Take hip pain seriously

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Andrew L. Rosen, MD

Many runners will experience some discomfort in their hips if they push their mileage and intensity during training. Most pain in the legs for runners is muscular in nature and is often the result of weakness and tightness of the supporting muscles. Classified as ‘tendonitis’, these conditions will often improve with simple treatments such as rest, anti-inflammatories, stretching and strengthening. Unfortunately, not all pain in runners is benign in nature. The excess forces on the bones of the legs in runners can create stress fractures in any part of the leg, from the pelvis to the foot. Most stress fractures of the legs are painful but also benign and heal uneventfully with a period of rest.

The hip is a unique joint
The hip is a special area because of the angle of the hip bone (femur) that receives substantially increased force with weight bearing compared to any other part of the leg. This bone has a potential to fully break (fracture) which can be catastrophic. A full fracture of the hip requires surgical treatment with insertion of large metal screws. The long-term consequence of these fractures can be even worse with bone necrosis which could even require a hip replacement.

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How to diagnosis a stress fracture
Because of the unique severity of stress fractures of the hip, sports medicine doctors are often much more aggressive with diagnosing hip conditions with an MRI scan which is usually able to determine if a fracture is present. The MRI also gives us information on how severe the fracture is and helps estimate the risk of complete fracture.

Signs of a possible stress fracture of the hip
• Pain located in the groin or front of the top thigh area
• Pain with contact of the leg on the ground
• Pain that worsens during a run

Should a runner get their hip checked?
The hip is one area that demands medical attention for pain that does not improve quickly. Not every ache in the hip requires an immediate trip to the orthopaedic surgeon, however pain that doesn’t improve with basic rest should be considered carefully.

It is especially important to be certain that a stress fracture isn’t present if soreness in the hip is present prior to a long race. Every year, marathon medical services are called to assist a runner who falls down when a full fracture occurs during a race. This is an avoidable catastrophe that informed runners should all be able to avoid.