Hip Stretch #1: Pigeon Pose

My personal favorite Hip stretch is the pigeon pose.  It targets several areas of your hip, gluteus, and even your hamstring to a lesser extent.  You want to aim for 2-3 sets of this stretch, and try to hold it for at least 30 seconds (with this particular stretch you can hold it for multiple minutes comfortably).

 To Perform:

1. Start by getting into a semi-lunge position with your front leg a little bit to the opposite side
2. Slowly bend your front leg to the side (Picture 1), if you are having trouble move your front foot closer to your other knee to decrease the angle
3. Ease into the position by leaning forward (Picture 2) until you feel a solid stretch and hold for an appropriate amount of time

Hip Stretch #2: Butterfly Stretch

The butterfly stretch is better known as a groin stretch, but is also a good stretch to loosen the Hips.  Remember that the hip joint and the groins share a lot of common muscles to perform their respective functions.  The butterfly stretch will allow you to open up your Hip and get a good stretch while also stretching your groin and adductors.

To Perform:

1. Sit on the floor with your legs out in front of you
2. Put the soles of your feet together as much as possible
3. Pull your feet towards you using your hands on your ankles
4. Push down on your knees using your elbows until you feel a good stretch

This article will cover all the various aspects of Hip pain, including the causes, diagnosis, treatment, and prevention techniques you can use in the future.

Hip Pain Overview

Hip pain is often associated with hip joint pain, and rightly so since the joint is the main component of the Hip.  However, in the context of this article, we will explore pain in the hip region in general, not limited to the joint itself.  The hip region pertains to the muscles, tendons, bones, and structural components that are in immediate conjunction with the hip joint.

Hip Pain Causes

Conditions

Arthritis

Arthritis is a well-known condition that can affect many parts of the body, including the hip.  The most prevalent type of hip arthritis is Osteoarthritis, which usually targets people as they become older (especially when overweight).  Arthritis is caused by cartilage (present in joints to protect bones) being worn down over time.  When the cartilage is reduced to a certain point, you will experience hip pain as a result of bones being exposed.

Bursitis

Bursitis is another condition that can occur anywhere in the human body that bones are present.  There are structures called bursae that act as cushions for your bones against other structures in your body (picture a small gel pack structure).  Bursitis of the hip occurs when the bursae near the hip joint become inflamed via a strain or trauma.  Based on the injury mechanism, it makes sense that bursitis typically is mostly seen in athletes, especially in contact sports.  The inflammation makes the bursae interact with structures it is not meant to and can cause significant hip pain depending on the degree of inflammation.

Osteonecrosis

This is one of the worst afflictions you could have; osteonecrosis is the deterioration and eventual ‘death’ of a bone, in this case part of the hip joint.  It is caused by a lack of blood to the region that results in the bones not being maintained sufficiently.  This condition needs to be caught early or bones will become extremely brittle and will be extremely susceptible to breakage.

Sciatica

The sciatic nerve runs down the back of your leg starting just above your hip in your lower back.  When this nerve is pinched or damaged, which is possible via several mechanisms (damage, nerve inflammation, etc.), it can cause many different types of pain; the group of symptoms is referred to Sciatica.  Typically pain from Sciatica is felt either in the lower back or gluteus, and can range from a dull radiating pain to a sharp pain felt sporadically.

Snapping Hip Syndrome

Snapping hip syndrome is typically classified as a hip flexor injury, but can also be seen as a hip injury.  The injury is developed when someone repeats a movement too often for their level of fitness.  When the movement involves bending or rotation of the hip, inflammation can occur as a result.  Typically the IT band is the culprit of the ‘snapping’ sound that is heard when the movement is repeated as it gets caught on a bone or structure near the back of the leg.  While not always, in most cases the snapping will be associated with hip pain.

Tendonitis

Much like snapping hip syndrome, tendonitis is an overuse injury that results in inflammation of a tendon, in this case one of the tendons in the hip region.  The inflammation of the tendon causes it to interact and rub against other internal structures causing pain in the region that can be sharp or dull depending on severity.

Injuries

Fracture

The most common serious hip injury in elderly people is a fracture.  This can be caused by many things, sometimes from some of the conditions explained above that weaken the structural integrity of the hip bones.  Depending on the person and the cause, surgery may be necessary to repair the hip.  The hip pain is easily recognizable as an extremely sharp sensation in the hip region and an inability to move the hip freely or at all.

