A paper published by the Orthopedic Journal of Sports Medicine in May of 2018 looked into the prevalence of hip pain in athletes. They found that hip and groin injuries are a common complaint among all athletes across a wide range of ability levels, accounting for 5-6% of all sports injuries.
There are many tissues that can be implicated in the hip. In younger athletes (those who still have open growth plates), there is an increased likelihood of apophyseal (where tendons attach to bone) or epiphyseal (where growth plates are) as those joints may not have ossified (hardened from cartilage to bone) yet. As an athlete ages, they're more likely to have hip pain attributed to tendonitis.
Endurance athletes (specifically runners) are at increased risk of bone stress injuries (which lead to stress fractures and, if left untreated, could result in tissue death) if they haven't taken care to appropriately progress their training, but also labral tears. Other tissues that might cause problems are the bursae around the hip bone, as well as the IT Band.
Additionally, it's not uncommon for pain to be referred to the side or back of your hip from the back or even the kidneys.
So. When the causes of hip pain can range from tendonitis to bone tissue death, how do you know if your hip pain is a problem? Here are a few questions that I would ask you if you were to consult with me.
1. Is your pain mechanical?
What is mechanical? Are you consistently able to reproduce your pain or symptoms? Does your hip start bothering you a mile and a half into even an easy run? This 'if
this, then that' relationship can give a lot of clues about what tissue might be giving you trouble. Do you have pain the the front of your hip with going up stairs/marching or trying to stretch it or with self massage of the same area but not with other activities (going down stairs)? Do you have pain just with activity but it goes away when you're resting?
Mechanical pain is something that a physical therapist can treat and treat very well. They'll assess your gait pattern, check out your strength, joint mobility and flexibility and get you started with a program to address the tissues that might be causing you trouble.
2. Do you experience any catching or locking in your hip?
While stiffness is not uncommon with changes to an exercise program, catching and/or locking might indicate something going on inside the actual hip joint (arthritis and/or a labral tear). If you have pain that wakes you up in addition to an increase in pain with running, walking or stair navigation, again, check in with your physical therapist. There are many athletes that have been able to manage their pain well with conservative treatment and don't end up getting surgery. Getting assessed and working on your joint mobility, strength and flexibility with a performance based physical therapist is often a great option.
3. Do you have any numbness or tingling?
This question mostly just teases out whether your neuromuscular system is involved at all. When nerves get compressed, the muscles they innervate don't get the amount of oxygen that they should and that can result in numbness, tingling or pain that is commonly reported as 'lightning-like.'
Neuromuscular pain can also be addressed with a physical therapy plan.
If you have pain that wakes you up at night, pain that is not improving with conservative management, or pain that is 'gnawing' or 'tooth-ache like' or unrelenting, even when you have stopped whatever activity it is that worsened your pain, it is time to get it checked out by your PCP or to get a second opinion if you're currently in a physical therapist's office.
Asking your PT to refer you to the doctor might help you get in sooner if your wait times are long, so again, starting at a physical therapists's office is not a bad idea. Your physical therapist is a Direct Access provider, regardless of what state you live in, and can certainly help you navigate your hip.