RW+ Membership Benefits This 30-Second Test Can Help a Runner’s Hips hip pain, my first request is for him to point to the painful area. After an incredulous look and a quick scan of the office walls for my medical school diploma, he will point to an area between the naval and the thigh. In fact, when asked to place their hands on their hips, most people will place their hands on the top of their pelvic bone.
Understanding hip problems requires a basic knowledge of hip anatomy. In the back, the pelvic bones (ilia) connect to the sacrum (lower back) at the sacroiliac (SI) joints. The pelvic bones join in the front to form the symphysis pubis (pubic region). The sockets of the hips are formed by indentations in the ilia (acetabulum). The hip joints are located where the legs attach to the body, commonly known as the groin. This is the usual site of pain with hip problems.
Runners may experience a myriad of problems in this area of the body, some of which can cause quite a bit of disability. The proper diagnosis is essential to initiating the appropriate treatment plan.
SI dysfunction, problems with the SI joints, is very frustrating. SI dysfunction can stem from a history of injury, such as a fall onto the buttocks or unexpectedly stepping off a curb or into a hole. Overstriding, especially on downhill running, may stress the SI joints. These joints have very little motion normally. As with all joints, the bones are connected by ligaments. A number of muscles attach to various sites on the sacrum and ilia and are responsible for hip and trunk function. Any of these structures may be inflamed in SI dysfunction.
The symptoms can be very confusing; pain is often localized to the SI joint, but may be referred to the buttocks, symphysis pubis, lower abdomen or lateral thigh. At times, pain may radiate to the foot, mimicking the symptoms of a ruptured disc. SI dysfunction often causes a functional leg-length difference due to a mild rotation of the affected half of the pelvis. Atypical stresses are placed on the lower back, opposite side of the pelvis and hips. As a result, there may be an alteration in gait, resulting in additional injuries.
Diagnosing SI dysfunction is based on the runner's history and a clinical examination. There is pain on palpation of the involved SI joint and the neurological examination is negative; X-rays and MRIs are typically normal, thus ruling out other problems, such as a sacral stress fracture.
The treatment of SI dysfunction involves relief of pain and improvement of flexibility and strength. For pain relief, anti-inflammatory medications (ibuprofen, naproxen, etc.) and ice massage over the painful area are effective. Physical therapy modalities such as electrical stimulation and mobilization of the SI joints may be helpful. As symptoms resolve, pelvic stabilization exercises and strengthening of the lower back and abdominal muscles should be initiated. For persistent symptoms, a sacroiliac belt may provide some relief. SI dysfunction may disrupt training for weeks to months. Continuing to run through the pain increases the likelihood of developing a compensatory injury due to an abnormal gait. Non-weight-bearing exercises, such as pool running or swimming, are effective ways to cross train during recovery and rehabilitation.
Sacroilitis, a different problem, may also cause pain in the sacrum and SI joints. This may be due to a variety of inflammatory conditions including disorders of the autoimmune family (such as ankylosing spondylitis and Reiter's Syndrome), arthritis and inflammatory bowel disease. Running does not cause this problem, but may precipitate symptoms.
Stress fractures of the sacrum may cause pain in the same area. This injury is often associated with an increase in mileage or intensity of training. The runner typically reports a vague lower back, buttock or hip pain that is exacerbated by weight-bearing activity. X-rays are usually normal and the diagnosis is made by MRI or bone scan. Treatment includes use of crutches until the runner can walk without pain. At that point, nonimpact cross training may be initiated for six weeks. During this time, core and hip flexibility and strengthening exercises should be started. Running is gradually reintroduced no earlier than six to eight weeks following the diagnosis
Sciatica is due to irritation of the very large sciatic nerve which exits from its boney protective cover on each side of the buttocks. This often causes pain radiating down the affected leg. The buttock is very tender to touch. One of the causes of sciatica is inflammation of the piriformis muscle; this muscle arises from the sacrum and attaches near the top of the femur (thigh bone). As in SI dysfunction there is pain on palpation around the SI joint, there is pain with stretching the sciatic nerve. Treatment is similar to SI dysfunction. With milder symptoms, the runner may continue training while rehabilitating.
