Help with Hip Pain

Jul 1, 20 13:14

Post #1 of 15 (2201 views)

Hi all!
I'm looking for someone's - anyone's - help ...
On May 21st I did something to bugger up my right hip. My training load was predominately (heavy) cycling. Running load was lower at the time as I was recovering from a tinge of plantar fasciitis, but still running easy. It started off as a "fluid-like" feeling on the outside of my right hip. Imagine a gel-pack sitting on the outside of your hip, inside your bike shorts. I took at 2 week break, with very light training load. The feeling didn't go away. I was building a workbench at the time, and while sitting on the lower shelf and standing up, I felt the front of my right hip flexor "twinge". This has since developed into a dull ache now around the top of my right iliac crest. The typical hip flexor kneeling stretch will lead to a painful dull ache a few hours afterwards and into the next day. I also feel a constant dull pain on my iliac crest. If I sit reading a book with my arm rested there, it developed into a painful dull ache. If I palpate the right ilium, there is one small spot that is super tender.
I have been seeing a physiotherapist and osteopath now for 5 weeks. Both seem to think its a form of hip bursitis. I have been given glute bridges and foam rolling of the IT band and quads as exercises - nothing else but applying some heat. We tried the kneeling hip flexor stretch and that was a bust. Tried step-ups and that also lead to hip pain (sharper, near the femur head).
Through my own research, it seems to be iliopsoas bursitis, as when I externally rotate a flexed hip, I get a clicking feeling in my hip joint. This is the only thing that seems to match up with the pain at the top of the iliac crest and my hip.
I am now on week 2 of complete rest and zero training with no signs of improvement since May 21st. If anyone has any suggestions on what this may be, if my self-diagnosis is incorrect, or even any suggestions on recovery, I would be eternally grateful.

Re: Help with Hip Pain [cjolliffe] [ In reply to ]

Jul 1, 20 16:05

Post #2 of 15 (2147 views)

cjolliffe wrote:

Hi all!
I'm looking for someone's - anyone's - help ...
On May 21st I did something to bugger up my right hip. My training load was predominately (heavy) cycling. Running load was lower at the time as I was recovering from a tinge of plantar fasciitis, but still running easy. It started off as a "fluid-like" feeling on the outside of my right hip. Imagine a gel-pack sitting on the outside of your hip, inside your bike shorts. I took at 2 week break, with very light training load. The feeling didn't go away. I was building a workbench at the time, and while sitting on the lower shelf and standing up, I felt the front of my right hip flexor "twinge". This has since developed into a dull ache now around the top of my right iliac crest. The typical hip flexor kneeling stretch will lead to a painful dull ache a few hours afterwards and into the next day. I also feel a constant dull pain on my iliac crest. If I sit reading a book with my arm rested there, it developed into a painful dull ache. If I palpate the right ilium, there is one small spot that is super tender.
I have been seeing a physiotherapist and osteopath now for 5 weeks. Both seem to think its a form of hip bursitis. I have been given glute bridges and foam rolling of the IT band and quads as exercises - nothing else but applying some heat. We tried the kneeling hip flexor stretch and that was a bust. Tried step-ups and that also lead to hip pain (sharper, near the femur head).
Through my own research, it seems to be iliopsoas bursitis, as when I externally rotate a flexed hip, I get a clicking feeling in my hip joint. This is the only thing that seems to match up with the pain at the top of the iliac crest and my hip.
I am now on week 2 of complete rest and zero training with no signs of improvement since May 21st. If anyone has any suggestions on what this may be, if my self-diagnosis is incorrect, or even any suggestions on recovery, I would be eternally grateful.

It does sound like hip bursitis or ilopsoas bursistis. I had hip bursitis for about 2 years a while ago. I never really got to the bottom of it. I ended up having 3 cortisone injections, I think one of them had a mild effect, the others did nothing. I know sleeping on that side made it worse as did running. I would often run in lightweight shoes with not much support or cushioning and would run in the cold without stretching. This no doubt contributed.

