The Hip

1. Trochanteric Bursitis: A bursa is a bag of fluid that sits in a joint and has the function of fascilitating the movement of that joint. A bursa may be injured by trauma, a fall, or a blow to the hip, or it may be inflamed by overuse, especially in the face of biomechanical abnormalities e.g. pronation.

   Presentation: pain over the outer hip associated with running, or lying on that side. Pain may radiate down the side of the thigh. The patient may walk with a limp, and there may be crepitations felt with ,movement of the limb. Tenderness over the outer hip area.

   Management: rest, ice, anti -inflammatories, compression using a neoprine sleeve, or pants, may help. If this does not work,. A cortisone injection may help, and in very severe cases surgery to remove the bursa may be required.

2. Arthritis: The hip joint itself may have arthritis, and or the capsule around the joint may be inflamed, causing a capsulitis, and pain with characteristic loss of movement in certain patterns. True hip pain is felt in the groin, any pain felt in the back of the hip, is unlikely to be a real hip problem, it is more likely to be referred from the back.

3. Groin injuries:

   Groin disruption: usually male patients, who engage in multiple sprint sports, which involve direction changes, e.g. ice hockey, soccer, rugby, and basketball. This injury is sometimes called a hernia, although this is the wrong name, as it is more a disruption of the inguinal ligament than a hernia (bulging out). The injury is caused by shearing forces acting across the region, partly associated with strong activity in the adductor muscles (inner thigh muscles). The iliohypogastric nerve, pubic symphysis, and adductor tendons. may also be affected.

   Presentation: One sided groin pain, worse at the start of exercise and at the end of sustained activity. Certain specific movements and activities will bring on the pain, e.g. sprinting or changing direction. The pain will be worse the night after activity. Groin pain on turning over in bed, climbing in and out of the car, coughing and sneezing. Sit up's will hurt , and so will kicking although the pain usually presents in the non-dominant leg. Pain may radiate into the testicles.

   Management: Severe pain in a high calibre athlete usually requires surgery, with post operative rehabilitation, and careful return to sport within 6-8 weeks. Younger athletes and endurance athletes respond to conservative treatment with rest, physiotherapy, and rehabilitation, with incremental return to sport.