The beginning of a new year! Everyone is bright-eyed and bushy-tailed, ready to start smashing their new fitness goals. Whether you’re a new runner or a well-seasoned one, this article will provide you with a summary of anterior (front) hip pain.
Fun always starts with a good disclaimer, so here’s mine as a physiotherapist: this article does not intend to diagnose or treat your anterior hip pain. If your pain persists and is hindering your daily activities, please visit a physiotherapist.
Anatomy
You have 5 hip flexors.
- Iliopsoas: consisting of the (1) psoas and the (2) iliacus muscle and are the only muscles that directly connect the lower limb and spine. These muscles play an important role in your posture and are the primary hip flexors. Both these muscles can cause back pain (due to assisting your questionable question-mark-posture at the desk). People that mainly work in a sitting position have these muscles in a shortened position the whole day which can cause stiffness and pain. Pain can be felt in the front of the hip or the groin. When this muscle becomes inflamed from overuse, it can cause a snap or painful click with certain movements – we call this Snapping Hip or Psoas Syndrome.
- Rectus Femoris: this muscle forms part of your quadriceps, thus it flexes the hip and extends the knee. This muscle can be activated to perform both functions, such as when you’re kicking a ball. This muscle typically starts to cause problems when the quadriceps aren’t strong enough when load is increased suddenly – especially when sprints are added.
- Sartorius: the longest muscle in the body. This muscle crosses the hip and knee joint as well, resulting in flexing the hip, adducting the leg and externally rotating the leg. The best way to describe this movement is kicking a ball across your body. If this muscle is affected, you can feel pain in the groin or even the inside of the knee. This muscle is typically affected when a runner overstrides.
- Pectineus: hip flexor and hip adductor (activated when kicking a ball across the body). A strain in this muscle results in pain on the inner thigh/groin area.
Not all pain in the front of the hip is a muscle strain. Other structures that can cause anterior hip pain are bursitis, tendonitis of the hip flexor muscles (due to constant overuse), stress fracture (considered when there’s pain on impact) and femoral nerve impingement.
Most Common Diagnosis
Snapping Hip Syndrome
There are 3 types of snapping hip: internal, external and intra-articular.
- Internal hip snapping – this is a snap occurring in the front of the hip but deeper into the tissue (not in the joint). This is caused when the iliopsoas tendon snaps audibly over the front of the femoral head when the hip flexors are contracting, feeling like the hip is catching or locking.
- External hip snapping – also called lateral snapping (at the side of your hip). This is caused by the ITB (iliotibial band) or glute tendons that move over the lateral (outside) part of the hip, making a loud click or pop (sometimes described as feeling like the hip is dislocating) when flexing, extending or internally rotating the hip and isn’t always painful. This snapping is visible when tested.
- Intra-articular hip snapping – the type of snapping that are worrisome. It can be labral tears (tear of the cartilage lining the joint), ligament of the femur tear or loose bodies of bone in the joint.
Iliopsoas Tendinopathy
Common occurrence with internal hip snapping due to the tendon getting inflamed with repetitive friction against the femur. Can occur independent of hip snapping with overuse when speed work and hills are added to the programme. Pain can radiate into the groin and lower back. Bursitis can be inflamed due to the tendon thickening with inflammation and irritating the bursitis when rubbing over it.
Strain
The 5 anterior hip muscles are affected during overuse or sudden increase in mileage or speed. Pain can radiate into the groin and can range from weakness pain to sharp and stabbing pain when running.
So, what can you do about this?
Stretching is not always the answer, and neither is complete rest. If you hear a popping sound and a sudden onset of pain, we might be looking at a tear, so stop what you’re doing, don’t push through the pain, and get yourself to a physiotherapist.
If pain persists over a few days and there is a gradual onset of pain, decrease mileage slightly, focus on strengthening and other low impact endurance activities (such as cycling and swimming).
Don’t ever stop with all activities completely, unless told so by a physiotherapist. Stopping all activities completely and then resuming increases your risk for injury significantly. Rather decrease and shift your load and monitor your symptoms.
Need a Physiotherapist?
Contact Elata Fourie, based at Traverse Health in Sugar Village.
Email: elata@traversehealth.co.za
Phone: (081) 318 4134
Direct Booking Link: https://traversehealth.co.za/make-a-booking/