A second type of fracture is a stress fracture, typically seen in high endurance athletes.  The repetitive stress over a long period of time, like in long-distance running can cause a micro fracture to occur in the hip.  The fracture will get bigger if the activity is continued; however, most cases of hip bone stress fractures are treated solely from rest.

Muscle Strain/Pull

The most common pulls in this region are found in the form of a hip flexor strain.  Briefly, the cause of a pull is from an explosive or awkward movement that causes a tear of some magnitude in the muscle.  Every time the muscle is used pain will be felt, and in the case of certain hip muscles, hip pain will be felt.

Diseases

Developmental Dysplasia

In some cases, a child does not develop properly, sometimes in regards to the hip.  Typically there is no hip pain as a child, but the effects are later seen as they grow and age in hip pain and early arthritis.

Legg-Calve-Perthes disease

One specific type of disease related to the hip is Legg-Calve-Perthes disease.  It is often found in children, usually males, and is related to osteonecrosis.  The leading theory of the cause is one of the hip bones has a lack of blood, occasionally both do, and becomes flat when it collapses, but no one knows for sure yet.

Hip Pain Treatment

The most important thing that I cannot stress enough is to go see a medical professional.  The internet is a great tool for understanding things better, but every type of pain is different and unique to you; in other words, self-diagnosis based on things you read will not be accurate enough to rely on for treatment.  If you would like more information on Hip Pain Causes check out our other articles.

There are however, some general things you can do:

• Anti-inflammatory pills: If you think there is a good chance your pain is caused by inflammation as described above, these can help short term before you see a doctor.
• Relax: Do not do anything that aggravates the pain, especially if you suspect a fracture is the culprit.
• Temperature: Again, if you suspect inflammation you can use ice to help control it temporarily.  If you are over 60 and suspect a blood flow problem coming on you can see if heat helps it feel better.

One final note: Hip pain can affect anyone regardless of age or fitness level and it can be very serious.  The first thing you should do is go see a doctor as soon as possible to get the problem diagnosed professionally.

Hip Bursitis Causes

The leading causes of bursitis come from athletic events, although it can be obtained in day to day activity.  Typically bursitis is caused as a result of some sort of strain or a blunt force to the hip region.  The impact can either damage the bursae directly or damage surrounding structures which results in bursa inflammation.

Hip Bursitis Diagnosis

The diagnosis of this condition relies on information about where and when the pain is occurring.  It is very difficult to scan the area for inflammation, so X-rays are typically only used to rule out other conditions with similar symptoms.

The location and intensity of the pain is very important to make a diagnosis.  Typically the following types of pain indicate bursitis:

• Pain in the hip during movement or when pressed upon
• Long lasting dull pain on the outside of the hip
• Trouble climbing stairs or performing activities with significant hip flexion.

Hip Bursitis Treatment

Initially the doctor will administer and local anesthetic using an injection to the area to confirm the diagnosis.  If the patient has bursitis he or she will experience immediate relief which will last temporarily.

Once home however you can treat the inflammation with anti-inflammatory over the counter medication, ice, and most importantly rest.  Stretching typically causes more pain, but if no pain is felt gentle stretching can be applied.  Try to avoid strenuous activity or any activity that causes you pain until you are fully healed.

If you don’t see improvement in a few weeks go see a doctor, more drastic treatment options like drainage may be necessary.

Currently there is a very low rate of complication from this type of surgery which is great, now assuming you have had the surgery and have a shiny new hip, you need to move on to rehabilitation.

Hip Replacement Rehabilitation

Your doctor should provide you with a lot of information about rehabilitation, if you have any questions during the time make sure that you ask.  Nonetheless I will still go over the basic information that should have been covered in case your doctor missed anything.

There are two aims of rehabilitation in this case: to prevent joint malfunctions, and to strengthen the hip for the future.  Firstly, while the hip may be brand new and strong, it doesn’t mean the hip joint is.  The tissue around it will be healing and your body will be getting accustomed to the new hip for the next little while so it is important to keep this in mind.

To prevent complications, try not to put excess stress on your hip by lifting heavy objects or doing strenuous exercise.  Another thing to watch out for is hip dislocation, which can happen if you cross your injured leg in front of the other.  As much as possible try to maintain a neutral, relaxed position for your legs.

