Treatment For Common Sports Injuries Of The Hip

Hip bursitis and groin strains are common sports injuries of the hip.

Hip Bursitis

This is a tiny jelly-like sac, which normally contains a small fluid amount. Bursae are positioned throughout the body, but most significantly around the shoulder, heel, elbow, hip, and knee. They lie between soft tissues and bones, reducing friction between them.

This bony point of the hip is known as the greater trochanter. This is a point of attachment for muscles which move the hip joint. There is a large bursa that overlies the greater trochanter and it can become inflammed, leading to hip bursitis ( or trochanteric bursitis).

hip bursitis

Relationship of trochanteric bursa between the iliotibial band and the greater trochanter

Symptoms

The main symptom is the pain at the greater trochanter region. The hip pain often extends to outside of thigh area. In early stages, this pain is often described as intense and sharp. In later stages, it becomes a dull ache. The pain is usually worse at night, when sleeping on the affected hip, and even when getting up after being seated for a while from a chair. Activities that aggravate this condition includes running, stair climbing, prolonged walking and squatting.

Risk Factors

Hip bursitis can affect anyone, but it is more common in middle-aged women and elderly people. It is also less common in men and younger people.

The following are some of risk factors that have been linked with the development of hip bursitis:

  • Repetitive stress (overuse) injury
    Excessive stair climbing, bicycling, running or prolonged standing are risk factors.
  • Hip injury
    An injury to this point of your hip may occur as a result of falling onto your hip, or after bumping your hip on a table’s edge, or lying on one side of your body for a longer duration.
  • Leg-length inequality
  • When one of your legs is shorter by more than 1 inch compared to the other, it will definitely affects your walking pattern and this can potentially cause inflammation of the hip bursa.
  • Bone spurs or calcium deposits
    These can develop within the tendons that attach to the trochanter. They can irritate the bursa and cause inflammation.

Diagnosis

Clinical examination is usually sufficient to diagnose this condition. Sometimes we may have to perform extra tests to rule out other possible conditions or injuries. These tests include xrays, ultrasound scans and MRI scans.

Treatment

Nonsurgical Treatment

This condition is usually treated successfully without surgery. Many people who have hip bursitis may sometimes experience a relief with a simple change in lifestyle changes. Some of the changes in lifestyles includes:

  • Modification of activities—avoiding the activities that worsen symptoms
  • Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, piroxicam, celecoxib, and others, to control inflammation and pain
  • Use of a walking cane or crutches for a week or more when needed

Physical therapy is very useful for this condition and manual therapy, ultrasound and stretches are particularly relevant. In more severe cases, an injection of corticosteroid together with a local anesthetic can be very useful in relieving the symptoms.

Surgical Treatment

Surgery is rarely required for hip bursitis. For the few cases that fail to respond to the above measures, excision of the bursa sac can be done as a day surgery procedure.

Groin Injuries

Most recently, one of our patients who was an MMA fighter in the heavyweight division tore his adductor longus muscle and tendon (muscle near the groin) off the bone during a fight. He presented with severe groin pain and difficulty walking. In most cases, this severe injury would have been treated with surgery. He was adamant that he did not want surgery and wanted to try platelet rich plasma (PRP) therapy. He was given 3 injections of PRP under ultrasound guidance (weekly intervals) and he was back to doing weights and MMA training 2 weeks after the last injection.

Muscle Tear treatment Ultrasound
Ultrasound on the day of the injury showing the adductor longus tendon and muscle pulled off the bone and looking very disorganised
Muscle Tear treatment Ultrasound
Ultrasound on the day of 3rd PRP injection showing good healing and nicely organized muscle bundles instead of the disorganized mass seen above

Surgical Treatment

Surgery is normally reserved for severe injuries such as tendon avulsion injuries where the tendon has pulled completely away from the bone. Surgery may also be required to repair a complete tear within the muscle.

Procedure
In order to sucessfully address a tendon avulsion, the surgeon will pull the torn tendon and muscle back into place and remove the remaining scar tissue. Following this the tendon is affixed to the bone with the aid of large stitches or staples.

Recovery after Groin Strain Or Tear

Provided you have been treated properly with rest, physical therapy, PRP injections or surgery, most muscle tears heal very well. The earlier you begin the RICE process and consult your physician the quicker you can return to normal activities.

Be careful about returning to physical activities too soon after your injury as repeated injury can lead to a chronic condition leading to hampered physical performance.





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