Weekend Warriors: Keeping Hips Strong and Flexible

The hips are a critical source of power and force, not just in sports but also in everyday living. Hip mobility and strength are vital to function, performance, and quality of life. Yet the health of the hip joint can tend to be overlooked by athletes—both pros and weekend warriors—when they train for and play sports, and this can result in hip flexor pain and a loss of hip mobility.

To understand hip function, let’s look quickly at their structure:

The body has two sets of ball-and-socket joints, the hips and shoulders. In the hip, the uppermost part of the thighbone forms a ball that fits into a cavity in the pelvis, the socket. Though mechanically similar to shoulder joints, hip joints have a deeper socket, with a greater mass of surrounding muscle and connective tissue. This makes the hip joint much more stable and resilient than a shoulder joint tends to be.

The hips serve as the strongest link in the kinetic chain, anchoring and powering nearly every sporting activity. Whether throwing, running, kicking, jumping, or just walking from point A to point B, the muscle, bone, and connective tissue of your hips move together in a well-coordinated rhythm.

Also very important, the hips function as the body’s shock absorbers. Strengthening them is like upgrading the shocks on your car to help steady the ride and avoid damage from continual impact.

When Injury Occurs

Despite their inherent sturdiness, hips can be susceptible to many issues that cause pain and loss of function:

• As mentioned, a large, complex array of muscles, tendons, and ligaments surround and stabilize the hip joint. Any one of these can be strained, pulled, or otherwise damaged by overuse, trauma, or instability, causing pain and limiting range of motion without involving the joint.
• The IT band is a long strip of connective tissue on the outside of each thigh, running from the pelvis to the knee. Overuse can cause it to rub against bone and create inflammation felt in the hip.
• Tendinopathy may degrade tendons over time, creating mechanical weakness and lack of flexibility that can translate to pain and stiffness.
• The labrum is the ring of cartilage that surrounds and cushions the area where the ball and socket connect. Tears of the hip labrum are extremely common and can cause pain and instability; however, many people can have small labral tears yet feel nothing in the early stages—a testament to the hardiness of the hip joint.
• Anatomical variations can cause mechanical problems with the joint and are described as femoroacetabular (hip) impingement syndrome. For example, cam impingement occurs when the ball end of the femur becomes egg-shaped, instead of perfectly spherical, hastening cartilage wear. Pincer impingement is caused by excess bone coverage of the acetabulum (or socket). Both types of impingement can cause hip labral tears.
• Osteoarthritis may begin to erode hip cartilage, the slippery, flexible tissue that acts as a cushion between the femur and pelvis, causing pain and loss of flexibility.

How does an athlete know that a hip injury has occurred? Symptoms may begin with pain, weakness, and stiffness in the thigh, groin, buttock, or inside or outside of the hip (particularly when walking or flexing the hip), and decreased range of motion in the hip. If these issues linger, it’s time to speak with an orthopedic specialist.

Diagnosing the Problem

When I first examine a new patient with hip pain, I can often determine a lot just by watching their posture and how they walk. Even sitting can be uncomfortable for some, which is usually readily apparent.

On the exam table, I put the hip and other joints through range-of-motion testing and check for level of strength. Often, one hip is shown to be much weaker than its counterpart. By demonstrating this imbalance, we help the patient better comprehend the issue, as well as any potential need for physical therapy or other interventions. While the hip joint may be the root of the problem, it’s frequently the surrounding structures that create issues for athletes and other active people.

Of course, X-ray imagery can often give us the view we need to rule out serious deficiencies in the joint. But I like to emphasize that “we don’t treat the image, we treat the patient.” One patient may very well have advanced arthritis, labral tears, and other problems causing impingement, yet continue to function perfectly normally. At the same time, someone else may strain a muscle and end up practically debilitated. Everyone responds to injury differently, so functional testing is critical.

Treating Hip Issues

Thanks to the abundant muscle mass surrounding the hip, strengthening and conditioning of this area can often get an athlete back on the road, field, or court. Fortunately, the hip responds very well to rehabilitation, and that’s generally where we start.

Physical therapy can address two problems: Conditioning strengthens the hip muscles to improve stability in the joint, and therapy can help the athlete reprogram certain movements to prevent future problems. (For example, a runner who returns to the road with the same unstable gait is almost sure to experience a recurrence of their issue, and perhaps some new problems as well.)

In addition, anti-inflammatory drugs or corticosteroid injections can sometimes enhance the effectiveness of therapy by reducing short-term pain and inflammation. Our goal is to get the joint moving well as quickly as possible. In orthopedics, “motion is lotion”—helping the patient to heal and get back in the game.

Most hip problems can typically be treated without surgery but, in cases where it’s the best course of treatment, we can perform minimally invasive hip arthroscopy. We insert a small camera and other instruments into the affected area to view the damage, correct problems, and make repairs, as needed.

Hip replacement surgery can be especially effective for people who have severe degenerative disease that has damaged bone and cartilage beyond repair.

Back in the Game, Safely

If you’re bouncing back from injury, it’s important to work with your orthopedic surgeon to prepare for a safe return to your sport. Likewise, jumping back into a particular sport that you haven’t played for years can take some prep as well.

After a decade off the court, suddenly deciding to join a five-on-five league with no preparation may have your feet, knees, and hips aching quickly. Part of the reason: your shock absorbers are not yet ready for strenuous activity on a hard surface. Weekend warriors can prepare their hips for the rigors of team sports and pick-up games by focusing on regular flexibility and strength.

And beyond managing the hard surface, dribbling, and shooting, basketball also requires constant stopping and starting, not to mention the need for endurance. So, regardless of your sport or favorite activity, break it down: what does it take to play basketball, ski, run long distances, or play rugby or hockey?

The web is a rich source of exercises specifically tailored to the needs of athletes beginning or returning to specific sports and activities. It’s fine to prepare for increased levels of activity on your own, as long as you use common sense with strength and flexibility exercises. However, if you’re unsure or still managing a prior injury, don’t hesitate to speak to a member of our orthopedics team to get yourself started.

A few other notes: Durable core muscles can help you be successful in nearly every activity—the stronger your core, the stronger your game. Aerobic fitness is vital, too, but be sure to build up gradually. Rushing out to perform at a high level of activity without prepping aerobically can be a recipe for problems as well.

We highly recommend cross training, a tactic that many of our professional athletes use. Athletes with the longest careers tend to be those who diversify their training activity, rather than stick solely with one single sport.

Experts at Orthopedics

In the current pandemic, many athletes—from professionals to weekend warriors—have been far less active physically. At the Hospital Center, we’re seeing a greater-than-normal amount of overuse injuries as athletes try to intensify activity too quickly.

If you’ve been inactive over the winter, yes, it’s certainly important to get moving! But it’s even more important to do so safely and gradually.

Our orthopedic surgeons are highly qualified to consult on hip injuries and the wide array of other injuries that athletes sustain. Most of our doctors have also played sports, some at the college level, and several of them currently work with our Washington, D.C., - and Baltimore-area professional sports teams.

Our team is also involved in important orthopedic research and was asked to manage the 2021 Annual Cherry Blossom Seminar. Held locally each spring for the past four decades, the Seminar is the oldest sports medicine and arthroscopy symposium in the United States and one of the most highly respected.

With this experience and involvement, we can assure every athlete—champions, weekend warriors, and everyone in between–that they’re in very good hands here at the Hospital Center.