I am glad you are taking the time to read this next post about hip pain, cycling, and why it is happening to you
I know I have been bouncing around lately with topics but write these posts based on experiences of patients and athletes I come across, what they have been doing with, and give you immediate and actionable tips about how you can get closer to being pain free.
Cycling is a very common recreational activity and sport that is great for the cardiovascular system and is low impact. Therefore, it is great for those who are worried about impactful activities (but remember, tolerable impact activity is still a good thing to have). This post is more for those who are more into the competitive form of cycling as this is more common based on the higher aggression in the fit of the bicycle to make the rider more aerodynamic and thus faster.
Now each of these points is not cut and dry and the rider can be dealing with more than just one of these at the same time (you may be dealing with all three!!). At the end of the day, if none of these tips seem to make your hip pain completely go away I advise you see your most trusted Physical Therapist who has experience with cyclists and hip pain to help you trouble shoot this issue with you.
Without further ado, it's time to get started:
Incorrect Bike Fit Appropriate bike fit is very key in any cycling athlete as it will optimize your performance in the sport or just in recreation altogether. Having the appropriate bike fit will also allow for evenly distributed amount of stresses as well on joints, muscles, and tendons to minimize injury. Either when a cycling athlete would like to have a more aggressive bike position or certain components on the bike are leading to a specific environment that will generate hip pain. Our hips have a given range and position that are able to attain naturally based on each person's individual hip morphology (shape). Some people have more shallow hip joints allowing more range of motion and some have more deep or a more encompassing socket around the head of the femur (thigh bone). The first and more shallow hip joint usually will not be affected with this issue (unless #2 is occurring...please read further to find out more on this). Most if not all people are not sure about what the shape of their hip joint looks like. It also isn't something you can really change but your bike fit is something that you can change. In this aspect, if you are getting a pinching or deep ache in your groin either after getting an "appropriate fit" for a bike or you change to a more aggressive position, then this may be something that could be going on. In order to alleviate this, you will need to go back to your cycling shop where you originally got fit and just have them adjust it to a less aggressive position...OR...more of what I have to discuss below. There are many components to a bike so there can be a myriad of things that need to be adjusted or changed that can affect how comfortable you feel while riding. This can be your seat post height, the drop height between your seat and your handlebars, and even the chain crank length. if you start noticing that dull, deep, achy pain in the front of the hip or into the groin, it is smart to first play around with the fit on your bike.
Hip and Core Weakness If you have already checked bike fit and everything appears solid but you still have hip pain when you go through the upstroke while cycling, this may be something else that can be going on. Hip and core weakness is another common aspect that could be leading to your issues, especially if you are using clip in pedals. The difference of using clip in pedals is that by being "locked in" to the bike, you are able to have power distributed from across the pedal stroke throughout each cycle If you are coming through the upstroke portion of the cycle and you do not have the strength to perform this activity over and over throughout your ride or you have weakness in your core that causes overloading of your hip flexors, you may develop some pain in the front of your hip or groin. The solution for this is pretty simple which is basically, get stronger. However, you hear other athletes and practitioners say "Don't strengthen your hip flexors, they are already strong. Especially, since you are tight already" With a large community of people at desk jobs (especially with Covid-19 related changes), over time we start to develop tightness or a shortening of our hip flexors or muscles in front of the hip. When these muscles are tight and you try to stand up straight, you may notice that you have increased tension in your back, you may feel like you are not completely upright, or you may feel some achiness/stiffness. Just because these muscles are tight does not mean that they are strong or overworked either. If you are someone especially just starting to cycle you may have weakness present as well. How flexible or short a muscle is NEVER dictates how strong it actually is. Therefore, if you are developing pain as a result of weakness in your hip flexors, simple strengthening of them will be key. This can be done through marching with resistance bands, mountain climbers, and abdominal exercises that involve leg movement. This goes similar to those whose core strength is not up to par as well. Having a strong core allows you for a strong and powerful foundation for you to work off of before moving your limbs through the given activity. This platform needs to not only be a static stabilizer but be able to be dynamically stable. Therefore, when cycling having a strength program that not only works on the core but also the endurance of it through motion are key. You can accomplish this by doing various types of planks as single simple example. Whether you are doing strict ones or doing transitional ones moving from your hands to your elbows, or doing side planks with a side leg raise or trunk rotations. There is so much you can do!!! Sometimes even this is not enough though. Sometimes the pain still continues even if you think that both of the above are on point and 100%. Let's get to the last point.