Hip Replacement Strengthening

The second part of recovery is to strengthen the muscles surrounding the hip.  Your doctor should have given you a specific routine, however if he did not you can refer to the articles about hip flexor strengthening to help give you some guidance.  The goal of strengthening these muscles is to prevent a re-occurrence of the issue that caused you to have to get a hip replacement in the first place.

Expect to have several follow up appointments with your doctor so he/she can assess the condition of the hip replacement.  If all is well these should take no time at all and you’ll have no future problems with your hip.

A hip replacement is sometimes required in the case of severe hip injuries or chronic hip joint pain.  In a total hip replacement both of these parts are replaced using some sort of metal replacement usually.  Total hip replacements are done when there is extensive damage to both parts of the hip joint that causes significant pain in day to day activities and there is no other way of fixing it.  Typically there will be significant damage to the area or worn down bone that will have to be reshaped or removed.

Hip Replacement Surgery Steps

The video provided below does a great job of walking you through the process of a total hip replacement surgery with visual aids, but in case that is not an option here is a summary of the procedure:

• The surgeon opens your hip by slicing open the side of your hip
• Carefully cutting through and separating the various muscles and ligaments in the way the surgeon proceeds to exposing the hip joint
• The femoral head is dislocated from the joint and removed
• Once the acetabulum is cleared of damage and reshaped, the new replacement acetabulum is inserted
• The top of the femur is sawn off and replaced with the new insert
• The femur is inserted in the leg, tested, and the patient is sewn back up carefully

Once the surgery is complete you are usually left in the hospital to rest for a week or two where your condition will be monitored by doctors.  Note that there is a very low rate of complication for hip surgery these days and once you are able to get around by crutches you will most likely be allowed to go home.

Following this time you should be given details on your hip surgery recovery that will include a rehabilitation program for you to follow.

Hip Pain Causes in Detail

The following sections will outline the 5 sources of hip pain causes and explain a little more of what they mean for you.

Fractures/Breaks

You are probably familiar with fractures as a result of trauma; most people have broken a bone at some point in their life. Unfortunately, a fracture in the Hip can be more problematic than other locations. A hip fracture usually occurs near the top of the thigh bone (femur) and almost always requires surgery to fix. Not only that but there can be other damage done to the region that is overlooked because of the break and can continue to cause pain after the bone is healed. Older people are especially at risk for a hip fracture as their bones often thin out as they age.

Contusions

Contusions, often referred to as bruises, are the result of a blunt trauma, often experienced while playing a contact sport. The pain from a bruise is usually caused from inflammation, while the actual injury is caused by damaged structures in the surrounding muscles.

Inflammation

Inflammation can occur in several different types of body parts, but most commonly is found in tendons. Tendons attach the muscles in your body to other structures, usually bones. If the inflammation in the tendon is bad enough it can lead to tendonitis of the afflicted muscle which can cause sustained pain over a long period of time.

A common instance of inflammation in the hip is to one of the bursa located along the femur. The bursa is a fluid-filled sac that acts as a cushion for the bone against other tissue in the body. When the bursa becomes inflamed it is called bursitis, and is a very common running injury that causes pain during movement.

Conditions/Diseases

There are several conditions and diseases that are Hip pain causes. These usually develop slowly over time, the most well-known one being Hip Arthritis. Arthritis is essentially the wearing down of protective cartilage at a joint and leads to very painful bone on bone contact.

Secondary Sources

Since the Hip is such a crucial and central body part, pain that starts in other places may be a hip pain cause. One example of this is Piriformis syndrome, which originates along the back of the leg. When the Sciatic nerve is pinched, in some cases the pain is felt in the hip region because of the long length of the nerve and the location of the pinch. There are also cases where people get groin or abdominal hernias that occur really close to the Hip Joint.

Want to Know More About Hip Pain Causes?

The more you know about injuries the better. You can learn more about the results of Hip pain causes in our article about Hip injuries.

Hip Pain Running Causes

The Hip joint and surrounding body parts are extremely intricate pieces of human machinery, which is why they can be prone to injury.  Although it is a relatively small area, both the Hip and Hip Flexor takes on a lot of stress, especially during running.  The trickiest part when you have Hip pain running is to determine the Hip pain causes.

