Blog 2: The Athlete’s Guide to Hip Pain: From Anatomy to Performance
Part 2: Anterior Hip Pain — What's Really Going On in the Front of Your Hip
Welcome back to our hip pain series! In Part 1, Dr. Keirstyn of Endurance Therapeutics covered hip anatomy and the different locations where hip pain shows up. Now we're diving into the most common complaint we see: anterior hip pain — that deep, nagging ache in the front of your hip or groin.
If you've ever felt:
A pinching sensation in your hip during deep squats
Groin pain that gets worse with running
Hip flexor tightness that stretching doesn't fix
A deep ache in your hip after long rides or skates
...then this blog is for you.
Anterior hip pain has multiple causes, and figuring out which one you're dealing with is critical to fixing it. Let's break them down.
1. Hip Impingement (Femoroacetabular Impingement - FAI)
What It Is:
FAI occurs when the ball (femoral head) and socket (acetabulum) don't fit together smoothly. Bone variations create abnormal contact, pinching soft tissues (especially the labrum) during hip movement.
Two Types:
Cam Impingement: Extra bone on the femoral head creates a "bump" that jams into the socket
Pincer Impingement: Extra bone coverage on the socket side, creating overcoverage
Mixed: Both cam and pincer features (most common)
What It Feels Like:
Deep groin pain or front-of-hip pain
Sharp pinching with hip flexion (bringing knee to chest)
Pain with deep squats, getting in/out of cars, sitting for long periods
Often described as "something catching" in the hip
Who Gets It:
Runners with high mileage
Cyclists in aggressive, low positions
Hockey players (repetitive hip flexion in skating)
Dancers requiring extreme hip ranges
Athletes in their 20s-40s (often goes undiagnosed for years)
The C-Sign: Patients often cup their hand around the front and side of their hip when describing pain location (classic sign of FAI).
Why Stretching Doesn't Help:
Many athletes assume tight hip flexors are the problem and stretch aggressively. But if you have FAI, stretching into hip flexion repeatedly pinches the labrum and makes things worse.
2. Labral Tears
What It Is:
The labrum is a cartilage ring that deepens the hip socket and acts as a shock absorber. Tears can happen from:
Chronic impingement (repetitive pinching wears it down)
Acute trauma (awkward landing, collision)
Hip dysplasia (shallow socket creates instability)
What It Feels Like:
Deep, sharp groin pain
Clicking, popping, or catching sensation in the hip
Pain with twisting, pivoting, or cutting movements
Locking or instability (feeling like hip "gives out")
Who Gets It:
Athletes with FAI (labral tears often develop secondary to impingement)
Hockey players (skating mechanics + contact)
Dancers (extreme ROM demands)
Soccer players (kicking, cutting)
Runners with hip instability
The Tricky Part:
Not all labral tears need surgery. Many athletes have asymptomatic labral tears that show up on MRI but don't cause pain. The key is whether it's limiting function and causing symptoms.
3. Hip Flexor Strains (Psoas, Iliacus, Rectus Femoris)
What It Is:
Hip flexors lift your knee and stabilize your pelvis during movement. Strains happen from:
Acute overload (sprinting, kicking)
Chronic overuse (repetitive hip flexion)
Compensating for weak glutes or core
What It Feels Like:
Pain in the front of the hip or upper thigh
Sharp pain with knee drive (running, climbing stairs)
Aching after activity
Tenderness to touch in the hip flexor area
Who Gets It:
Runners (especially sprinters, those increasing speed work)
Cyclists (prolonged hip flexion in riding position)
Dancers (repetitive leg lifts, leaps)
Soccer and hockey players (explosive movements)
The Difference from FAI/Labral Issues:
Hip flexor strains are usually more superficial — you can often palpate (touch) the tender area. FAI and labral pain are deep and harder to pinpoint. Flexor strains also improve with rest, while impingement doesn't.
4. Hip Capsular Restrictions
What It Is:
The hip capsule is thick ligamentous tissue surrounding the joint. When it tightens (from prolonged sitting, lack of movement variability, or post-injury scarring), it limits hip mobility and creates compensatory stress.
What It Feels Like:
Stiffness and restricted range of motion
Deep, dull aching in the front of the hip
Difficulty with hip extension (leg behind you) or rotation
Feeling "locked up" or "stuck"
Who Gets It:
Desk workers who run or cycle (prolonged hip flexion tightens anterior capsule)
Post-injury (scar tissue limits capsule mobility)
Athletes who only move in one plane (cyclists, runners)
Why It Matters:
Capsular restrictions force other joints (lower back, knee, ankle) to compensate, often leading to secondary injuries.
5. Referred Pain from the Lower Back
The Confusion:
Not all "hip pain" is actually from the hip. Lower back issues (disc problems, facet joint irritation, SI joint dysfunction) can refer pain to the groin or front of the hip.
Clues It's Referred:
Pain changes with back movements (bending, twisting)
Associated lower back stiffness or pain
Numbness or tingling down the leg
Pain improves with lying down
Who Gets It:
Runners with lower back issues
Cyclists with poor core stability
Athletes with previous back injuries
How to Tell Them Apart
Self-Assessment Clues:
Hip Impingement/Labral:
Pain with deep hip flexion (knee to chest)
C-sign when describing pain
Clicking or catching sensation
Pain worsens with activity involving hip flexion
Hip Flexor Strain:
Tender to touch in the front of hip
Pain with resisted hip flexion (lift knee against resistance)
Improves with rest
Often follows a specific event or training spike
Capsular Restriction:
Limited range of motion (especially rotation, extension)
Stiffness, not sharp pain
Gradual onset, no specific injury
Associated with prolonged sitting or repetitive sport
Referred from Back:
Pain changes with spine movements
Associated back symptoms
Often bilateral or vague location
The Truth: Many athletes have overlapping issues (e.g., FAI + capsular restriction + weak glutes). That's why professional assessment matters.
What You Can Do Right Now
If You Suspect Anterior Hip Pain:
1. Reduce Aggravating Activities
Limit deep hip flexion (high knees, steep hills, aggressive cycling position)
Modify training volume, not necessarily stop completely
2. Focus on Hip Extension and Glute Activation
Glute bridges, single-leg deadlifts, hip extension work
Counteracts the constant hip flexion from sport
3. Avoid Aggressive Hip Flexor Stretching
If you have impingement, deep stretching makes it worse
Focus on gentle mobility, not forcing range
4. Address Contributing Factors
Strengthen glutes and core (reduces compensation)
Improve hip rotation mobility
Check bike fit, running form, skating mechanics
When to Seek Professional Help
See Dr. Keirstyn if:
Pain lasting more than 2-3 weeks
Clicking, catching, or locking sensations
Pain limiting your sport or daily activities
You've tried rest and modification without improvement
You have none of the pain yet but want to be preventative !
At Endurance Therapeutics, we:
Perform movement assessments to identify the root cause
Differentiate between impingement, labral issues, strains, and restrictions
Create individualized treatment plans
Guide you through rehab and return to sport
What's Next
In Part 3, we'll cover lateral hip pain — the outside-of-hip pain that runners and cyclists know all too well. We'll break down gluteal tendinopathy, IT band issues, and greater trochanteric pain syndrome.
If you're dealing with anterior hip pain right now, don't wait for it to become chronic. Book an assessment with Dr. Keirstyn and let's figure out exactly what's going on.
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161 | 🔗 https://endurance.janeapp.com/#staff_member/1
Coming up next: Part 3 — Lateral Hip Pain: What's Causing Pain on the Outside of Your Hip