I don't even remember how it went away, I think it was a gradual thing over many months. Sorry that's not much help. Rest did nothing, I didn't run for 2 months, first run back it was sore within 1km. Perhaps play around with your running and see what work e.g intervals on a treadmill, easy running on grass, hill repeats, run walking etc

Re: Help with Hip Pain [cjolliffe] [ In reply to ]

Jul 1, 20 16:32

Post #3 of 15 (2135 views)

Try some KT Tape. I had bursitis in the same area. Would have sharp stabbing pain for the first mile of my run then go away. About 1-2 hrs after the run the pain would come back worse. Getting in and out of the car was an ordeal, going up stairs hurt, walking hurt. 3 days later it would be a dull ache. Next time I would run the same thing would happen. After 3 weeks I tried some KT tape before my run. No pain running. Left it on for a couple of days. Day after I took it off it was aching. Taped it up again with no pain again. Kept it taped for 3 weeks and pain disappeared. Haven't had a problem since. For $20 for the tape it might be a cheap cure.

Re: Help with Hip Pain [mattr] [ In reply to ]

Jul 1, 20 17:17

Post #4 of 15 (2115 views)

Thank you both!

Funny thing is, there is no pain during activity. Whether that be bike or run, besides the fluid-like feeling. It’s only hours afterwards or the next day that there is any pain.

Re: Help with Hip Pain [cjolliffe] [ In reply to ]

Jul 1, 20 18:03

Post #5 of 15 (2102 views)

I'm not a doctor, this is my current experience to contrast with your own.

It's funny, I had very similar symptoms, though more severe, I went from running to being on crutches to walk in about 10 minutes. I am currently in recovery as well.

The hip flexor discomfort, the iliac crest pain, etc.

I never had a fluid like feeling though.

I was initially diagnosed with greater trochanter bursitis, physio was like no way that's it.

Further investigation including a ct scan, it turns out I have bone edema on the lesser trochanter which suggests damage to the iliopsoas tendon, and sure enough, that is right in line with all my areas of discomfort.

The click MIGHT well be in line with snapping hip syndrome, which is associated with the iliopsoas as well. Check it out.

Quite often the term "bursitis" comes up and it may have nothing to do with the bursa but instead with the muscle/tendon. Some of the reading I've done suggests that overloading at higher training paces without adequate strength in the hip rotators can end up aggravating an issue like this.

So far I'm on a week and a half of rest, I've gone from 2 crutches to one, at TIMES I can hobble around with none ( but with a gross limp ).

The case studies I have read seem to suggest that if it's tendon related, that a targeted strengthening regiment has better outcomes sooner than simply resting it, and as such I've started to follow the prescribed hip rotator exercises, some clamshells and will eventually graduate to mini squats ( would be WAY Too painful atm with the hip flexor engagement )

I don't know if that'll help, but it's where I currently am.

Last edited by: dfquigley: Jul 1, 20 18:04

Re: Help with Hip Pain [cjolliffe] [ In reply to ]

Jul 1, 20 18:23

Post #6 of 15 (2090 views)

Upright health and Kelly Starrett you tubes have good stuff. Lots free, but they also have subscriptions for instance Upright Health has healthy hips 1& 2. My iliac crest pain helped with Couch stretch and waking up glutes to take load off of QL. But we are all a bit different so I would punch in area of pain in you tube and browse plus a good heat pad. Also piriformis may be a problem too but not sure where it produces referred pain. Good luck and trial and error, but not too much too quick.

