Common Hip and Pelvic Injuries: Here’s why you’re in pain and what you should do about it

Common Hip and Pelvic Injuries: Here’s why you’re in pain and what you should do about it

Your hips and pelvis are essential for basic movement, as they are literally the connection between the upper body and lower body. Your hip is a ball-and-socket joint, with a ball at the end of your femur fitting into a socket (acetabulum) formed by the joining of all three bones in your pelvis. An injury or condition to this region can make it very difficult to live your everyday life without constant pain. Your hips were made for moving. That’s why if you experience any pain that is disrupting your daily routine, you should give yourself the best chance to recover and get your life back.

Your risk of falling increases as you get older because of poor balance, bent over posture and weakness of muscle and bones. These injuries become more common in older people as their bones become more fragile and weak from calcium loss, and in athletes who play contact sports. Falling on hard surfaces such as an icy ground, can lead to hip or pelvic injuries that can be quite painful. There are other causes, such as blunt trauma from a car crash that can injure this region and must be assessed by your physician immediately.

Hip and pelvic injuries are often divided into different categories. All injuries cause pain and ultimately disability, as well as a negative effect on quality of life, if not addressed quickly and appropriately.

Overuse injuries include repetitive stress activities, tendinitis, bursitis, muscle strains, iliotibial band (ITB) syndrome, snapping hip syndrome and even stress fractures and sacroiliac dysfunction.

Overuse injuries occur when there are repetitive forces placed on a certain structure or region of the hip. Overuse injuries are a major cause of pain and disability in the hip and pelvis. Weekend warriors, high level athletes or individuals who perform repetitive activities with their hips and pelvis throughout the day are prone to these kinds of injuries. For example, if you are a runner or a bicyclist, your hips go through many cycles of rotation with each step you take or each rotation of the pedal. Structures such as the iliotibial band (ITB) pass over a “normal bump in your bone” called the greater trochanter. If your ITB is inflexible, it will begin to snap over the greater trochanter with each step in the walk or rotation of the pedal. This “snapping” can cause an irritation of the IT band itself or an irritation and inflammation of the bursa (a fluid-filled sac that is present over bumps in protrusions of a bone anywhere in the body) causing trochanteric or hip bursitis. This type of injury causes pain, stiffness and possible snapping (external snapping hip syndrome) directly at the outside of the hip. If not addressed through physical therapy and stretching, it can lead to increased pain, including limping and an inability to continue running, cycling or even working. A qualified physical therapist with experience or specialization in treatment of the hip is imperative to ensure a complete and speedy return to your preferred activity.

Overuse of the muscle and tendons that attach to the hip and pelvis often result in pain, which can be severe, and tenderness to the touch in the front, outside, behind the hip and pelvis, and on the groin. One example of this is iliopsoas tendinitis, which is characterized by pain often accompanied by a snap in the front of the hip, known as internal snapping hip syndrome. These injuries occur when there is more stress and exertion placed on the muscle or tendon, than the structures can handle. The result is pain, inflammation and disability.

One last type of overuse injury to the hip and pelvis is a stress fracture. These types of fractures, also called fatigue fractures, occur when too much repetitive stress or forces are put on the bones which cause a small “crack” or break in the bone.

The treatment of these types of injuries is usually rest, anti-inflammatories and physical therapy with a therapist who is a hip specialist. If pain is severe and present in the groin during weight bearing, or there’s an inability to put weight on it, x-rays may be advised and an orthopedist should be consulted.

Anatomic causes and changes in the anatomy of the hip and pelvis can lead to progressive pain, disability and even arthritis of the hips. These include femoral-acetabular impingement (FAI), hip developmental dysplasia, labral tears and detachments around the acetabulum.

Anatomic differences are variances in the anatomy of the hip and pelvis. Very often, the differences are development in nature and continue to progress up to adulthood. Most of these issues involve the position of the socket, also known as the acetabulum. The most common is developmental dysplasia of the hip (DDH). This disorder involves a poorly developed fitting acetabulum (socket) with the head of the femur. This lack of congruity can cause deep pain in the groin with activities. This poor congruity can lead to progressive wear and tear on the cartilage that will eventually cause arthritis of your hip, which comes with chronic pain, limited range of motion and loss of function. These issues are usually diagnosed with an x-ray or other imaging. An orthopedist should be consulted and many times it can be managed conservatively with high quality physical therapy. If needed, there are also surgical techniques to correct the acetabulum to allow for a better fitting hip joint. Physical therapy and rehabilitation will be needed to recover full function after this type of surgical correction.

Another anatomic difference includes changes in the shape of the ball and socket called femoral acetabular impingement syndrome and labral tears of the hip. These are related problems that cause pinching, pain, limited range of motion and pain after activity. In the long term, if not treated by surgery and/or physical therapy, it can cause cartilage damage and arthritis. The main symptoms in this syndrome are pain and pinching in the inside joint of the hip as well as pain in the outside of the hip while sitting or performing exercises.

Traumatic injuries occur through accidents and high energy forces, such as car accidents, a fall from a height such as a ladder or stairs, icy weather falls, or even falls from tripping and landing on hard surfaces. These can cause pubic rami fractures, acetabular fractures, femoral neck fractures, trochanteric fractures, hip dislocations and stress fractures.

High level athletic activities can also cause a hip or pelvis injury. These fractures usually occur in different areas of the hip and pelvis such as the femoral neck, greater trochanter, acetabulum, pubic rami, sacrum, etc. and are characterized by severe pain in the hip and pelvis area, a leg length shortening of the injured side, inability to bear weight through the lower extremities, and disability. These are very noticeable injuries and anyone experience these symptoms should immediately go to the emergency room or see an orthopedist. All serious injuries will eventually need to be managed and treated with high quality physical therapy.

Physical therapy and rehabilitation for the treatment of hip injuries or conditions are integral to getting you back to fully enjoying the activities you love. Specialty centers, such as the Professional Physical Therapy Hip Center of Excellence are preferred choices of most physicians, as they offer patients the best chance at attaining full recovery. Our physical therapists are trained in the safest and most effective therapeutic exercise techniques, as well as specific manual techniques such as joint mobilizations, soft tissue release and mobilizations. Our specialized progression programs will allow for the quickest and safest path to recovery.

As a physical therapist and hip specialist for over 32 years, I’m passionate about the care and rehabilitation of patients who suffer from hip and pelvic injuries. That’s why I worked with Professional Physical Therapy to develop a hip specialization course designed exclusively for the best of the best therapists at our company. This ensures the treatment given by our hip specialists is consistent and most effective from one clinician to the next, while keeping up with the traditionally high standards of practice at Professional Physical Therapy.

If you are suffering from any of these injuries, visit to find a Professional Physical Therapy clinic near you and schedule an appointment.


Benjamin Gelfand PT, DPT, SCS

Benjamin Gelfand is an experienced Physical Therapist and Hip Specialist. He is currently the Regional Clinical Excellence Director in Manhattan and Brooklyn at Professional Physical Therapy.

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