Hip Morphology In this last point, I touched base on it in the first point but I want to go a little more in depth. Hip morphology or the shape of your hip joint is another aspect that can greatly affect your ability to get into a racing or aero position on a triathlon or road bike. As I stated above, people can have different presentations of the shape of their hip that can either limit or provide excessive range to their hip joint. This point again is more for those who have limited range and therefore will have impingement or pinching of the femur (thigh bone) on the rim of the socket of the hip joint (pelvis). This can occur as a result of a number of ways. Below I will discuss the three most common ways this occurs.
The most common and impactable reason for this change in your hip joint mobility is essentially...your mobility. Sometimes because we sit or perform activities within a given range of motion, we can develop tightness in the hip capsule and ligaments of the joint. When this occurs, the extra material that we have to completely raise our knee to our chest instead drives the head of the femur deeper into the socket as it has nowhere else to go...leading to pain. We can fix and adjust this by doing home mobility and flexibility drills that you can learn from a Physical Therapist or you can risk it and go on YouTube to find a possible solution (YouTube is great but everyone is so different so please go to the Physical Therapist first).
The second cause for this change in hip morphology is bony changes compared to the norm. This can be something that is congenital (from birth) or it can be something that is developed over time due to the stresses we apply to the body. These changes are more common in those who perform rotational activities for extended periods such as soccer and football (do not take this statement as a reason to avoid these sports - they are fun and safe). There are three changes that occur (as seen below) include a CAM lesion, Pincer lesion, or you can have some form of both. The CAM lesion is defined by bony overgrowth that occurs on the femoral (thigh) side of the hip joint which bumps into the rim of the socket of the hip resulting in a catching or pinching. The Pincer lesion is a bony overgrowth that occurs on the Acetabular (pelvic) side of the hip joint resulting again in pinching if engaged in that range of the joint. When we get a combination of both of these, this still ultimately results in some level of bony formation on the femoral and acetabular side (both components of the hip joint) resulting in...again...pinching, impingement, and pain. In order to fix this, it can be done in a number of ways. Preferably we would like to avoid surgery if possible. However, if you ultimately want to completely fix this surgical excision of the bony overgrowth is the ultimate solution. HOWEVER, if you want to avoid surgery (which I would advise if possible) is to choose a less aggressive riding position and get whatever extra range you can through seeing a physical therapist if you have a combination of this bony growth plus hip capsule mobility restrictions.
The last aspect of hip morphology changes that can occur and lead to anterior hip pain when going through the upstroke while cycling is hip arthritis. When we have the development of arthritis, it is something that occurs over the course of a number of years. It is something that happens as a result of gradual wear and tear. It can occur from direct trauma to the joint but does not occur that often. Regardless of this fact of its onset, arthritis is the gradual shrinkage of articular cartilage, thickening of cortical bone, and development of bony outgrowths/bone spurring. Depending on the amount and size of these spurs and other bony/joint changes will affect how much pain, stiffness, and pinching you will have while riding. As I discussed above, you will not only just have the arthritis but may have a combination of weakness or tightness in the hip capsule. Solutions to this include first working on your strength and stability but at the same time improving mobility as much as possible. During this time you can also adjust you bike fit as needed into a less aggressive position. Ultimately, depending on how much these hip joint changes are impacting your life activities due to the arthritis the eventual solution is surgery. If you can put it off for as long as possible, however, is optimal in order to extend the life of your function (through guided exercise and mobility training) but also extend the life of any eventual surgery you may have. There are many options out there for surgery which range from resurfacing where you only change the joint cartilage components, unilateral joint replacement (replace either the hip socket or the femoral head), or a full joint replacement. These surgeries can last for an extended period of time and you can eventually get back to cycling to a level you choose....as long as you are willing to work to get back to it. You can do anything you set your mind to. All you need is a dedicated team (MD and PT) who will support and guide you to your ultimate goals
I hope this was very informative and helpful. I know this was a little lengthy but I like to try to be as fully descriptive as possible but concise. There is much more information I could give about this topic that is specific to you but I want to be able to have each person who is more curious ask the questions and seek more information if it is something that is important to them or a loved who is going through this type of situation. I hope you enjoyed this blog post and look forward to any comments or questions you may have. Please feel free to reach out either on my social media accounts on Facebook (https://www.facebook.com/ascentphysicaltherapyny) and Instagram (https://www.instagram.com/ascent_pt_multisport/).
If you have been dealing with hip pain while you cycle or just hip pain in general, please feel free to check out my website to learn more about how I can help you get back to the activities you love. Check out www.ascentptny.com
See you in the next post!