The hip joint is a large ball and socket joint that’s important for lower extremity movement. The joints consist of the articulation of the femur (upper thigh bone/ball) and the acetabulum (the socket).
The bones are lined with cartilage and the acetabulum is lined with a fibrocartilage called the labrum. The hip joints, as with all joints, are held together by connective tissue called ligaments. Ligaments are very important for hip joint health, stability, and function.
What Are Hip Ligaments?
Ligaments are soft tissues that connect bone to bone. Ligaments in the hip are like strong pieces of duct tape that keep the ball in the socket, thus providing stability to the hip.
Muscles and ligaments contribute to the stability of the hip but the ligaments are typically the last line of defense for preventing injury to the hip. There are ligaments in the front, back, bottom, and deep within the hip that help protect the hip, which we will discuss.
The hip ligaments encompass various types, forming a vital network within the hip joint.
- Iliofemoral ligament: Sometimes called the Y ligament of Bigelow, due to its “Y” shape, this is the strongest ligament in the body. It is located in the anterior (front) of the hip and runs across the side of the femur as well. It attaches the femoral neck to the ilium bone. It supports standing posture and limits excessive extension of the hip.
- Pubofemoral ligament: This ligament runs across the front of the hip as well. It attaches from the femoral neck to the pubic bone. It helps to limit hip external rotation.
- Ischiofemoral ligament: This ligament runs across the posterior (back) of the hip joints. It attaches the femur to the ischium bone. It prevents excessive extension and internal rotation of the hip.
These ligaments above make up the “capsule” of the hip joint.
- Ligamentum teres: This ligament is also known as the ligament of the head of the femur or round ligament of the femur. It is a pyramidal ligament that attaches the middle part of the femoral head (called the fovea) to the acetabulum. It has two bands and is surrounded by a synovial sheath, similar to the ACL in the knee.
This ligament acts as a secondary stabilizer of the hip capsular ligaments listed above, particularly in flexion, abduction/adduction, and rotation. The ligament has nerve endings throughout, so it can be a source of pain if injured.1
- Acetabular labrum: This ligament is a robust band that extends from the bottom of the hip’s acetabular labrum to the femoral head. It plays a crucial role in supporting the femoral head and distributing the load-bearing surface, preventing downward pulling forces.
Common Hip Ligament Conditions
Let’s discuss the common injuries and associated problems with ligament injuries.
Hip Ligament Injuries
The hip ligaments can be injured from a trauma such as a fall, motor vehicle accident, or sports injury. After trauma, the ligament tissue is stretched or torn, thus it doesn’t function well to stabilize the hip. This can result in pain in the actual ligament or pain from extra stress on the hip cartilage, labrum, or bone.
Also, the muscles can hurt or spasm as they have to work harder to stabilize the hip or they can be tight from trying to prevent excess movement, which causes pain.
Ligaments can also be injured over time from micro trauma from repetitive activities. Typically, asymmetries in your body posture alignment, muscle discrepancy, or congenital abnormalities can lead to greater stress on hip ligaments, causing them to get stretched or torn over time.
Labral tears often result from hip ligament injury or they can happen concordantly with hip ligament injuries.
A common mechanism for hip labral tears is:
- The patient sits a lot, so the butt muscles become weak. Hip flexion movements now are not countered by the glut muscles, so there is more stress on the post-hip ligament (ischiofemoral ligament).
The ligament is damaged acutely with running or jumping or becomes weakened over time. Then the femur moves to superior (high) and anterior (front) with hip flexion, which leads to stress on the anterior superior labrum, inducing tears and pain.
A hip dislocation is a major injury to the hip ligaments that leads to the femur bone being taken out of the socket/acetabulum. This usually results from a major trauma like a motor vehicle accident. This type of trauma could result in a complete tear of one or more hip ligaments and many times may need surgical repair.
Adhesive Capsulitis of the Hip
Adhesive capsulitis is not a direct injury to the hip ligaments in which the ligaments are torn, stretched, or loosened, but is when the hip capsular ligaments are inflamed and too tight or thickened. Adhesive capsulitis can be the result of moderate to severe hip osteoarthritis.
The chronic pain and inflammation lead to less hip motion and then the ligaments become tight and thickened. Some metabolic conditions such as diabetes or an abnormal reaction to a medication can also predispose a patient to hip adhesive capsulitis.