Tightness

The first, and hopefully the cause of your Hip pain running is that your Hip is simply tight.  Usually this will be noticed in pain or discomfort mainly at the start of your run and just after.  If you believe this is the case it is a relatively easy fix by performing some Hip stretches.  In a few weeks of consistent stretching you should see a major pain reduction, if not dissolution completely.

Hip Injury

There are many kinds of Hip Injuries that you can read more about in our article about that topic.  What I would like to touch upon here is what might cause the injuries while running and where the pain would be located.

Anterior Hip Pain Running

The anterior part of your hip is the front portion, centered at the Hip joint.  If you have anterior Hip pain running, the problem is usually because of the Hip joint or one of your hip flexors.  Please refer to our article on Hip Flexor injury if you think you have a muscular injury in that region.  Otherwise, the Hip joint could be developing arthritis if you are over 50, or most commonly you could have a Hip labral tear.

Lateral Hip Pain Running

As many runners have experienced, the IT band can be an often source of frustration.  Because of the length of the IT band, sometimes it can affect the Hip.  Bursitis in either the Hip or the IT band can cause significant pain in the lateral region (side).  The bursa inflammation can be triggered during movement which is why it is often a source of Hip pain while running.

Posterior Hip Pain Running

The final source of Hip pain running is in the posterior region, commonly known as the backside.  The pain here is usually related to gluteal pain, the most common affliction being Piriformis syndrome.  Piriformis syndrome is closely related to sciatica and is usually felt in a constant aching pain that may flare up and feel almost like a muscle pull while running.  To fix Piriformis syndrome perform the following stretch: Sit down with one leg bent, then place the foot of the other leg just in front of the knee of the bent leg.  Once in this position use your arm to push forward the free knee until you feel a stretch in your gluteal/Hip region.

As always, if your injury seems severe and you feel lost on what to do about it, please go see a doctor.  It is much easier for him/her to perform an MRI and find out once and for all what the injury is if you are just randomly guessing and trying things out.

How to prevent Hip Pain Running

There are two main things that you can do to prevent Hip pain running.  The first of which is to improve your technique.  The Hip in particular is very sensitive to discrepancies between legs, so if you are inconsistent with your technique it can often lead to pain.

The second way to prevent Hip pain is to consistently perform hip strengthening.  The stronger and more conditioned the surrounding muscles and tissues are, the less likely they are to get hurt from the high levels of stress during running.

Do not settle and accept Hip pain running because it will hurt your performance, and more importantly your enjoyment.

Hip Extensors Anatomy

Most people would be surprised to learn that the hip extensors are mainly made up of 2 major muscle groups: the Hamstring and the Gluteus Maximus.

Hamstring

You are probably familiar with the Hamstring, but just in case you are not here’s a quick refresher.  The Hamstring is composed of the large muscle and tendons behind your thigh muscle and is used heavily in running and athletic activity.

Gluteus Maximus

The Gluteus Maximus is the most obvious opponent of the hip flexors as it is located right behind the pelvis.  It is the largest of the gluteal muscles and extremely powerful in humans and primates.

Why Are the Hip Extensors Important?

You may be asking yourself what the importance of the Hip Extensors is in relation to the Hip Flexors.  The answer is simple, in that since the two muscle groups are antagonists (oppose) of each other, anything you do to one of them affects the other.

When you get a hip flexor injury, the typical course of action is to rest and encourage healing, and then hip flexor strengthening because your muscles have weakened through inactivity.  However, most people do not strengthen their hip extensors, which have also become weak because they have not been used much due to the hip flexor pain.  When this happens, the hip flexors become much stronger than the hip extensors and cause a muscular imbalance.  Muscular imbalances usually lead to non-proper functioning body parts and often injury like a hip flexor strain as a result of one muscle being stronger than the other, which is the last thing you want.  This illustrates the importance of training the Hip Extensors like the Hamstring and Gluteus Maximus alongside with the hip flexors to develop total functional symmetry.

Q: I’m confused on where the Hip Flexor is located, can you clarify this?
A: The Hip Flexor isn’t actually a single muscle; it is a large group of muscles and tendons that are located in the hip region. Sometimes people will interchange Hip Flexor with Iliopsoas, which is the main muscle involved in vertical hip flexion, but in reality this group is composed of so much more. There are muscles from the groin, thigh, back, and abdominals that are all considered part of the Hip Flexor because they aid in flexion in one way or another. The actual muscle group has parts that go down to almost your knee, from the middle of your body to your outside, and almost up to your chest area; in other words, it spans very far.

