you can do on your own to start reducing your pain. If you are having pain in the front of your hip this blog is for you!


Let's start with some anatomy!


The hip is a complex joint with various muscles that work together to support movement and stability.

It plays a crucial role in:

  • Weight-bearing and Support

  • Mobility and Range of Motion

  • Connection between the Trunk and Lower Limbs

  • Power Generation

  • Posture and Stability

  • Transmission of Forces

  • Pelvic Movement


hip anatomy

The hip is a highly stable and weight-bearing joint. It is a ball-and-socket joint and is made up of:

  1. Bones

  2. Articular Surfaces

  3. Joint Capsule

  4. Synovial Membrane

  • inner lining of the joint capsule is the synovial membrane, which secretes synovial fluid to lubricate the joint, reducing friction and allowing smooth movement.

  1. Ligaments

  2. Iliofemoral Ligament: on the anterior hip joint and is one of the strongest ligaments in the body. It helps prevent hyperextension of the hip joint.

  3. Pubofemoral Ligament: on the anterior-inferior aspect of the hip joint, it also contributes to stability by limiting excessive extension and abduction.

  4. Ischiofemoral Ligament: on the posterior side of the hip joint, it helps limit hyperextension.

  5. Muscles:

    1. Hip Flexors (e.g., iliopsoas, tensor fasciae latae (TFL), rectus femoris)

    2. Hip Extensors (e.g., gluteus maximus)

    3. Hip Abductors (e.g., gluteus medius/minimus, tensor fasciae latae (TFL))

    4. Hip Adductors (adductor magnus, longus, brevis)

    5. External Rotators (e.g., piriformis, gemellus superior, gemellus inferior, obturator internus/externus),

    6. Deep Hip Stabilizers (e.g., quadratus femoris, obturator internus, gemellus superior, gemellus inferior, piriformis)

  6. Blood Supply: from branches of the femoral artery, which provide nutrients and oxygen to the joint structures.


Because the hip is so complex, there can be many reasons for hip pain in general, but in this post we are covering causes for anterior hip pain.


The 5 major reasons for Anterior Hip Pain are:

  1. Muscle Strains

  2. Hip Flexor Tendinopathy

  3. OA

  4. Labral Tear

  5. Hip Impingement


Let's go over each of these pathologies!


(1) Muscle Strains

Muscle Strains involve the stretching or tearing of the muscles surrounding the hip region. Strains can occur when these muscles are subjected to excessive force, overuse, or sudden movements.

Causes:

  • overuse or repetitive stress on the hip muscles as seen in activities like long-distance running & sports like soccer

  • sudden twists and turns in sports

Symptoms

  • Pain

  • Swelling

  • Bruising

  • Weakness

  • Limited range of motion


(2) Hip Flexor Tendinopathy

Hip flexor tendinopathy refers to a condition characterized by pain and dysfunction in the hip flexor tendons. The hip flexors are a group of muscles that allow the hip joint to flex or bend. Tendinopathy refers to any pathology or damage to a tendon, which is the fibrous tissue that connects muscles to bones.

The hip flexor tendon that may be affected is the iliopsoas tendon, which is a combination of the psoas major and iliacus muscles' tendons combined.

Causes:

  • overuse

  • repetitive strain

  • poor biomechanics

  • muscle imbalances

  • sudden injuries

  • inadequate warm-up

Symptoms:

  • Pain in the front of the hip or groin area

  • Tenderness when pressing on the tendon

  • Swelling

  • Stiffness in the hip joint

  • Weakness in the hip flexor muscles


(3) Hip Impingement

Aka femoroacetabular impingement (FAI), is a condition where there is abnormal contact between the femoral head and the acetabulum. This abnormal contact can lead to friction, wear and tear of the hip joint, and can contribute to the development of hip pain and labral tears.

There are 3 main types of hip impingement:

  1. Cam Impingement: excess of bone on the femoral head, usually on the front and upper portion.

  2. Pincer Impingement: excessive coverage of the femoral head by the acetabulum due to an overgrowth of the acetabular rim.

