Sports Medicine

, Volume 24, Issue 4, pp 273–288 | Cite as

Common Hip Injuries in Sport

  • Kevin T. Boyd
  • Nicholas S. Peirce
  • Mark E. Batt
Injury Clinic


As a major weight-bearing joint, normal hip function is fundamental to successful sporting participation. Not only is it important in running-, jumping- and kicking-based activities, it also contributes to the generation and transference of forces in upper limb-dominated activities. Injuries to the hip do not account for a large proportion of the sports physician’s workload, but may result in significant morbidity. The wide variety of acute, subacute and chronic injuries, affecting both the joint and surrounding soft tissues, can prove a diagnostic dilemma. The predisposition and the types of injuries around the hip vary with the age of the athlete. The young child rarely sustains a significant injury but one should be aware of orthopaedic conditions common in this age group that may manifest themselves through exercise. The immature skeleton of the adolescent is relatively injury prone and the demands of sport often exceed the capacity of the growing musculoskeletal system. In adults and older athletes, a further spectrum of injury exists, along with the effects of aging tissues and the concerns of degenerative joint disease. Rational treatment is based on a clear diagnosis developed through sound knowledge and a thorough history and examination. For the sports physician, treatments are typically early physical therapy and structured, progressive rehabilitation programmes which are individualised to the needs of the athlete. The spectrum of hip injuries is reviewed with current recommended diagnoses and management.


Femoral Head Stress Fracture Osteoid Osteoma Slip Capital Femoral Epiphysis Avulsion Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Lloyd-Smith R, Clement DB, McKenzie DC, et al. A survey of overuse and traumatic hip and pelvic injuries in athletes. Physician Sports Med 1985; 13: 131–41Google Scholar
  2. 2.
    Requa RK, Garrick JG. Adult recreational fitness. In: Caine DJ, Caine CG, Linder KJ, editors. Epidemiology of sports injuries. Champaign (IL): Human Kinetics Publishers, 1996: 14–28Google Scholar
  3. 3.
    Reid DC. Prevention of hip and knee injuries in ballet dancers. Sports Med 1988; 6(5): 295–307PubMedCrossRefGoogle Scholar
  4. 4.
    Knutzen K, Hart L. Running. In: Caine DJ, Caine CG, Linder KJ, editors. Epidemiology of sports injuries. Champaign (IL): Human Kinetics Publishers, 1996: 357–9Google Scholar
  5. 5.
    Larson M, Pearl AJ, Jaffet R, et al. Soccer. In: Caine DJ, Caine CG, Linder KJ, editors. Epidemiology of sports injuries. Champaign (IL): Human Kinetics Publishers, 1996: 387–98Google Scholar
  6. 6.
    Bijur PE, Trumble A, Harel Y, et al. Sports and recreation injuries in US children and adolescents. Arch Pediatr Adolesc Med 1995; 149(9): 1009–16PubMedCrossRefGoogle Scholar
  7. 7.
    Velin P, Four R, Matta T, et al. Sports injuries in children [in French]. Arch Pediatr 1994; 1(2): 202–7PubMedGoogle Scholar
  8. 8.
    Watkins J, Peabody P. Sports injuries in children and adolescents treated at a sports injury clinic. J Sports Med Phys Fitness 1996; 36(1): 43–8PubMedGoogle Scholar
  9. 9.
    Gardner E. The innervation of the hip joint. Anat Rec 1948; 101: 353–8PubMedCrossRefGoogle Scholar
  10. 10.
    Gardner E, Gray DJ, O’Rahilly R. Anatomy: a regional study of human structure. Philadelphia: WB Saunders, 1975Google Scholar
  11. 11.
    Giladi M, Milgrom C, Stein M, et al. External rotation of the hip: a predictor of risk of stress fractures. Clin Orthop 1987; 216: 131–4PubMedGoogle Scholar
  12. 12.
    Reid DC. Problems of the hip, pelvis, and sacroiliac joint. In: Sports injury assessment and rehabilitation. New York: Churchill Livingstone, 1992Google Scholar
  13. 13.