Re: Help with Hip Pain [cjolliffe] [ In reply to ]

Jul 1, 20 19:27

Post #7 of 15 (2071 views)

cjolliffe wrote:

Hi all!
I'm looking for someone's - anyone's - help ...
On May 21st I did something to bugger up my right hip. My training load was predominately (heavy) cycling. Running load was lower at the time as I was recovering from a tinge of plantar fasciitis, but still running easy. It started off as a "fluid-like" feeling on the outside of my right hip. Imagine a gel-pack sitting on the outside of your hip, inside your bike shorts. I took at 2 week break, with very light training load. The feeling didn't go away. I was building a workbench at the time, and while sitting on the lower shelf and standing up, I felt the front of my right hip flexor "twinge". This has since developed into a dull ache now around the top of my right iliac crest. The typical hip flexor kneeling stretch will lead to a painful dull ache a few hours afterwards and into the next day. I also feel a constant dull pain on my iliac crest. If I sit reading a book with my arm rested there, it developed into a painful dull ache. If I palpate the right ilium, there is one small spot that is super tender.
I have been seeing a physiotherapist and osteopath now for 5 weeks. Both seem to think its a form of hip bursitis. I have been given glute bridges and foam rolling of the IT band and quads as exercises - nothing else but applying some heat. We tried the kneeling hip flexor stretch and that was a bust. Tried step-ups and that also lead to hip pain (sharper, near the femur head).
Through my own research, it seems to be iliopsoas bursitis, as when I externally rotate a flexed hip, I get a clicking feeling in my hip joint. This is the only thing that seems to match up with the pain at the top of the iliac crest and my hip.
I am now on week 2 of complete rest and zero training with no signs of improvement since May 21st. If anyone has any suggestions on what this may be, if my self-diagnosis is incorrect, or even any suggestions on recovery, I would be eternally grateful.

Your glut med and TFL insert at the top of your iliac crest. I am a doctor and I also know this more than others as I currently have a torn glut med tendon. I had 4 weeks of pain very well localised to my iliac crest, the likely insertion point and source of the tear. My physio thought it was either a glut med and TFL injury, my sports doc ordered an MRI urgently which revealed a decent tear. Don't know yet what we will do, will know next week.
My advice, get scanned if you can as clinical acumen only takes you so far, even with the most experienced physio's.

Re: Help with Hip Pain [Amnesia] [ In reply to ]

Jul 2, 20 4:45

Post #8 of 15 (2003 views)

Good morning everyone. Thank you very much for all the thoughts and feedback. I greatly appreciate it!

My coach suggested that my TFL May be the culprit as well.

I don’t know a whole lot about tears, but there was no sudden event or instance where the pain developed. Not even sudden pain. The moment I felt the “fluid-like” feeling on the outside of my right hip, I stopped cycling with any sort of intensity. I thought I was doing the right thing by stopping before doing any damage, but possibly the damage was already done somehow? It was just a development of a dull pain at the iliac crest..

Given that there hasn’t been any improvement, it sounds like getting some imaging done would be the next step.

Re: Help with Hip Pain [cjolliffe] [ In reply to ]

Jul 2, 20 5:04

Post #9 of 15 (1997 views)

cjolliffe wrote:

Good morning everyone. Thank you very much for all the thoughts and feedback. I greatly appreciate it!

My coach suggested that my TFL May be the culprit as well.

I don’t know a whole lot about tears, but there was no sudden event or instance where the pain developed. Not even sudden pain. The moment I felt the “fluid-like” feeling on the outside of my right hip, I stopped cycling with any sort of intensity. I thought I was doing the right thing by stopping before doing any damage, but possibly the damage was already done somehow? It was just a development of a dull pain at the iliac crest..

Given that there hasn’t been any improvement, it sounds like getting some imaging done would be the next step.

Interestingly enough, I cannot recall the exact moment this happened, all I know is that I developed this pain and it became more noticeable. Sudden onset stuff tends to point more towards a year, I really felt like i had ripped something off my iliac crest (which is in a way what the scan shows).

I love the clinical acumen of practitioners but often it can be tricky as you really need good imaging to know what is going on (and granted imaging can also cause more issues with false positives etc).

Re: Help with Hip Pain [Amnesia] [ In reply to ]

Jul 2, 20 5:06

Post #10 of 15 (1993 views)

Is that right? That’s crazy!!!

