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Hip Pain

Hip pain can present itself in different ways. Hip pain can be felt deep in the hip, in the groin, on the outside of the hip, out the outside of the thigh or at the front part of the hip by the pelvis. The conditions can range from tendonitis, bursitis or even arthritis. When looking at the hip, the knee and the ankle must be considered for many times hip pain can result from poor body mechanics at the lower leg.

General Anatomy

Bones
Provides structural support for the body and serves as an anchor points for ligaments and tendons.

Ligaments
Ligaments are non-elastic tissues which connect one bone to another bone giving our body structure its stability. When frequently or severely injured, ligaments become "stretched out" causing the joint to become loose or more unstable. Ligaments have a poor blood supply so have a tendency to heal more slowly than other tissues. Injuries to ligaments are called "sprains".

Tendons
Tendons are elastic tissues that connect a muscle to a bone.

Muscles
Muscles are elastic tissues. Muscles and tendons work together to create the body's motion. Injuries to muscles and tendons are called "strains".

Cartilage
Cartilage is the spongy material that lines the ends of the bones. It works as the body's "shock absorber", helping to cushion the impact placed upon the bones during activity as well as directly protecting the ends of the bones. This is called articular cartilage.

Bursa
Bursa are fluid filled sacs that lie between tissues or tissues and bones preventing friction.

Bones

Femur
The femur is the bone that makes up the hip; however, when assessing the hip medical practitioners will consider the pelvis and low back as well. So the bones considered are the femur, the low back, and the pelvic. When you touch the outside of your hip you are actually touching the "greater trochanter".

As we age, we can have the on-set of hip arthritis. Pain associated with this is often "deep" and can refer to the inside of the hip (the groin).

Femur Bone Diagram of the Sacroilic Joints, Sacrum, and Ilium Normal Hip VS Arthritic Hip

Muscles

Like all other joints, the muscles help provide support in addition to creating motion. If the muscles of the hip and tight/weak it can cause issues to arise at the ankle, knee, back as well as at the hip.

Muscles of greater significance are:

Tensor Fascia Latae
This muscle runs from the flare of the hip bone (ilium) all the way down to the knee. Tightness of this muscle can cause increased pressure and friction over the hip itself (greater trochanter) and the underlying bursa resulting in hip pain (tendonitis or bursitis). It can also lead to pain in the knee and or outer thigh.

Rectus Femoris
This is one of the quadricep muscles that runs from the knee to the top of the pelvis. This muscle is highly used (trained by runners and kickers) for it helps extend the knee and flex the hip. Tightness and/or weakness in this muscle can lead to back, hip or knee pain.

Side View of Hip Muscles Front View of Hip Muscles

Bursa

The bursa are those fluid filled sacs that are located between structures to help prevent friction; however, if the overlying muscles are tight the bursa can become irritated and inflammed causing pain (bursitis). Busitis pain is often located on the outside of the hip. If the bursa is inflammed you will be recreate the pain by pressing on it.

Hip Bursa