Hip Pain Care in Atlanta.
Hip flexor strain, tendonitis, and what else it might be
A hip flexor strain, hip flexor tendonitis, and bursitis are three different things, and it is the location of the pain that distinguishes them.
Pain in the groin and the front of the hip tends to involve the hip flexor muscles which bend the hip, lifting the knee towards the chest. Pain over the bony prominence on the outside of the upper thigh usually originates from either a bursa or a tendon. And pain deep in the buttock is rarely any of the three.
Hip flexor strain is an overuse of the hip flexor muscles and their common tendon. The iliopsoas muscle is the deepest of these muscles and its tendon extends across the front of the joint. Repeatedly lifting the leg strains the tendon.
Tendonitis is the next stage of this process. Rather than injury occurring all at once, the tendon becomes inflamed and weakens over time. It is also called tendinopathy.
Bursitis has a different pattern. A bursa is a tiny fluid filled sac between a tendon and a bone, and the large bursa over the outside of the hip becomes compressed when the tight band of tissue running down the thigh grinds against it. Bursitis shows up as tenderness along the side of the hip, sometimes a burning sensation, and pain that is exacerbated by walking, running, prolonged sitting, and sleeping on that side.
Two more conditions share this map. Irritation or tearing of the gluteus medius tendon causes similar outer hip pain and weakness lifting the leg out to the side. Pain that radiates down the back of the leg accompanied by numbness or tingling is the sciatic nerve irritated by a muscle that runs over it.
Hip pain when you lie down
Dr. Langer operated on my hip about 2 years ago. My experience was wonderful as far as operations go. Downtime was minimal. Now my right hip is bothering me and today I am making an appointment to see him.
Most nighttime hip pain is lateral, and the quickest way to get relief is to get off of it. The reason it's worse at night than when sitting in a chair is because the bursa and the gluteus medius tendon are being pressed up against the bone beneath them. So sleep on the other side or on your back, and skip crossed-leg sitting during the day, which stresses the same tissue.
Ice and an over-the-counter anti-inflammatory calm a flare. None of that explains the cause of the irritation, though. In most cases, the irritation is caused by a muscular imbalance. When the gluteus medius is unable to stabilize the pelvis, another nearby muscle takes over and tightens the tissue spanning the bursa. Strengthening the weak muscle is what actually corrects the problem, and it is usually the step that gets skipped.
Night pain that persists, or any noticeable loss of strength lifting the leg out to the side, deserves an examination. Hip x-rays won't reveal an inflamed bursa or a torn tendon. An MRI or ultrasound is needed.
Hip pain that shows up when you run
I am a Div I athlete and traveled from Southern California for arthroscopic hip surgery. One year later I am back playing football and pain-free. Thank you Dr. Langer.
The running motion is a repetitive action that occurs thousands of times, one limb at a time, which means that it's more likely to uncover a problem than to cause it.
The site of the pain is usually enough to narrow the diagnosis. One-sided pain in the front of the hip and groin, aggravated by driving the knee up, is characteristic of hip impingement, in which an overgrowth of bone on the head of the femur or on the edge of the acetabulum abuts during the latter part of the range of motion. That friction irritates and damages the labrum, the ring of cartilage surrounding the socket, and it can end in a hip labral tear. The pattern is common enough in runners to have earned the name runner's hip. Pain on the outer part of the hip is pain in the gluteus medius. Pain on the sit-bone side of the hip is pain in the hamstring tendons. That's the part that gets loaded the most when you swing your leg forward with a straight knee.
Beginners get runner's hip more than advanced runners. This is because the hip is getting more work than it's used to, and tendons don't adapt quickly to new loads, so the training needs to ramp up slowly.
It settles with the same things that prevent it: a real warm-up, gradual mileage, honest recovery after hard sessions, and hip and thigh strengthening so imbalances do not creep in late in a run.
If your hip is sore at the same time every run, or if it's still sore the next day, then it's no longer a training issue.
Hip pain when you walk or take stairs
The hip is loaded differently when you walk and when you climb stairs, and the difference is diagnostic. The hip takes on many times your body weight per step, so a joint that's silent at rest can be very noisy after a block.
Walking on level ground.
Hip pain in the front of the hip, aching after longer walks, occasional sharp twinges: these are the typical symptoms of worn joint surfaces. The hip joint will become increasingly stiff, especially with internal rotation.
Alternating walking with swimming or cycling helps, and a cane in the opposite hand takes load off when needed.
Climbing stairs and lifting the knee.
Climbing stairs means the leg is raised repeatedly against gravity, which can irritate the tendon crossing the front of the hip joint. If you hear a snap or click next to the pain, this is probably what's happening. Reduce the training load, stretch, and strengthen the hip flexors, and it usually settles.
Standing up after sitting still.
For people with impingement, the pain after a long car ride or a day in the office is typically worse than the pain after walking around for a bit. This is because they have held their hip flexed all along. The solution is to keep moving throughout the day, instead of resting more.
Sudden hip pain while walking, with no injury behind it, is different from an ache that builds. Clicking, locking, or the feeling of something catching inside the hip belongs in the same category; those point at the joint itself rather than the muscles around it. A hip labral tear or a loose piece of cartilage can do exactly that.
Fast relief, and what it does not fix
No quick fix eliminates hip pain in thirty seconds. What thirty seconds can do is stop you from making it worse: get off the leg, get out of the position that set it off, and give the irritated tissue time to calm down.
