Diagnosis and Treatment of Hip Girdle Pain in the Athlete

Abstract

Evaluation of an athlete's report of "hip pain" is challenging. Many conditions involving the pelvic girdle can present with overlapping pain distributions, and athletes often may have coexisting disorders. Appropriate evaluation requires thorough, systematic consideration of intra-articular hip disease, extra-articular local causes of hip pain, and referred pain from other musculoskeletal or even visceral sources. Although our understanding of intra-articular hip disorders has been greatly enhanced in recent decades through advances in hip arthroscopy, gaps still exist in our understanding of appropriate treatment, including effective nonsurgical protocols and when to consider surgical intervention. For instance, we have a better understanding of hip dysfunction related to structural changes that occur prior to the onset of arthritis, but we are also learning that correction of the structural changes does not always guarantee a correction of dysfunction and pain. Furthermore, athletes need instruction and guidance in retraining appropriate movement patterns after a surgical intervention. Risk stratification regarding which athletes need surgical intervention and what their needs are after specific surgical procedures remain undefined. In this review we will describe the differential diagnosis of hip and pelvic girdle pain in the athlete and then discuss how to use a history, physical examination, and appropriate imaging and diagnostic injections to arrive at a proper diagnosis. Lastly, a brief discussion is included of key concepts and controversies involved in treating some of the most common hip disorders experienced by athletes.

Team Approach: Hip Preservation Surgery

“…Comprehensive nonoperative can serve as a stand-alone treatment for some patients and by facilitating readiness for surgery and optimal postoperative functional outcomes for others. First-line treatment includes physical therapy, nonsteroidal anti-inflammatory drug (NSAID) medication, education regarding positions that cause hip impingement or overstretching of the hip capsule; shared decision-making regarding activity modifications that are acceptable to the patient (including technique modifications, not necessarily activity cessation), and/or a one-time intra-articular corticosteroid injection 36,37 .…”

Female Athlete Hip Injuries: A Narrative Review

“…It occurs more frequently in athletes performing repetitive hip movements at supraphysiologic ranges and under high loads, such as soccer players, tennis players, and dancers. [75][76][77] It has also been proposed to occur more frequently in the setting of hypermobility. 58 Among a group of 894 athletes, symptomatic iliopsoas tendon dysfunction was found to affect female athletes more frequently than male athletes (17% vs 6%, respectively), occurring most commonly in soccer players.…”