Dr. O'Donnell treats hip and thigh problems in athletes and active adults: femoroacetabular impingement, labral tears, hamstring strains and proximal hamstring avulsions, greater trochanteric bursitis and gluteal tendon problems, and hip arthritis. Patients range from University of Miami and club athletes with groin pain on deep squats, to sprinters with a pulled hamstring, to adults in Coral Gables and Miami whose hip limits walking.
The first task is to locate the pain. Groin pain that pinches with the hip flexed and turned in usually comes from the joint; pain on the outside of the hip that hurts lying on that side comes from the trochanteric bursa or gluteal tendons; pain at the sitting bone is the hamstring. Standing X-rays show the shape of the joint and the width of the joint space, which decides more than any other single finding, and MRI is added when a labral tear, a hamstring avulsion or a cartilage lesion would change the plan. Almost every patient starts with 6 to 12 weeks of rehabilitation built around gluteal and core control, with an ultrasound-guided injection when the hip is too irritable to progress. When that fails and the findings fit, Dr. O'Donnell performs hip arthroscopy, reshaping the bone that caused the impingement and repairing the labrum in the same operation. A complete hamstring avulsion is repaired within 4 weeks. Arthritis with a narrowed joint space is treated with total hip replacement when pain limits daily life.
Rehabilitation follows Dr. O'Donnell's written hip arthroscopy and hip replacement protocols, with weight bearing, brace use and return to running set on criteria. Arthroscopy is outpatient at Bayside Surgery Center; patients outside South Florida can send imaging through mymedicalimages.com and arrange telemedicine consults and post-operative visits.
When to see a specialist
Hip and groin soreness after a hard week of training usually improves within two weeks with reduced load. See a specialist when any of these apply:
- A sudden tearing pain at the back of the thigh or the sitting bone, with bruising that spreads down the leg within a few days
- Groin pain that pinches when you squat deeply, sit low, or bring the knee to the chest, present for more than 6 weeks
- Catching, clicking or a sense of the hip locking with turning
- Inability to bear weight on the leg after a fall, or a leg that appears shortened or turned out
- Pain on the outside of the hip that wakes you when lying on that side and has not improved with 6 weeks of stretching and strengthening
- Hip pain with reduced rotation that is limiting walking distance or putting on shoes and socks
How Dr. O'Donnell decides between rehab and surgery
Joint pain is decided on three findings: the response to a real course of rehabilitation, the exam, and the X-ray. For hip impingement and a labral tear, Dr. O'Donnell recommends arthroscopy only when groin pain persists after 6 to 12 weeks of therapy, the impingement tests reproduce the pain, the X-rays show a cam or pincer shape that can be corrected, and the joint space is preserved. The bone is reshaped and the labrum repaired together, because a repair without correcting the bone re-tears. Arthroscopy is not offered when the joint space is under about 2 mm or the socket is dysplastic; the arthritic hip is managed with injections and activity change until replacement is justified.
Muscle and tendon injuries are decided on the MRI. A grade 1 or 2 hamstring strain is loaded early and returned to sprinting on criteria, not a date. A complete avulsion of two or three tendons from the sitting bone with more than about 2 cm of retraction is repaired within the first 4 weeks, before the tendon scars to the sciatic nerve. Trochanteric bursitis is treated with gluteal strengthening and an ultrasound-guided injection; surgery is reserved for a torn gluteal tendon.
Hip conditions we treat 5
Hip procedures 2
Rehabilitation protocols
Dr. O'Donnell's written physical therapy protocols for this joint, shared with your therapist and progressed on criteria rather than dates.
Frequently asked questions
Do I need an MRI for hip pain?
Not at the first visit in most cases. Standing X-rays show the joint shape and joint space, which decide more than an MRI does, and the exam locates the source. An MRI, sometimes with contrast, is ordered when a labral tear or cartilage lesion would change the plan, or promptly when a hamstring avulsion is suspected, because that injury has a 4-week repair window. Existing imaging can be uploaded through mymedicalimages.com.
Can a hip labral tear heal on its own?
The tear itself rarely heals, because the labrum has almost no blood supply, but the pain often settles. Most patients are treated for 6 to 12 weeks with activity changes, gluteal and core strengthening and, if needed, an ultrasound-guided injection, and many stay comfortable. Arthroscopic repair is recommended when pain and catching persist and the X-ray shows a correctable bone shape with a preserved joint space.
How long is recovery after hip arthroscopy?
Crutches for about 2 to 4 weeks, with a brace to protect the repair, then a progressive strengthening program. Desk work is possible within one to two weeks, driving once off crutches and pain medication, running at about 3 months, and return to cutting sport at 4 to 6 months when strength and hop tests match the other leg. The timeline is set out in Dr. O'Donnell's protocol.
When is it time for a hip replacement?
When the X-ray shows a narrowed or bone-on-bone joint space and the pain limits walking, sleep or work despite activity changes, strengthening and injections. Age is less important than function. A total hip replacement relieves arthritic pain reliably, most patients walk the same day, and return to cycling, golf and swimming is expected; high-impact running is discouraged to protect the implant.