    Ogden JA. Skeletal injury in the child. Philadelphia: Lea & Febiger, 1982Google Scholar
  14. 14.
    Johnson RC, Smidt GL. Measurement of the hip joint during walking. J Bone Joint Surg 1969; 51A: 1083–94Google Scholar
  15. 15.
    Rydell N. Biomechanics of the hip joint. Clin Orthop 1973; 92: 6–15PubMedCrossRefGoogle Scholar
  16. 16.
    Morris JM. Biomechanical aspects of the hip joint. Orthop Clin North Am 1971; 2: 33PubMedGoogle Scholar
  17. 17.
    Nordin M, Frankel VH. Biomechanics of the hip. In: Nordin M, Frankel VH, editors. Basic biomechanics of the skeletal system. Philadelphia: Lea & Febiger, 1980: 149–77Google Scholar
  18. 18.
    Waters PM, Millis MB. Hip and pelvis injuries in the young athlete. Clin Sports Med 1988; 7(3): 513–26PubMedGoogle Scholar
  19. 19.
    Sim FH, Scott HG. Injuries of the pelvis and hip in athletes. In: Nicholas JA, Hershmann EB, editors. The lower extremity and spine in sports medicine. St Louis: CV Mosby, 1986: 1119–69Google Scholar
  20. 20.
    O’Donoghue, DH. Injuries of the hip and pelvis. In: Treatment of injuries to athletes, 3rd ed. Philadelphia: WB Saunders Co., 1976: 471–521Google Scholar
  21. 21.
    Antao NA. Myositis of the hip in a professional soccer player: a case report. Am J Sports Med 1988; 16(1): 82–3PubMedCrossRefGoogle Scholar
  22. 22.
    Kaeding CC, Sanko WA, Fischer RA. Myositis ossificans: minimising downtime. Physician Sports Med 1995; 23(2): 77–82Google Scholar
  23. 23.
    Schmidt SA, Kjaersgaard-Anderson P, Pedersen NW et al. The use of indomethacin to prevent the formation of heterotopic bone after total hip replacement: a randomised, double-blind clinical trial. J Bone Joint Surg 1988; 70A: 834–8Google Scholar
  24. 24.
    Gross ML, Nassser S, Finerman GAM. Hip and Pelvis. In: DeLee JC, Drez D Jr, editors. Orthopaedic sports medicine: principles and practice, vol. 2. Philadelphia: WB Saunders Co., 1994: 1063–85Google Scholar
  25. 25.
    Jackson DW. Managing myositis ossificans in the young athlete. Physician Sports Med 1975; 3(10): 56–61Google Scholar
  26. 26.
    Garrett WE, Safran MR, Seaber AV, et al. Biomechanical comparison of stimulated and nonstimulated muscle pulled to failure. Am J Sports Med 1987; 15: 448PubMedCrossRefGoogle Scholar
  27. 27.
    Zairns B, Ciullo JV. Acute muscle and tendon injuries in athletes. Clin Sports Med 1983; 2: 167–82Google Scholar
  28. 28.
    Garrett WE. Muscle strain injuries. Am J Sports Med 1996; 24(6): S2–8PubMedGoogle Scholar
  29. 29.
    Merrifield HH, Cowan RF. Groin strain injuries in ice hockey. J Sports Med 1973; 1: 41PubMedCrossRefGoogle Scholar
  30. 30.
    Metzmaker J, Pappas A. Avulsion fractures of the pelvis. Am J Sports Med 1985; 13: 349–58PubMedCrossRefGoogle Scholar
  31. 31.
    Rich BS, McKeag D. When sciatica is not disc disease: detecting piriformis syndrome in active patients. Physician Sports Med 1992; 20(10): 104–15Google Scholar
  32. 32.
    Hallin RP. Sciatic pain of the piriformis muscle. Postgrad Med 1983; 74: 69PubMedGoogle Scholar
  33. 33.
    Julstrud ME. Piriformis syndrome. J Am Podiatr Med Assoc 1989; 79(3): 128–31Google Scholar
  34. 34.
    Pace JB. The piriformis syndrome. West J Med 1976; 124: 435–9PubMedGoogle Scholar
  35. 35.