When You Should See a Doctor for Your Hip Ligament Pain
If you have hip pain, you should see a board-certified non-surgical musculoskeletal physician, such as a physical medicine and rehabilitation (PMR) specialist, sports medicine physician, or pain physician.
If you have had a major trauma, suspect a fracture or complete ligament tear, or you have done all non-surgical interventions with no help then you should see a board-certified orthopedic surgeon.
Typically, at the onset of mild to moderate hip pain from suspected ligament injury, you may give it four to six weeks of activity modification and conservative care, such as ice, heat, over-the-counter meds, stretching, home exercises, etc.
If this doesn’t resolve the issue then you should see a physician. If you have had any traumatic hip injury, you should see a physician right away. Also, you should see a physician if you have:
- Worsening pain
- Difficulty walking or standing without assistance
- Signs of infection, such as fever, redness, or warmth
- Signs of a blood clot, such as redness and swelling
- Tingling, weakness, numbness in your legs, feet, or toes
Diagnosing Hip Ligament Conditions
Diagnosis of hip ligament injuries starts with a comprehensive history and physical examination from a musculoskeletal expert. A doctor will test the hip range of motion, look for tender spots, see what maneuvers may elicit pain, and test stability. Imaging tests may be performed.
A diagnostic ultrasound can be used to look for damage in the hip capsular ligaments, tendons, and the joint. An X-ray can be taken to see if there is a hip dislocation or any injuries to the bone. An MRI can visualize the joint in more detail for bone, cartilage, labrum, joint, ligament, and tendon injuries.
Treatment Options for Hip Ligament Pain
The first line of treatment for hip ligament injuries is physical therapy and other conservative care. If this fails, traditional intervention treatments usually consist of injections of medication such as steroids. However, these cannot be used to help hip ligaments because steroids can actually break the ligaments down.
At the Centeno-Schultz Clinic, we provide cutting-edge regenerative medicine solutions for hip ligament tears. These therapies work to stimulate the ligaments to heal themselves. Care must be taken to have an accurate diagnosis, choose the best therapy, and deliver that therapy via precise injection under image guidance into the damaged ligament and other injured structures to optimize the therapeutic benefit.
The two main treatments we use to heal hip ligament injuries are platelet-rich plasma and bone marrow concentrate containing stem cells.
Platelet-Rich Plasma (PRP) Treatments
PRP involves obtaining blood from a vein in a simple blood draw, centrifuging (spinning) that blood to separate the components, and then isolating and concentrating the platelets.
At the Centeno-Schultz Clinic, we use specialized lab personnel to do this, so we can concentrate more platelets and customize the treatment to each patient for better outcomes. PRP has growth factors that help stimulate soft tissue healing, similar to when you heal from a cut on your skin.
PRP works well for mild to moderate hip ligament tears when patients do not have severe hip arthritis and they are younger.
Bone Marrow Aspirate Concentrate (BMAC)
BMAC contains stem cells and is obtained by taking bone marrow from the iliac crest (hip bone) safely and comfortably. The bone marrow is processed similarly to PRP to concentrate the cells in the marrow.
Stem cells are the most powerful healing cells. BMAC is used for more severe hip ligament tears, for patients who have moderate to severe hip arthritis as well, or in older patients.
In addition to using PRP or BMAC to help heal ligament tears, we will also look for associated injuries that contribute to overall hip dysfunction, such as labral tears, tendon injuries, or cartilage damage. We can also treat any other areas such as the spine or knee that may be contributing to the hip dysfunction and pain when needed. Thus, we take a very comprehensive approach.
Don’t Ignore the Pain in Your Hip
Hip ligament pain might seem like a minor nuisance at first, but left untreated, it can lead to severe discomfort and movement restrictions. However, early intervention can make a significant difference. Implementing effective treatment strategies shortly after the onset of symptoms can alleviate pain, restore mobility, and help prevent further complications.
At the Centeno-Schultz Clinic, we specialize in early intervention and advanced treatment options for hip ligament pain. Our team of experts focuses not only on alleviating symptoms but also on treating the root cause of the issue. With our cutting-edge regenerative medicine solutions, we provide patients with alternatives to invasive surgeries, promoting natural healing and recovery.
- The role of the ligamentum teres in the adult hip: redundant or relevant? A review. O’Donnell JM, Devitt BM, Arora M. J Hip Preserv Surg. 2018 Jan 10;5(1):15-22. doi: 10.1093/jhps/hnx046. eCollection 2018 Jan. Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798146/)