Q: Is the Hip Flexor only used to lift up the knee?
A: No! While this is the main function of the Hip Flexor, you must remember that the muscles contained in the group aid in any direction of hip flexion. The Hip is essentially the pivot point between the top of your leg and your pelvis that allows you to move your leg a full 360 degrees around. The Hip Flexor is responsible for providing the force required for every part of this whether it is vertical or horizontal movement.

Q: I have a sharp pain in my Psoas region every time I lift up my leg; I think I hurt it while running, can I still keep training?
A: This is most likely a Hip Flexor Strain and you need to proceed cautiously. Refer to the article about Hip Flexor pain and classify your injury. From there take appropriate steps to help your recovery. If it is a class one strain you may be able to train lightly with minimal risk of further injury. However, in almost all cases it is much better to take whatever time is needed to heal off and heal correctly. If you train through an injury it is going to result in scar tissue accumulation.

Q: I always come back from injuries too soon and get hurt again, why is this and how can I prevent it from happening?
A: It can be frustrating, which is why it is unfortunate that this is one of the most common problems that people have, especially athletes. There are a few factors at play here, first and foremost is that when you take time off to heal a Hip Flexor injury, your muscles become weaker. It is VERY easy to overdo it when you return from injury. Instead, make sure you have strengthened your muscles sufficiently by performing a Hip Flexor strengthening routine before you return to strenuous training.

Secondly, make sure you do not resume straight to full training capacity. You need to allow your muscles and body time to readjust to the level of stress that is placed upon them or you’ll end up overtraining and getting hurt again. Start very slowly and continue to move your training volume up slowly to stay injury free.

If you have any other questions let me know!

The basic definition of hip arthritis is an aging condition brought on by the general wear and tear of the hip joint over time.  The protective cartilage that separates the bones that meet at the joint is worn down which opens up the joint for bone on bone and bursa contact, which leads to significant hip joint and hip flexor pain.

Hip Arthritis Causes

There is no single cause that is attributed to Osteoarthritis, there are several factors that can contribute to your chance of having the condition; genetics for example can play a large role in this.  That being said, there are some things that have been linked to developing hip arthritis:

Weight

If you are overweight everything that you do will put more stress on your hip joint, which will accelerate any development of hip arthritis.

Posture

Similar to being overweight, when you have bad posture you put more stress on certain parts of your body than you should, the hip joint included.  While there may not be many short term effects of this hip arthritis can be a long term result.

Injuries

If you have had any traumatic hip injuries (like a complete hip flexor strain)in the past you are more likely to develop hip arthritis.  Previous injuries can cause scar tissue to develop, move body parts slightly out of place, and change your walking and sitting posture.

Hip Arthritis Symptoms

The nature of the condition means that any hip joint pain will only get worse as the cartilage continues to degrade, which means that it is crucial to try to recognize hip arthritis early on for treatment.

If you have hip arthritis you will experience pain with common everyday activities like walking, sitting, anything with movement really.  You may also feel a lot of stiffness in the hip area and have trouble walking correctly.

Treatment

There are limited options to reverse the effects of hip arthritis other than hip replacement surgery.  Typically this is put off as long as possible as any surgery comes with cost and risk of complications.

If you are diagnosed with hip arthritis you will most likely be recommended to try one of the following to reduce pain and limit further cartilage deterioration.

Lose Weight: It may not always be applicable, but for the reasons explained above, if you are overweight it will take some stress off your joints if you lose a few pounds.

Walking Assistance: No one enjoys it, but using a walker or a cane can really make a big difference in managing the pain by taking stress off of your hip joint(s).

Painkillers: Usually not the first recommendation, but if there is also inflammation present in your hip (often in Rheumatoid arthritis), you may be given painkillers/anti-inflammatories

Strengthening Routine: If you follow a Hip Flexor strengthening routine you can also relieve some pressure that is directly on the hip joint, which will reduce pain.

Hip Arthritis Prevention

There is no way to prevent hip arthritis for sure, but if you follow the suggestions in the treatment section of this article you can help to minimize your chances of developing the condition.  You can find more information on Hip Pain here.