    Karl RD. Scintigraphic appearance of the piriformis muscle syndrome. Clin Nucl Med 1985; 10: 361PubMedCrossRefGoogle Scholar
  36. 36.
    Nakano KK. Unraveling the mysteries of piriformis syndrome. J Musculoskeletal Med 1986; 3: 8Google Scholar
  37. 37.
    Solheim LF, Stewers P, Paus B. The piriformis muscle syndrome. Acta Orthop Scand 1981; 52: 73–5PubMedCrossRefGoogle Scholar
  38. 38.
    Puranen J, Orava S. The hamstring syndrome. Am J Sports Med 1988; 16(5): 517–21PubMedCrossRefGoogle Scholar
  39. 39.
    Scharberg JE, Harper MC, Allen WC. The snapping hip syndrome. Am J Sports Med 1984; 12(5): 361–65CrossRefGoogle Scholar
  40. 40.
    Zoltan DJ, Clancy WG, Keene JS. A new operative approach to snapping hip and refractory trochanteric bursitis in athletes. Am J Sports Med 1986; 14: 201–4PubMedCrossRefGoogle Scholar
  41. 41.
    Brignall CG, Stainsby GD. The snapping hip: treatment by zplasty. J Bone Joint Surg 1991; 73B: 253–4Google Scholar
  42. 42.
    Dederich R. Die schnappende Hufte: erweiterung des Tractus Iliotibialis durch Z-plastik. Z Orthop 1983; 121: 168–70PubMedCrossRefGoogle Scholar
  43. 43.
    Vaccaro JP, Sauser DD, Beals RK. Iliopsoas bursa imaging: efficacy in depicting abnormal iliopsoas tendon motion in patients with internal snapping hip syndrome. Radiology 1995; 197: 853–6PubMedGoogle Scholar
  44. 44.
    Jacobsen T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med 1990; 18: 470–4CrossRefGoogle Scholar
  45. 45.
    Fitzgerald RH Jr. Acetabular labrum tears: diagnosis and treatment. Clin Orthop 1995; 311: 60–8PubMedGoogle Scholar
  46. 46.
    Altenberg AR. Acetabular labral tears: a cause of hip pain and degenerative athritis. South Med J 1977; 70: 174–5PubMedCrossRefGoogle Scholar
  47. 47.
    Walsh ZT, Micheli LJ. Hip dislocation in a high school football player. Physician Sports Med 1989; 17: 112Google Scholar
  48. 48.
    Stewart WJ. Aseptic necrosis of the head of the femur following traumatic dislocation of the hip joint: case report and experimental studies. J Bone Joint Surg 1933; 15: 413–38Google Scholar
  49. 49.
    Epstein HC. Traumatic dislocations of the hip. Clin Orthop 1973; 92: 116PubMedCrossRefGoogle Scholar
  50. 50.
    Nelson CL. Traumatic recurrent dislocation of the hip. J Bone Joint Surg 1970; 52A: 128Google Scholar
  51. 51.
    Canale ST, King RE. Pevic and hip fractures. In: Rockwood CA, Wilkins KE, King RE, editors. Fractures in children, 3rd ed. Philadelphia: JB Lippincott Co., 1991: 991–1120Google Scholar
  52. 52.
    Macfarlane I. A survey of traumatic dislocation of the hip in children [abstract]. J Bone Joint Surg 1976; 58B: 267Google Scholar
  53. 53.
    Paletta G Jr, Andrish JT. Injuries about the hip and pelvis in the young athlete. Clin Sports Med 1995; 14(3): 591–628PubMedGoogle Scholar
  54. 54.
    Gartland J, Brenner J. Traumtic dislocations in the lower extremity in children. Orthop Clin North Am 1976; 7: 687–700PubMedGoogle Scholar
  55. 55.
    Cooper DE, Warren RF, Barnes R. Traumatic subluxation of the hip resulting in necrosis and chondrolysis in a professional football player. Am J Sports Med 1991; 19(3): 322–3PubMedCrossRefGoogle Scholar
  56. 56.
    Fullerton LR Jr. Femoral neck stress fractures. Sports Med 1990; 9(3): 192–7PubMedCrossRefGoogle Scholar
  57. 57.
