Hip Sprains
What Is a Hip Sprain?
A hip sprain is a soft-tissue injury that occurs when the muscles and tendons supporting the hip are stretched beyond their elastic limit or torn. Although it is commonly called a sprain, the problem is usually a muscle-tendon strain. The hip flexors, the groin (adductor) muscles and the lower abdominal muscles are most often affected.
The severity ranges from mild to severe; in severe cases it becomes noticeably harder to move the hip. Most hip sprains heal without surgery. For other hip problems you can review the hip page.
How Does It Happen? Risk Factors
Hip sprains develop through two main mechanisms, and certain factors raise the risk.
- Acute injury: a fall, a sudden stretch or an unexpected force in contact sports that suddenly overloads the muscle.
- Overuse: gradual wearing and irritation of the muscle and tendon through repetitive movements.
- Risk factors: a previous injury in the same area, muscle tightness and imbalance, inadequate warm-up, a sudden and intense increase in training, fatigue and poor conditioning.
Grades of Injury
Muscle-tendon injuries are graded into three levels according to the severity of the damage; this determines the treatment time and the outlook.
- Grade 1: a simple stretch of the muscle; there is mild pain and tightness with strength largely preserved.
- Grade 2: a partial tear; there is marked pain, swelling, sometimes bruising and a loss of strength.
- Grade 3: a complete tear or the tendon avulsing from bone; there is a marked loss of strength and sometimes a palpable gap.
Symptoms
Symptoms vary with the grade of injury; in mild cases there is pain only with activity, while in severe cases there is pain at rest and marked weakness.
- Pain in the hip or groin that increases when the relevant muscle is used.
- Swelling and, at times, bruising.
- Restricted movement and a sense of weakness in the muscle.
- Sometimes a feeling of tearing or a pop at the moment of injury.
Conditions That Can Be Confused With It
A muscle-tendon strain is not the only cause of hip and groin pain; examination and, where needed, imaging tell them apart. Problems arising from within the joint (femoroacetabular impingement, a labral tear) usually cause deep groin pain that increases with rotation and squatting, whereas in a sprain the pain becomes prominent when the relevant muscle contracts and stretches.
Pain on the outer side of the hip suggests bursitis and tendon problems, and persistent groin pain suggests conditions such as athletic pubalgia (sports hernia) and hernia. If a fracture of the hip bone is suspected, especially when weight cannot be borne after a fall, this is an emergency.
Diagnosis
The diagnosis is usually made from the history and physical examination. How the injury happened, the location of the pain and which movement increases it are asked about; the strength and tightness of the affected muscle are tested.
Imaging is not needed in every patient. An X-ray is requested when a bone injury or avulsion is suspected, and MRI or ultrasound to clarify the grade of a tear or when the expected response to treatment does not occur.
Non-Surgical Treatment
The large majority of hip sprains heal without surgery. The aim is first to reduce pain and swelling and then to restore the muscle's strength and flexibility gradually.
- Relative rest in the first days, avoiding the movements that provoke pain and, where needed, reducing load with crutches.
- Cold application and, where needed, light compression for swelling and pain; short-term anti-inflammatory medication under medical advice.
- Range-of-motion work as pain settles, then progressive strengthening and flexibility exercises.
- An individualised physiotherapy programme if symptoms persist.
Exercise and Rehabilitation
The aim of rehabilitation is not just to relieve pain but to restore the muscle's strength and flexibility so that re-injury is prevented. The programme is individualised to the patient's symptoms and progresses within the limits of pain.
- Early phase: controlling pain and swelling and preserving pain-free range of motion.
- Middle phase: progressive strengthening of the affected muscle and the surrounding hip and trunk muscles.
- Advanced phase: a controlled return with sport-specific movements and acceleration-deceleration work.
When Is Surgery Needed?
Surgery is rarely needed for a hip sprain. It is generally considered in selected injuries where the tendon has torn completely or has avulsed from bone with a large fragment and leaves a marked loss of strength.
In these situations the torn tendon or bone fragment is reattached to the bone. The decision is made on an individual basis according to the type of injury and the patient's activity level and expectations.
Recovery and Prevention
Recovery time varies with the grade of injury; mild sprains settle within a few days to weeks, while severe tears can take longer. Return to activity is planned gradually according to pain-free movement and the recovery of muscle strength rather than a fixed date; an early, forced return increases the risk of re-injury.
- A regular exercise programme that keeps the hip, groin and trunk muscles strong and flexible.
- Warming up before activity, cooling down afterwards and increasing load step by step.
- Not returning to sport before a previous injury has fully recovered.
When Should You See a Doctor?
Most hip sprains settle with measures started at home; however, some symptoms call for assessment.
- The pain does not settle within a few days, persists despite rest or leg movements become difficult.
- There is a marked loss of strength, a palpable gap or a clear feeling of tearing at the moment of injury.
- Weight cannot be borne on the hip after a fall; this needs urgent assessment for a fracture.
For the assessment of hip symptoms you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within hip surgery.