Blog 1: The Athlete’s Guide to Hip Pain: From Anatomy to Performance
Part 1: Understanding Hip Anatomy & Common Pain Locations
Welcome to the first blog in our 5-part series where Dr. Keirstyn of Endurance Therapeutics will be talking about everything related to hip pain in athletes. If you're a runner dealing with deep groin pain, a cyclist with hip flexor tightness that won't quit, a dancer struggling with clicking hips, or a hockey player whose hip aches after every game — this series is for you.
Hip pain is one of the most misunderstood complaints in sports medicine. Athletes often can't pinpoint where it hurts, and even when they can, they're told conflicting things: "It's just tight," "You need to stretch more," "Stop running for 6 weeks."
The truth: Hip pain isn't one thing. It's a dozen different issues that all feel vaguely similar. Understanding where your pain is coming from is the first step to fixing it.
Over the next 5 parts, we'll break down:
Hip anatomy and pain locations (this blog)
Anterior (front) hip pain
Lateral (side) hip pain
Movement patterns that create hip problems
Rehabilitation and long-term hip health
Let's start with the basics.
Hip Anatomy: A Quick Overview
Your hip is a ball-and-socket joint where your femur (thigh bone) meets your pelvis. It's designed for both mobility (walking, running, kicking) and stability (standing on one leg, absorbing impact).
Key Structures:
The Joint Itself:
Femoral head: The ball at the top of your thigh bone
Acetabulum: The socket in your pelvis
Labrum: Cartilage ring that deepens the socket and cushions the joint
Joint capsule: Thick ligamentous tissue surrounding the joint
Muscles Around the Hip:
Hip flexors: Psoas, iliacus, rectus femoris (lift your knee)
Glutes: Maximus, medius, minimus (extend and stabilize)
Adductors: Inner thigh muscles (bring leg toward midline)
Deep rotators: Small muscles that control hip rotation
Bursae:
Fluid-filled sacs that reduce friction between tissues
Key ones: trochanteric bursa (side of hip), iliopsoas bursa (front of hip)
Where Does It Hurt? Pain Location Matters
Hip pain can present in different locations, and each tells a different story.
1. Anterior Hip Pain (Front of Hip/Deep Groin)
What It Feels Like:
Deep in the front of the hip or groin
Often described as "inside the hip"
May feel like pinching with leg movement
Common Causes:
Hip impingement (FAI)
Labral tears or irritation
Hip flexor strains
Capsular restrictions
Referred pain from lower back
Who Gets It:
Runners with high mileage
Cyclists in aggressive positions
Dancers with extreme range demands
Hockey players with repetitive skating stride
2. Lateral Hip Pain (Side of Hip)
What It Feels Like:
Pain on the outside of the hip
Often worse lying on that side
May radiate down outer thigh
Common Causes:
Greater trochanteric pain syndrome (previously called "bursitis")
Gluteus medius/minimus tendinopathy
IT band tension
Referred pain from lower back
Who Gets It:
Runners, especially those increasing mileage
Cyclists with poor bike fit
Anyone with weak hip stabilizers
3. Posterior Hip Pain (Back of Hip/Deep Buttock)
What It Feels Like:
Deep in the buttock
May feel like "sciatica"
Often worse with sitting or hip flexion
Common Causes:
Piriformis syndrome
Deep gluteal syndrome
Hamstring tendinopathy at origin
SI joint dysfunction
Referred pain from lower back
Who Gets It:
Runners with weak glutes
Cyclists with prolonged hip flexion
Anyone with sitting jobs who trains hard
4. Groin Pain (Inner Thigh/Pubic Area)
What It Feels Like:
Inner thigh or pubic bone pain
Often sharp with quick movements
May feel like pulling sensation
Common Causes:
Adductor strains
Athletic pubalgia (sports hernia)
Osteitis pubis
Hip adductor tendinopathy
Who Gets It:
Hockey players (wide skating stance)
Soccer players (kicking, cutting)
Dancers (turnout demands)
The C-Sign: A Diagnostic Clue
Ask an athlete with true hip joint pain to point to where it hurts, and they'll often make a "C" shape with their hand, cupping it around the front and side of their hip. This is called the "C-sign," and it's a strong indicator of intra-articular (inside the joint) pathology like impingement or labral issues.
If they point to one specific spot on the outside or front of the hip, it's more likely muscular or tendon-related.
Why Hip Pain is So Common in Athletes
The Hip's Dual Role:
Your hip must be both mobile (for running, kicking, skating) and stable (for single-leg stance, absorbing impact). When one role is compromised, injury follows.
Common Patterns:
Too much mobility, not enough stability: Dancers, gymnasts, yoga enthusiasts (hypermobile hips that lack control)
Too much stability, not enough mobility: Lifters, desk workers who run (stiff hips that compensate elsewhere)
Repetitive demands without adequate strength: Any athlete who increases volume without building capacity
What Causes Hip Pain in Athletes?
Hip pain rarely comes from a single incident. It builds over time from:
1. Repetitive Movements
Running stride (thousands of hip flexion/extension cycles)
Cycling position (prolonged hip flexion)
Skating stride (extreme hip abduction and rotation)
Dance movements (extreme ranges, turnout demands)
2. Muscle Imbalances
Weak glutes → hip flexors and adductors overwork
Tight hip flexors → limited hip extension, altered gait
Weak deep hip rotators → compensation at knee or back
3. Training Errors
Rapid mileage increases
Inadequate recovery
Poor cross-training (no strength work)
Ignoring early warning signs
4. Biomechanical Issues
Hip impingement anatomy (bone shape variations)
Leg length discrepancies
Foot/ankle dysfunction affecting hip mechanics
Core weakness creating instability
When to Seek Help
Red Flags:
Pain lasting more than 2 weeks despite rest
Pain that changes your gait or technique
Clicking, catching, or locking sensations
Night pain or pain at rest
Sharp pain with specific movements
Don't wait until it's severe. Early intervention prevents small issues from becoming chronic problems.
What's Next in This Series
Now that you understand hip anatomy and where pain can come from, Part 2 will dive deep into anterior hip pain — the front-of-hip and deep groin pain that plagues runners, cyclists, and dancers. We'll cover hip impingement, labral issues, hip flexor strains, and how to tell them apart.
If you're currently dealing with hip pain and want answers now, book an assessment with Dr. Keirstyn at Endurance Therapeutics. We'll identify exactly what's causing your pain and create a plan to get you back to training pain-free.
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161 | 🔗 https://endurance.janeapp.com/#staff_member/1
Stay tuned for Part 2: Anterior Hip Pain — What's Really Going On in the Front of Your Hip