Did you have any other signs or symptoms? Bruising, swelling, etc?

Re: Help with Hip Pain [cjolliffe] [ In reply to ]

Jul 2, 20 8:21

Post #11 of 15 (1957 views)

I'm just now getting back to running after almost a year of dealing with hip pain., three months off running, just cycling/swimming (when able!)
I had xrays and MRI just to rule out arthritis. didn't want to be grinding anything away...… verdict for me was no arthritis, Dr said the hip structure was good, but severe bursitis and partial hamstring tears both sides.

I ran through the pain all last year and this spring it became unbearable to run. My bad.
Two cortisone shots..they helped. the biggest thing that helped was no running/hiking for two months. As doctor said "you have to put out the fire..if there's even an ember there, it will flare again."

PT exercises given by skype appointments to strengthen all hip muscles. Stretches that didn't aggravate the condition further.

I've also discovered that being a side sleeper all my life was suddenly a no-go. Once I gave up and learned to sleep on my back it got better a lot faster.
Just now back to 3 mile run/walks that are going well...building gradually to all running and eventually more distance.

I was able to cycle through it as long as I kept rides under 40 miles..now building that as well.

My advice is-don't ignore it, it will bite back.

Re: Help with Hip Pain [TricentralPA] [ In reply to ]

Jul 2, 20 9:10

Post #12 of 15 (1943 views)

Wow! That’s a lot to deal with! I wish you the best of luck coming back from that!

I’d like to think I haven’t just ignored it and trained through it. The first three weeks after the initial fluid-like feeling were very light (not complete rest however). I tried during the fourth week to give it a shot and when it seemed to still be there, that’s when we decided to just give it two solid weeks off with zero training.

As I’m sure you know, the frustration is that it seemingly developed behind the scenes, well before any obvious symptoms that may have lead to me pulling the plug earlier. Plus what originally made me stop was a non-painful fluid feeling

Re: Help with Hip Pain [cjolliffe] [ In reply to ]

Jul 2, 20 9:30

Post #13 of 15 (1938 views)

it can be very tricky in that, you think you're good to go, it's feeling ok, and halfway through a run it starts right up again.
do you have a physical therapist helping you? they are pretty good at knowing when to put the brakes on and when to go.

Re: Help with Hip Pain [TricentralPA] [ In reply to ]

Jul 2, 20 9:48

Post #14 of 15 (1929 views)

I do have a physiotherapist and an osteopath helping me at the moment. I've had PT treatments for the past month (1-2 times per week) with no signs of improvement. PT hasn't been very talkative - they just said that it looked like hip bursitis, don't do anything that aggravates it. I was prescribed banded glute bridges, foam rolling my IT band and quads and using a lacrosse ball to roll the tender point on my hip, and only use heat. The osteopath seemed to think that my adductor muscles wee very tight, and thought that this may have caused for my leg to rotate inwards, emphasizing the use of the lateral leg muscles, which could have lead the to injury. The osteo I just started seeing, and it has been just manual manipulations and stretching, no at home exercises or such.

I tried doing my own stretching and yoga, and that just made it worse. Particularly doing the kneeling hip flexor stretch, guaranteed later that day or even into the next day, I would have this dull ache. So I have obviously stopped stretching and yoga, and just stuck to the PT exercises. However I am left with an intermittent ache primarily atop the iliac crest and directly at my front hip flexor. I haven't been on the bike for a while to know if the fluid feeling still exists.

Re: Help with Hip Pain [cjolliffe] [ In reply to ]

Jul 2, 20 9:59

Post #15 of 15 (1926 views)

if you are resting and doing as they advise it should show signs of getting better soon.
if it were me, and it didn't start to improve soon, I would ask for MRI so there's no question of it being something more sinister. And, if you aren't seeing any improvement with the plan you've been given, maybe seek out new medical providers at some point.

It is a slow healing condition. Best of luck.

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