Only 5% of overuse injuries were to the hip and pelvis in a recent investigation. Because of this low incidence, these injuries have not been extensively studied. They reviewed the clinical records of 222 hip and pelvic injuries in 204 patients seen in a two year period. Hip injuries are not common. One survey of 1,819 overuserunning injuries indicated that hip injuries accounted for 5%, a distant fourth to the knee. Lower leg injuries have been assesed with regard to incidence, etiological factors,and pathophysiology, and a treatment protocol has been formulated. Although much of the theory for lower leg problems applies to hip problems, the anatomy and function of the hip is more complex than the other lower extremity areas. There is a lack of detailed information on hip and pelvic function in health disease.
The excessive up and down tilt in the frontal plane of the pelvis in running would be influenced by a weak abductor muscle system, which would be prone to strain/tendinitis or bursitis. Weakness in the muscle system would also lead to a functional positive Trendelenburg sign and an increase in the shear forces along the sacroiliac joints, resulting in inflammation and pain. Running on uneven terrain would contribute to this effect. Studies show that ten of 23 patients had a leg length discrepancy, which would also increase shear force. One patient had ankylosing spondylitis, with a positive bone scan of both sacrioliac joints and positive HLA-B27 but negative x-rays. Thus they need to consider non-athletic musculoskeletal problems in athletes with joint pain.
Stress fractures of the hip and pelvis are uncommon, ranging from .005 to .22% of running injuries and 3.2 to 4% of stress fractures in athletes. Femoral neck stress fractures can be devastating. Without rapid diagnosis and treatment the resulting disability can preclude not only return to the sport but also the ability to function normally on a day to day basis.Any hip, groin, perineal, anterior thigh, or knee pain that is activity related, often with a recent increase in training, must be carefully assesed with an in depth history examination.