  3. Mixed Impingement: combination of both cam and pincer impingements.

Causes:

  • genetic predisposition

  • abnormal hip joint development

  • repetitive activities & sports that involve hip flexion & rotation

Symptoms:

  • Pain in the hip or groin area, often worsened by certain movements or activities

  • Decreased Range of Motion

  • Stiffness in the hip joint

  • Catching or Clicking Sensation


(4) Osteoarthritis (OA)

Osteoarthritis (OA) in the hip is a degenerative joint disease that primarily affects the hip joint. Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage that cushions the ends of bones wears down over time. As a result, the bones in the affected joint begin to rub against each other, leading to pain, stiffness, and reduced mobility. OA can effect the articular cartilage, synovial membrane, and bone.

Causes:

  • age

  • genetics

  • joint overuse

  • previous joint injuries

  • obesity

Symptoms:

  • Pain in the hip joint, often exacerbated by weight-bearing activities

  • Stiffness especially after periods of inactivity

  • Decreased range of motion

  • Swelling in the joint


(5) Labral Tear

A labral tear refers to damage or injury to the labrum, which is a ring of cartilage that surrounds the socket of a joint. It's role is to provide stability to the hip joint, cushion the joint, and help distribute load forces during movement.

Causes:

  • trauma: a direct injury or impact to the hip joint, such as a fall or sports-related injury

  • repetitive movements like excessive twisting in certain sports or occupations

  • structural abnormalities

  • Hip Impingement

Symptoms:

  • Pain in the hip or groin area.

  • Catching or locking sensation

  • Decreased range of motion

  • Clicking or popping


Now that we have covered the 5 common reasons anterior hip occurs we can move the FUN PART....Treatment! Treatment options for anterior hip pain pathologies are very similar.


They include:

  1. Activity Modification: Avoiding activities that exacerbate symptoms, for example if it hurts to squat deep, squat to the level above the pain.

  2. Lifestyle Modifications: Managing your weight to reduce the load on your hip, participating in routine exercise to keep your hip moving

  3. Ice and Anti-Inflammatory Medications

  4. Joint Supplements: Glucosamine and chondroitin supplements for joint health

  5. Joint Injections: Corticosteroid injections into the hip joint can sometimes reduce inflammation and pain

  6. Assistive Devices: Canes, crutches, or braces can be used to help reduce joint stress and improve stability

  7. Surgical Intervention: In cases where conservative measures are ineffective, arthroscopic surgery may be considered to address the impingement, reshape the bones, and repair any associated labral tears

  8. Physical Therapy: Lastly... Our FAVORITE! Specific exercises to improve joint mobility, strength, and flexibility


Physical Therapists oversee the rehabilitation process to ensure you are incorporating all of the treatments above needed and we guide this process from the beginning to the end. We ensure that you are doing the right things at the right time depending on the severity of your hip pain and what phase you begin treatment at.


In the Beginning Phase we focus on:

  • decreasing pain, swelling and tenderness

  • increasing ROM

  • Improving Mobility and Flexibility

In the Middle Phase we focus on:

  • improving balance, stability & control

  • improving strength

In the Final Phase we focus on:

  • improving power, speed, agility, and sports performance


Physical therapy may vary for each of these conditions based on the limitations you present with. If you want to find out how we approach PT differently for each of these conditions head to our YouTube page and watch our full podcast for this Topic. You can also listen to it on the platforms listed below. If you are experiencing anterior hip pain the BEST thing you can do is get a Physical Therapy consult. Sometimes there are some simple and very effective exercises that you can start implementing that will help your hip immediately start feeling better. Other times you may need some intensive work to restore mobility, flexibility, stability and strength in your hip joint. Either way suffering through it is not helpful! Find yourself a PT to help you!


If you are struggling with an hip pain, don't wait- get it checked out! Reach out because we would love to help you! We work with clients on-site and virtually through Telehealth.


Click here if you are interested in booking a session or getting more information! https://www.physicaltherapysanpedro.com/sports 

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Much Love <3 ,


The PTSP Docs

Dr. Brown, Dr. Bay, Dr. Yana







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