Hip Injuries in the Endurance Athlete

Evaluation and management of the endurance athlete with hip pain require a thorough knowledge of the layered structure of normal anatomy and abnormal pathoanatomy in and around the hip joint. The subjective history and objective physical examination must be combined with any imaging to properly “treat the athlete and not the X-ray.” Patients with intra-articular pathology report deep groin pain, worse with the offending sporting activity, deep flexion, and rotational maneuvers. Physical examination typically reveals a loss of hip flexion and rotation with positive impingement findings. Risk factors for femoral neck stress fracture must be sought, evaluated, and promptly managed as this is an unmissable diagnosis. Femoroacetabular impingement and labral tears are likely the most common diagnosis in endurance athletes. Plain radiographs are very useful in endurance athletes with hip pain. However, advanced imaging with MRI and CT has a distinct and growing role in appropriate evaluation. Sources of pain around the hip joint frequently coexist, and the clinician must systematically assess all potential diagnoses, as they are not mutually exclusive.