Many people experience pain in the front of their hip but they do not know what it his or how it came about. Often times people just try to live with it or push through it within their daily activities until it stops them from participating in their hobbies or sports. There could be many reasons for pain in the front of the hip. In this blog post we will review the different types of anterior hip pain, symptoms, causes and some easy things you can do on your own to start reducing your pain. If you are having pain in the front of your hip this blog is for you!
Let's start with some anatomy!
The hip is a complex joint with various muscles that work together to support movement and stability.
It plays a crucial role in:
Weight-bearing and Support
Mobility and Range of Motion
Connection between the Trunk and Lower Limbs
Power Generation
Posture and Stability
Transmission of Forces
Pelvic Movement
The hip is a highly stable and weight-bearing joint. It is a ball-and-socket joint and is made up of:
Bones
Articular Surfaces
Joint Capsule
Synovial Membrane
inner lining of the joint capsule is the synovial membrane, which secretes synovial fluid to lubricate the joint, reducing friction and allowing smooth movement.
Ligaments
Iliofemoral Ligament: on the anterior hip joint and is one of the strongest ligaments in the body. It helps prevent hyperextension of the hip joint.
Pubofemoral Ligament: on the anterior-inferior aspect of the hip joint, it also contributes to stability by limiting excessive extension and abduction.
Ischiofemoral Ligament: on the posterior side of the hip joint, it helps limit hyperextension.
Muscles:
Hip Flexors (e.g., iliopsoas, tensor fasciae latae (TFL), rectus femoris)
Hip Extensors (e.g., gluteus maximus)
Hip Abductors (e.g., gluteus medius/minimus, tensor fasciae latae (TFL))
Hip Adductors (adductor magnus, longus, brevis)
External Rotators (e.g., piriformis, gemellus superior, gemellus inferior, obturator internus/externus),
Deep Hip Stabilizers (e.g., quadratus femoris, obturator internus, gemellus superior, gemellus inferior, piriformis)
Blood Supply: from branches of the femoral artery, which provide nutrients and oxygen to the joint structures.
Because the hip is so complex, there can be many reasons for hip pain in general, but in this post we are covering causes for anterior hip pain.
The 5 major reasons for Anterior Hip Pain are:
Muscle Strains
Hip Flexor Tendinopathy
OA
Labral Tear
Hip Impingement
Let's go over each of these pathologies!
(1) Muscle Strains
Muscle Strains involve the stretching or tearing of the muscles surrounding the hip region. Strains can occur when these muscles are subjected to excessive force, overuse, or sudden movements.
Causes:
overuse or repetitive stress on the hip muscles as seen in activities like long-distance running & sports like soccer
sudden twists and turns in sports
Symptoms
Pain
Swelling
Bruising
Weakness
Limited range of motion
(2) Hip Flexor Tendinopathy
Hip flexor tendinopathy refers to a condition characterized by pain and dysfunction in the hip flexor tendons. The hip flexors are a group of muscles that allow the hip joint to flex or bend. Tendinopathy refers to any pathology or damage to a tendon, which is the fibrous tissue that connects muscles to bones.
The hip flexor tendon that may be affected is the iliopsoas tendon, which is a combination of the psoas major and iliacus muscles' tendons combined.
Causes:
overuse
repetitive strain
poor biomechanics
muscle imbalances
sudden injuries
inadequate warm-up
Symptoms:
Pain in the front of the hip or groin area
Tenderness when pressing on the tendon
Swelling
Stiffness in the hip joint
Weakness in the hip flexor muscles
(3) Hip Impingement
Aka femoroacetabular impingement (FAI), is a condition where there is abnormal contact between the femoral head and the acetabulum. This abnormal contact can lead to friction, wear and tear of the hip joint, and can contribute to the development of hip pain and labral tears.
There are 3 main types of hip impingement:
Cam Impingement: excess of bone on the femoral head, usually on the front and upper portion.
