Hip Pain - Sports PhysioTherapy Online

Hip pain is a common complaint among lifters and other athletes. The complex and tissue-dense nature of this region complicates diagnoses. Unfortunately, most clinicians struggle navigating this and often misinterpret assessment findings or assign false diagnoses altogether. Below we’ll explore a basic birds-eye view of the topic, and help you decide if or when you require a consult.

Functional Anatomy

The hip is a ball (From the thigh bone) and socket (From the pelvis) joint sealed by a layer of fibrocartilage known as a labrum. A whopping 21 different muscles cross over and influence movement of this joint. Some of these are very large and powerful, such as the gluteal group, and the ball and socket joint allows for a large degree of movement.

Range of motion of the hip joint varies between individuals, contextual factors such as sport and more. Pain-free individuals and athletes vary significantly between each other in terms of range of motion (1, 2). What appears to be “normal” range of motion also appears to vary between sports (3). There is also some evidence that it even varies throughout the course of a competitive season (4). Therefore it is difficult to argue about a generalisable hip range of motion for all humans, and that it would be a major contributor to the pain experience. It also appears to adapt based on our environment and the stresses we expose our body to.

Muscle weakness

Gluteal muscle weakness is often implicated in various hip pain syndromes, but its role is more complex than commonly perceived. The concept of "gluteal amnesia" or the notion that individuals forget to activate their gluteal muscles lacks scientific backing. Research suggests that manual muscle testing and functional analysis used to assess gluteal strength are often unreliable and fail to provide a definitive link between muscle weakness and pain (5, 6). In clinical practice, the validity of tests like the Trendelenburg test, which assesses hip abductor strength, is questionable. Studies have shown inconsistencies in the test's ability to accurately diagnose gluteal muscle weakness as a cause of hip pain (7, 8). Moreover, an increase in gluteal muscle activation has been observed in some individuals experiencing pain, contradicting the idea that weakness alone is the issue (7, 8). The narrative around gluteal muscle weakness often fails to account for the individual variability in strength requirements. For instance, what constitutes sufficient strength for a marathon runner differs from that of a powerlifter. Emphasizing functional capacity over raw strength values is crucial, as pain is influenced by multiple factors, including fitness levels, stress, and individual goals.

Overall, while strengthening the gluteal muscles can enhance hip function and stability, it should not be viewed as a standalone solution for hip pain. A multifaceted approach addressing various contributing factors is essential for effective management (9, 10).

Causes

If you’re familiar with our other articles, some of which can be found here and here, you’ll know that we see pain as a complex and multi-factorial phenomenon. Outside of special circumstances such as trauma, the development of hip pain much like other musculoskeletal pain is often the culmination of risk factors, and a little bit of chance. For our readers, the first and foremost thing we will look at is your training, how its designed, and assess for any signs of excess fatigue. Next we will cover a psychosocial assessment to determine any additional risks there.