The real first-line measures are just as unglamorous: avoid whatever was causing the problem, especially long walks or runs on rough ground, ice the area, and take an over-the-counter anti-inflammatory if your stomach tolerates it. If stillness rather than exertion is the trigger, do the reverse and move more through the day.
None of that addresses the cause: a weak muscle along the side of the hip, a chronically overloaded tendon, or a spur of bone scraping the edge of the socket. Because the cause stays, the pain returns as soon as you go back to what you were doing. When the culprit is a tendon or a bursa rather than the joint surface, regenerative medicine covers non-surgical options worth discussing.
What a hip preservation specialist does
The goal of hip preservation is to save your hip rather than replace it, and the key is knowing when to operate. Untreated impingement can lead to a torn labrum, damaged joint surface cartilage, and eventually arthritis. Once a hip is already arthritic, impingement surgery has little left to protect, which is why timing matters so much.
The surgeon matters too. Fellowship training in hip arthroscopy, layered on top of an orthopedic residency, is what separates a hip preservation specialist from a general orthopedic surgeon, and two of the credentials on record speak directly to it. Completed advanced fellowship training in Hip Arthroscopy with Marc Philippon, MD. Completed three advanced orthopedic fellowships.
Ask what the surgeon does before surgery. The operation itself, hip arthroscopy, uses a tiny camera and instruments through a few small incisions, and the evidence favors it over traditional open surgery for patient comfort and for how often a second operation is needed. None of that is a reason to operate early. The standard here starts from joint preservation, not from a replacement timetable, and Dr. Langer's training is laid out in full on the about page.
How Atlanta Sports Medicine Institute works up a hip
There's a routine to working up a hip problem, and the pictures come last.
The history comes first: when the pain started, where it sits, what makes it worse, and whether hip arthritis runs in the family.
The exam follows. Walking reveals a limp before you're aware of one. Standing on one leg shows whether the pelvis stays level, which is the job of the muscle at the side of the hip. Sitting and rotating the thigh inward is the movement that a deteriorated joint loses first. Pulling the knee toward the chest and rotating it inward recreates impingement pain.
And only then does imaging have its say. An x-ray shows the contour of the bones and the space between the ball and the socket. The cartilage doesn't show up on an x-ray, so the space is a stand-in for how much is left. The normal hip has a smooth contour; a lump on the ball distorts it. An MRI comes in when a torn labrum or damaged cartilage is the question, and it often uses a contrast dye that makes a tear glow. Surgery is offered only when it has the best chance of significant, lasting improvement; a bad MRI alone does not put an operation on the calendar.
Atlanta patients arrive at every point on that continuum. The hip arthroscopy page explains what an operation entails, and if your hip has been sore long enough to bring you here, request an appointment.
Hip Pain
Start with clarity about your hip.
If pain is limiting the way you train, work, sleep, or move, an evaluation can turn uncertainty into a practical next-step plan.
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A focused conversation
Explain what you want to return to, not only what hurts.
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A whole-hip assessment
Look for the combination of findings that best explains the symptoms.
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A clear next-step plan
Understand the likely cause, whether imaging helps, and what comes next.
Care built around diagnosis, clarity, and durable function.
Atlanta Sports Medicine Institute helps active patients understand what may be driving their symptoms and compare appropriate treatment paths. The experience should be precise, understandable, and tied to the activities each patient wants to return to.
What are some hip strengthening exercises I can do at home?
Train the muscles on the side of the hip because they keep your pelvis level when you're standing on one leg. You can load them without equipment by taking your leg out to the side against a band, standing on one leg and keeping your hips even, or doing a slow step-up with a controlled lowering. Add work in front of the hip if climbing stairs and bringing your knee up hurt, but always stretch before you strengthen. Don't push through sharp pain; if your hip is sorer the next day, your exercise program probably isn't right for your diagnosis.
What hip pain exercises should I avoid?
Avoid whatever reproduces your pain, which is more useful than any fixed list. It's typically going to be prolonged walking or jogging on rough terrain, stretching in the direction that causes pain, and lifting your legs repeatedly when the pain is in the front of the hip. Two non-exercise behaviors are equally important. Lying on the painful side, and crossing your legs while seated, both press the tissue on the outside of the hip. Your hip won't calm down if you continue doing those things.
What are the best painkillers for hip pain?
Most hip problems will respond to anti-inflammatories such as ibuprofen or naproxen, which reduce both the inflammation and the pain. Whether this will be safe for you depends on what other medicines you are taking and the health of your stomach and kidneys, so check with your doctor. Injections are an option when medication alone is not enough, but the relief is short-term and differs widely between patients. An injection does not repair the tissue underneath, so it cannot be the whole plan.
What exercises should I avoid with hip osteoarthritis?
A tired hip doesn't fare well under repeated pounding. Running, jumping and long walks on rough hard surfaces are usually the first to go. Swimming and cycling put far less strain on the joint while keeping you active, and staying active beats resting an arthritic hip into stiffness. It's easy for an arthritic hip to become stiff. The goal is to stay mobile without becoming sore the following day.
What are good hip pain exercises for women?
The treatment for these three conditions isn't really any different, though the diagnosis can vary. Hip bursitis and gluteus medius tendon problems appear most often in middle-aged women with no injury behind them, and piriformis syndrome appears more often in women as well. All three respond to the same regimen: strengthen the muscles on the outside of the hip, which keep the pelvis level, and release tightness in the iliotibial band that runs along the outer leg. Which one it is dictates the specifics of the program, so it's helpful to know which of the three you have.
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