Hip Pain, What a Pain in the Butt!

Have you recently goggled “butt pain, “ “my hip hurts,” “hip pain with running,” “dead butt syndrome,” or “why can’t I run!” If you have then you are like many people that have consulted Dr. Google and still haven’t found any answers.

In the United Stated there are approximately 30-40 million runners1 and last year over 1.3 million people competed a triathlon2. It has been reported that as many as 92% of runners may be injured yearly3 and 11% of all running injuries are at the hip and the pelvis.

Pain in the hip can impact quality of life, your ability to run or compete in triathlon in addition to every day activities such as sitting, standing or walking. Even if they can run through it many of my clients complain of decreased speed, decreased power and inability to train as desired because of hip pain. Don’t let your hip pain keep you from reaching your maximum potential.

First Identify the Source

There are several pathologies that may cause your hip to hurt and many of them are often treated conservatively with physical therapy. Here are a few of the most common sources of hip pain and how they manifest.

Labral tear: presents as aching pain in the outside of the hip or groin typically in the shape of a “C” or it can present as buttock pain. Symptoms can also be described as “stiff,” clicking or catching in the hip or sharp pain with squatting. It will typically be painful with running, prolonged sitting, especially in a deep chair, squatting and walking. This can be ruled in with a clinical exam but an MRA will be needed for absolute diagnosis. Just because you have a labral tear does not mean you need to have surgery.

Gluteal tendonopathy: presents as pain is in the outside of the hip and may radiate down the thigh. It is often misdiagnosed as “bursitis.” It could be painful lying on you side at night, standing, walking, climbing up or down stairs, and sitting5. It may be caused from increased compression on the glute tendon from what I call “lazy standing” sticking you hip out and putting weight on one leg or even sitting with your legs crossed.

Stress fracture: may initially present as aching pain in the hip but eventually will be sharp pain with weightbaring. Stress fractures typically are painful with running or activity and will improve with rest, will present with point tenderness and may have sensitivity to vibration. A stress fracture is diagnosed with an x-ray, however it will not show up unless the x-ray is 7-10 days after the injury has occurred. A stress fracture is one thing that you cannot run through.

Lumbar spine radiating pain: even if your back doesn’t hurt you may have a back injury that presents as pain in the hip. Symptoms may include aching in the buttock, outside of the hip, groin or thigh. You may even experience numbness or tingling. The lower spinal segments can refer pain into the hip and that is why it is important for your healthcare provider to perform a comprehensive physical exam of you hip as well as what lies above and below.

Trigger points in the hip musculature: from poor running form, muscle imbalance, weakness, wrong position on the bike, compensatory movements after an ankle sprain or other lower leg injury. This pain will likely be more diffuse and achy in nature. It may be more difficult to pin point. Often it will improve when you roll it out with a trigger point ball or foam roller. Pain from trigger points is tricky because you may get better with self-treatment – but you have to ask yourself why did the pain occur in the first place. If it is poor running form, bike fit or weakness the pain will likely come back if the root cause is not treated.

Assess Your Training Habits.

• Are you overtraining?

• Have you suddenly increased your frequency, intensity or duration of your runs? You may need to dial back your training and modify what you are doing. If you aren’t sure you may want to invest in a coach.

• Is it time to get new running shoes? It is good practice to replace your running shoes every 300-400 miles.

• Do you need to re-fit for your bike? It is a good idea to have your bike fit specialist check your fit every year.

• Make sure you are taking care of your body: foam rolling before and/or after your workouts, cross training, stretching, getting enough rest and the right nutrition.

When should I seek medical attention?

I typically tell my patients that if something is nagging and causing them to change their typical workout routine for 7 days or more its time to seek help. Just because you “seek help” doesn’t mean you will have to stop training or running. It is always better to have something looked at sooner rather than later because it will decrease the cost, time and energy spent on getting yourself back to 100%.

What kind of medical professional should I see?

For severe pain that prevents you from running or training you should first see your primary care physician or an orthopedic doctor. They will be able to rule out major medical issues, serious injuries or refer you to physical therapy. In some states you are required to see an MD prior to seeing a physical therapist.

For pain that limits your ability to train or run but allows you to “push through it” you may be able to first see a physical therapist or chiropractor.

Physical therapist specialize in treating the musculoskeletal system i.e. bones, muscles, joints, ligaments, tendons and how they all interact with one another. PT’s are trained to identify dysfunctional movement patterns such as poor running form, impaired squatting, bending, lifting, walking and much more. In most states you can go to see a physical therapist without a script from your physician. However your physical therapist may still need one to perform certain techniques such as dry needling.

Chiropractors focus on the diagnosis and treatment neuromuscular disorders. They emphasis the use of manual adjustment and/or manipulation to treat many overuse injuries. Despite common belief chiropractors and physical therapists can and often do work very well together to enhance a patients healing process.

Hip pain is frustrating, but if you take the time to step back identify the issue, assess your training and seek out good medical care you could be back in the game sooner than you think.

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1. usarunning.com

2. usatriathlon.com

3. Yamato TP, Saragiotto BT, Dias Lopez, A A Concensus Definition of Running-Related Injury in Recreational Runners: A Modified Delphi Approach. . J Orthop Sports Phys Ther. 2015;45:375-380.

4. Taunton JE et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002;36:95–101

5. Grimaldi A, Fearon A. Gluteal Tendinopathy: pathomechanics and implications for assessment and management. J Orthop Sports Phys Ther. downloaded from http://www.jospt.org at on September 22, 2015