Pincer Impingement: excessive coverage of the femoral head by the acetabulum due to an overgrowth of the acetabular rim.
Mixed Impingement: combination of both cam and pincer impingements.
Causes:
genetic predisposition
abnormal hip joint development
repetitive activities & sports that involve hip flexion & rotation
Symptoms:
Pain in the hip or groin area, often worsened by certain movements or activities
Decreased Range of Motion
Stiffness in the hip joint
Catching or Clicking Sensation
(4) Osteoarthritis (OA)
Osteoarthritis (OA) in the hip is a degenerative joint disease that primarily affects the hip joint. Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage that cushions the ends of bones wears down over time. As a result, the bones in the affected joint begin to rub against each other, leading to pain, stiffness, and reduced mobility. OA can effect the articular cartilage, synovial membrane, and bone.
Causes:
age
genetics
joint overuse
previous joint injuries
obesity
Symptoms:
Pain in the hip joint, often exacerbated by weight-bearing activities
Stiffness especially after periods of inactivity
Decreased range of motion
Swelling in the joint
(5) Labral Tear
A labral tear refers to damage or injury to the labrum, which is a ring of cartilage that surrounds the socket of a joint. It's role is to provide stability to the hip joint, cushion the joint, and help distribute load forces during movement.
Causes:
trauma: a direct injury or impact to the hip joint, such as a fall or sports-related injury
repetitive movements like excessive twisting in certain sports or occupations
structural abnormalities
Hip Impingement
Symptoms:
Pain in the hip or groin area.
Catching or locking sensation
Decreased range of motion
Clicking or popping
Now that we have covered the 5 common reasons anterior hip occurs we can move the FUN PART....Treatment! Treatment options for anterior hip pain pathologies are very similar.
They include:
Activity Modification: Avoiding activities that exacerbate symptoms, for example if it hurts to squat deep, squat to the level above the pain.
Lifestyle Modifications: Managing your weight to reduce the load on your hip, participating in routine exercise to keep your hip moving
Ice and Anti-Inflammatory Medications
Joint Supplements: Glucosamine and chondroitin supplements for joint health
Joint Injections: Corticosteroid injections into the hip joint can sometimes reduce inflammation and pain
Assistive Devices: Canes, crutches, or braces can be used to help reduce joint stress and improve stability
Surgical Intervention: In cases where conservative measures are ineffective, arthroscopic surgery may be considered to address the impingement, reshape the bones, and repair any associated labral tears
Physical Therapy: Lastly... Our FAVORITE! Specific exercises to improve joint mobility, strength, and flexibility
Physical Therapists oversee the rehabilitation process to ensure you are incorporating all of the treatments above needed and we guide this process from the beginning to the end. We ensure that you are doing the right things at the right time depending on the severity of your hip pain and what phase you begin treatment at.
In the Beginning Phase we focus on:
decreasing pain, swelling and tenderness
increasing ROM
Improving Mobility and Flexibility
In the Middle Phase we focus on:
improving balance, stability & control
improving strength
In the Final Phase we focus on:
improving power, speed, agility, and sports performance
Physical therapy may vary for each of these conditions based on the limitations you present with. If you want to find out how we approach PT differently for each of these conditions head to our YouTube page and watch our full podcast for this Topic. You can also listen to it on the platforms listed below. If you are experiencing anterior hip pain the BEST thing you can do is get a Physical Therapy consult. Sometimes there are some simple and very effective exercises that you can start implementing that will help your hip immediately start feeling better. Other times you may need some intensive work to restore mobility, flexibility, stability and strength in your hip joint. Either way suffering through it is not helpful! Find yourself a PT to help you!
If you are struggling with an hip pain, don't wait- get it checked out! Reach out because we would love to help you! We work with clients on-site and virtually through Telehealth.
Click here if you are interested in booking a session or getting more information! https://www.physicaltherapysanpedro.com/sports
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Much Love <3 ,
The PTSP Docs
Dr. Brown, Dr. Bay, Dr. Yana
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