Pain along the back of the hip can be a very complex and puzzling condition to figure out. It's a fairly rare problem and affects athletes involved in golf, dance, or soccer most often. This article was written to help physicians diagnose with accuracy the problem and the cause.
The best way to evaluate and diagnose patients with posterior hip pain is always with a systematic and logical approach. That means knowing the anatomy, possible causes of hip pain, how to classify the disorder, and ultimately, knowing how to treat the real underlying problem.
Because the patient's symptoms are often vague and hard to pinpoint, special tests and imaging studies aid in the diagnostic process. The physician must also keep in mind that pain along the back of the hip could be coming from elsewhere -- like the sacroiliac joint, low back, or knee. It could be from a muscle strain, hernia, degenerative disc disease, fracture, or even from a hip dislocation.
One thing we know for sure. Based on how the nerves to the skin, soft tissues, and muscles work, posterior hip pain is rarely coming from inside the hip joint. The most common source of this type of pain is from the muscles or bursae.
The bursae are tiny fluid-filled pads between layers of muscle or between muscle and bone. They cushion the force of load and strain on the area where they are located. But they can get pinched, compressed, and inflamed causing a well-known condition called bursitis.
How does the physician sort this all out? First, by taking a very complete patient history. What happened? How did it happen? What are the symptoms? When did the problem start and how long has it been bothering the athlete? What makes it better or worse? Through a series of questions, the examiner can often tell if there is anything more serious going on (e.g., fracture, tumor, systemic disorder).
Making sure there isn't some other medical condition behind the pain is important because hip pain can be coming from the gastrointestinal or reproductive systems. Treatment for those types of problems is very different from treatment for muscle or other soft tissue issues.
Testing begins with an assessment of posture, alignment, motion, strength, and flexibility. Most of the time, there are enough clues from the patient history and exam to make an accurate diagnosis.
But sometimes, it's necessary to take X-rays or order other imaging studies like MRIs, CT scans, ultrasound studies, or even arthrography. That last test involves injecting a dye into the joint and taking pictures to see if the dye seeps out of the joint into the bone or tissues around the joint.
Arthrography is really a test for problems inside the joint and the authors already made note of the fact that this is a rare source of posterior hip pain in the athletic population. With athletes, MRIs are the best way to evaluate the soft tissue structures around the hip.
The authors offer a discussion centered on six of the most likely causes of posterior hip pain in athletes. These include: 1) pain coming from the lumbar spine, 2) problems in the sacroiliac joint, 3) muscle pain, 4) piriformis syndrome, 5) hamstring rupture, and 6) femoroacetabular impingement.
