Soccer Player with Injury Causing Hip Pain Consults Dr. Lox
A professional soccer player was doing a cutting move while playing in a game. He developed instant hip pain. It was not severe, but when he tried to run again he could not. He consulted Dennis M. Lox M.D. two days later. Dr. Lox is a Sports and Regenerative Medicine expert. The soccer player had some hip pain with range of motion, a normal gait or walk, no muscular tenderness or other provocative maneuvers to elicit other pain areas. As it was an acute injury within two days, and he was young 24, it was felt rest, ice, an oral anti-inflammatory, cold laser, and conservative management was the best course with follow up the next Monday. He was to refrain from soccer.
The following Monday was 7 days after his injury. He felt nearly 100% better. His physical examination was now normal. The hip range of motion was full without pain now. He felt in another two days he could return to practice. Cold laser, ice, and an oral anti-inflammatory were continued. He was instructed to stop the practice if hip pain returns. He was also told to ease into practice with light running, followed by slow progression.
If his symptoms return with practice, an MRI would be ordered of his hip to exclude more serious injury.
Not all Hip Pain is Easy
There are several muscle strains commonly injured about the hip with running sports, especially those with cutting during running, like soccer.
The hip flexors lying anterior to the hip joint, the hamstrings lying posterior to the hip joint, the adductor muscles on the inside of the hip, the gluteal muscles which extend and abduct the hip, the tensor fascia lata, and the iliotibial band on the outer aspect of the thigh extending to the knee.
Inside the hip joint, the cartilage covering the femoral head, known as the labrum can be torn.
Hip Avascular Necrosis or AVN
Avascular necrosis sometimes referred to as osteonecrosis, occurs when the blood supply to a region of bone becomes impaired. This leads to ischemia (lack of blood supply), and the region of bone becomes necrotic or dies. This is what happens with a heart attack or some strokes. Blood supply becomes impaired (ischemia), and heart tissue may die. The problem with AVN is athletes get hurt all the time, and AVN is relatively infrequent. So, AVN is not typically thought of as a first diagnosis. Some great athletes developed AVN, and it was not initially considered. This is what happened to the legendary Football and Baseball Player Bo Jackson. Trauma is the leading cause of AVN, and the hip is the most commonly affected joint in avascular necrosis, so when hip pain does not resolve in a timely manner, additional testing, and the consideration of AVN should occur.