    McBryde AM Jr. Stress fractures in athletes. J Sports Med 1975; 3: 212PubMedCrossRefGoogle Scholar
  58. 58.
    Sterling JC, Edelstein DW, Calvo RD, et al. Stress fractures in the athlete: diagnosis and management. Sports Med 1992; 14(5): 336–46PubMedCrossRefGoogle Scholar
  59. 59.
    Johnson AW, Weiss CB, Wheeler DL. Stress fracture of the femoral shaft in athletes — more common than expected: a new clinical test. Am J Sports Med 1994; 22: 248–56PubMedCrossRefGoogle Scholar
  60. 60.
    Prather JL, Nusynowitz ML, Snowdy HA, et al. Scintigraphic findings in stress fractures. J Bone Joint Surg 1977; 58A: 869–74Google Scholar
  61. 61.
    Sterling JC, Webb RF, Meyers MC, et al. False negative bone scan in a female runner. Med Sci Sports Exerc 1993; 25: 179–185PubMedGoogle Scholar
  62. 62.
    Lee JK, Yao L. Stress fractures: MR imaging. Radiology. 1988; 169: 217–20PubMedGoogle Scholar
  63. 63.
    Devas MB. Stress fractures of the femoral neck. J Bone Joint Surg 1965; 47B: 728–38Google Scholar
  64. 64.
    Pankovich AM. Primary internal fixation of femoral neck fractures. Arch Surg 1975; 110: 20–6PubMedCrossRefGoogle Scholar
  65. 65.
    Wolfgang G. Stress fracture of the femoral neck in a patient with open capital femoral epiphysis. J Bone Joint Surg 1977; 59A: 680–1Google Scholar
  66. 66.
    Bevier WC, Wisell RA, Pyka G, et al. Relationship of body composition, muscle strength and aerobic capacity to bone mineral density in older men and women. J Bone Min Res 1989; 4: 421–32CrossRefGoogle Scholar
  67. 67.
    Clawson DK, Melcher PJ. Fractures and dislocations of the hip. In: Rockwood CA, Green DP, editors. Fractures, vol. 2. Philadelphia: JB Lippincott Co., 1975Google Scholar
  68. 68.
    Ireland D, Fisher R. Subtrochanteric fractures of the femur in children. Clin Orthop 1975; 110: 157–66PubMedCrossRefGoogle Scholar
  69. 69.
    Colonna PC. Fractures of the neck of femur in children. Am J Surg 1929; 6: 793CrossRefGoogle Scholar
  70. 70.
    Hughes L, Beaty J. Fractures of the head and neck of femur in children. J Bone Joint Surg 1994; 76A: 283–92Google Scholar
  71. 71.
    Veselko M, Smrkolj V. Avulsion of the anterior-superior iliac spine in athletes: Case reports. J Trauma 1994; 36(3): 444–6PubMedCrossRefGoogle Scholar
  72. 72.
    Combs JA. Hip and pelvis avulsion fractures in adolescents: proper diagnosis improves compliance. Physician Sports Med 1994; 22(7): 41–9Google Scholar
  73. 73.
    Anderson M. Magnetic resonance imaging of radiographically occult bony trauma. West J Med 1996; 165(1): 58PubMedGoogle Scholar
  74. 74.
    Brandser EA, El-Khoury GY, Kathol MH, et al. Hamstring injuries: radiographic, conventional tomographic, CT and MR imaging characteristics. Radiology 1995; 197(1) 257–62PubMedGoogle Scholar
  75. 75.
    Watanabe H, Shinozaki T, Arita S, et al. Irregularity of the apophysis of the ischial tuberosity evaluated by magnetic resonance imaging. Can Assoc Radiol J 1995; 46(5): 380–5PubMedGoogle Scholar
  76. 76.
    Clancy WJ, Foltz A. Iliac apophysitis and stress fractures in adolescent runners. Am J Sports Med 1976; 4: 214–6PubMedCrossRefGoogle Scholar
  77. 77.
    Hosli P, Laer VL. Traumatic apophyseal separation in the pelvis and upper femur [in German]. Orthopade 1995; 24(5): 429–35PubMedGoogle Scholar
  78. 78.
    Sundar M, Carty H. Avulsion fractures of the pelvis in children: a report of 32 fractures and their outcome. Skeletal Radiol 1994; 23(2): 85–90PubMedCrossRefGoogle Scholar
  79. 79.
    Winkler A, Barnes J, Ogden J. Break dance hip: chronic avulsion of the anterior superior iliac spine. Pediatr Radiol 1987; 17: 501–2PubMedCrossRefGoogle Scholar
  80. 80.
    Wooton J, Cross M, Holt K. Avulsion of the ischial apophysis: the case for open reduction and internal fixation. J Bone Joint Surg 1990; 72B: 625–7Google Scholar
  81. 81.
    Fernbach S, Wilkinson R. Avulsion injuries of the pelvis and and proximal femur. Am J Roentgenol 1981; 137: 581–4Google Scholar
  82. 82.
    Khoury M, Kirks D, Martinez S. Bilateral avulsion fractures of the anterior superior iliac spine in sprinters. Skeletal Radiol 1985; 13: 65–7PubMedCrossRefGoogle Scholar
  83. 83.
    Carp, L. Fracture of the anterior superior spine of the ilium by muscular violence. Ann Surg 1924; 79: 551–60PubMedCrossRefGoogle Scholar
  84. 84.
    Deehan D, Beattie T, Knight D. Avulsion fracture of the straight and reflected heads of rectus femoris. Arch Emerg Med 1992; 9: 310–3PubMedGoogle Scholar
  85. 85.
    Godshall R, Hansen C. An injury of young athletes. J Bone Joint Surg 1972; 55A: 1301–2Google Scholar
  86. 86.
    Miller A, Stedman G, Beisaw N. Sciatica caused by an avuslion fracture of the ischial tuberosity: a case report. J Bone Joint Surg 1987; 69A: 143–5Google Scholar
  87. 87.
    Schlonsky J, Olix M. Functional disability following avulsion fracture of the ischial epiphysis: a report of two cases. J Bone Joint Surg 1972; 54A: 641–4Google Scholar
  88. 88.
    Gill DRJ, Clark WB. Avulsion of the ischial apophysis. Aus NZ J Surg 1996; 66(8): 564–5CrossRefGoogle Scholar
  89. 89.
    Martin T, Pipkin G. Treatment of avulsion of the ischial tuberosity. Clin Orthop 1957; 10: 108–18PubMedGoogle Scholar
  90. 90.
    Merlino A, Nixon J. Isolated fractures of the greater trochanter: a report of twelve cases. Int Surg 1969; 52: 117–24PubMedGoogle Scholar
  91. 91.
    Aicardi C, Baldoni ME, Calati C, et al. Ultrasonography in the diagnosis and follow-up of transient synovitis of the hip in children [in Italian]. Ortoped Traumatol Oggi 1994; 14(1): 37–9Google Scholar
  92. 92.
    Hart JJ. Transient synovitis of the hip in children. Am Fam Physician 1996; 54(5): 1587–91PubMedGoogle Scholar
  93. 93.
    Lawson JP, Keller MS, Rattner Z. Recent advances in pediatric musculoskeletal imaging. Radiol Clin North Am 1994; 32(2): 353–75PubMedGoogle Scholar
  94. 94.
    Fink AM, Berman L, Edwards D, et al. The irritable hip: immediate ultrasound guided aspiration and prevention of hospital admission. Arch Dis Child 1995; 72(2): 110–4PubMedCrossRefGoogle Scholar
  95. 95.
    Catterall A. The natural history of Perthes disease. J Bone Joint Surg 1971; 53B: 37–53Google Scholar
  96. 96.
    Herring JA. The treatment of Legg-Calve-Perthes disease. J Bone Joint Surg 1994; 76A; 448–58Google Scholar
  97. 97.
    Crawford A. Slipped capital femoral epihysis. J Bone Joint Surg 1988; 70: 1422–7PubMedGoogle Scholar
  98. 98.
    Enneking WF. Musculoskeletal tumor surgery. New York: Churchill Livingstone, 1983Google Scholar
  99. 99.
    Ahlfeld SK, Makley JT, Derosa GP, et al. Osteoid osteoma of the femoral neck in the young athlete. Am J Sports Med 1990; 18(3): 271–6PubMedCrossRefGoogle Scholar
  100. 100.
    Batt ME, Timmerman LA. Hip pains in a recreational runner. Int J Sports Med 1995; 16: 563–7PubMedCrossRefGoogle Scholar
  101. 101.
    Blair SN, Kohl HW, Powell KE, et al. Running and the incidence of osteoarthritis [abstract]. Med Sci Sports Exerc 1990; 22 Suppl.: S116Google Scholar
  102. 102.
    Panush RS, Schmidt C, Caldwell JR, et al. Is running associated with joint disease? JAMA 1986; 255: 1152–4PubMedCrossRefGoogle Scholar
  103. 103.
    Puranen J, Ala-Ketola L, Peltokallioi P, et al. Running and primary osteoarthritis of the hip. Br Med J 1975; 2: 424–5PubMedCrossRefGoogle Scholar
  104. 104.
    Lane NE, Bloch DA, Jones H, et al. Long distance running, bone density and osteoarthritis. JAMA 1986; 255: 1147–51PubMedCrossRefGoogle Scholar
  105. 105.
    Nigg BM. Biomechanics as applied to sports. In: Harries M, Williams C, Stanish WD, et al., editors. Oxford textbook of sports medicine. Oxford: Oxford University Press, 1996Google Scholar
  106. 106.
    Spector TD, Harris PA, Hart DJ, et al. Risk of osteoarthritis associated with long-term weight-bearing sports: a radiologie survey of the hips and knees in female ex-athletes and population controls. Arthritis Rheum 1996; 39(6): 988–95PubMedCrossRefGoogle Scholar
  107. 107.
    Vingard E, Alfredsson L, Goldie I, et al. Sports and osteoarthritis of the hip: an epidemiological study. Am J Sports Med 1993; 21: 195–200PubMedCrossRefGoogle Scholar
  108. 108.
    Segesser B, Morscher E, Goesele A. Disturbances in the growth plates as a result of sports stress [in German]. Orthopade 1995; 24(5): 446–56PubMedGoogle Scholar
  109. 109.
    Van Dijk CN, Lim LSL, Poortman A, et al. Degenerative joint disease in female ballet dancers. Am J Sports Med 1995; 23(3): 295–300PubMedCrossRefGoogle Scholar
  110. 110.
    Klunder KB, Rud B, Hansen J. Osetoarthritis of the hip and the knee joint in retired football players. Acta Orthop Scand 1980; 51: 925–7PubMedCrossRefGoogle Scholar
  111. 111.
    Stover B, Sigmund G, Huhle P, et al. Early alterations in the hip joint following epiphysiolysis for slipped femoral head: results of an MRI study [in German]. Radiologe 1994; 34(1): 46–51PubMedGoogle Scholar
  112. 112.
    Legal H, Reinecke M, Ruder H. Zur biostatischen Analyse des Huftgelenkes. Z Orthop Ihre Grenzgeb 1980; 118: 804–15PubMedCrossRefGoogle Scholar
  113. 113.
    McGrory BJ, Stuart MJ, Sim FH. Participation in sports after hip and knee arthroplasty: review of literature and survey of surgeon preferences. Mayo Clin Proc 1995; 70(4): 342–8PubMedCrossRefGoogle Scholar
  114. 114.
    White J. Exercise and total hip replacement. Physician Sports Med 1992; 20(3): 222–8Google Scholar
  115. 115.
    Mallon WJ, Liebelt RA, Mason JB. Total joint replacement and golf. Clin Sports Med 1996; 15(1): 179–90PubMedGoogle Scholar

Copyright information

© Adis International Limited 1997

Authors and Affiliations

  • Kevin T. Boyd
    • 1
  • Nicholas S. Peirce
    • 1
  • Mark E. Batt
    • 1
  1. 1.Centre for Sports Medicine, Department of Orthopaedic and Accident SurgeryUniversity of NottinghamNottinghamEngland

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