For many people, riding is a way of life. The close connection to the horse, the feeling of freedom in the open countryside, or the concentration on subtle aids in dressage: all of this makes riding unique. But when the hips give out, joy quickly turns to frustration. Hip pain is one of the most common problems in equestrian sports. It can alter the rider's position, make communication with the horse more difficult, and in the worst case, force them to give up riding altogether.

Why hip pain is so debilitating when riding

The hip is one of the most important joints in the human body. It connects the torso to the legs, bears our entire body weight, and enables movements such as walking, sitting, and climbing stairs. When riding a horse, the hip plays an even more significant role

• It is the "control center" for the seat.
• We control the horse with the slightest movements of the pelvis.
• A stable, relaxed seat is only possible with healthy hip joints.

When the hip hurts, not only the rider suffers, but also the horse. A tense seat leads to unclear signals. Many horses react to this with nervousness, resistance, or behavioral changes.

Therefore, hip pain is not just a physical problem, but affects the entire rider-horse team.

Typical symptoms of hip pain in equestrian sports

Hip problems can manifest in many different ways. Particularly in equestrian sports, typical patterns repeatedly emerge:

• Groin pain while sitting in the saddle : Riders often experience a pulling or stabbing sensation in the groin, especially during long riding sessions.
• Pain when trotting or galloping : Dynamic movements put more strain on the hip, and discomfort occurs particularly often in this area.
• Restricted movement : Some affected individuals notice that they can no longer tilt their pelvis freely or that their legs no longer fall freely outwards.
• Asymmetrical seat : To avoid pain, the weight is shifted – this results in the horse receiving one-sided aids.
• Radiating pain into the leg or buttocks : Hip problems can irritate nerves, leading to pain in the thigh or buttocks.
• Problems mounting or dismounting : Sometimes the problem is not riding itself, but getting in and out of the saddle.

Many riders recognize themselves in these symptoms. It's important to take these complaints seriously.

Causes of hip pain while riding

The causes are varied – it's not always osteoarthritis.

1. Muscular problems

• The adductors (inner thigh muscles) are heavily used during riding. They can become tense or shortened.
• The iliopsoas muscle (hip flexor) is prone to overuse injuries, especially during long periods of sitting in the saddle.

2. Incorrect seat or saddle problems

An ill-fitting saddle or an uneven seat position leads to incorrect weight distribution. Even small asymmetries can have significant effects.

3. Hip joint diseases

• Fetal Impingement Injury (FAI) : A bony narrowing in the hip joint leads to pain during certain movements.
• Labral damage : The labrum can tear and cause pain in the groin.
• Osteoarthritis (coxarthrosis) : Joint wear and tear, often in old age or after previous injuries.

4. Traumas

Falls from a horse or direct blows to the hip can cause long-lasting problems.

5. Problems in the pelvis or sacroiliac joint

Not all "hip pain" actually originates in the hip joint. The sacroiliac joint (SI joint) can also cause discomfort.

How the diagnosis is made

An orthopedist or sports medicine specialist proceeds in a structured manner:

1. Interview (medical history) : When does the pain occur? Only while riding or also in everyday life? Are there any pre-existing conditions or falls?
2. Physical examination : mobility, special tests (e.g. impingement test), muscle status.
3. Imaging:

• X-rays show bone changes and osteoarthritis.
• MRI makes cartilage, labrum and muscles visible.
• Ultrasound is suitable for tendons and bursae.

Functional analysis : Some doctors observe the rider's posture or use video analysis.

This usually allows the cause of the hip pain to be clearly identified.

Treatment without surgery – what really helps

Many hip problems can initially be treated conservatively. There are several sensible approaches, especially for riders:

1. Seat training and saddle check

An incorrectly adjusted or ill-fitting saddle is often the root of the problem. A riding instructor or a riding posture trainer can help correct the rider's position.

2. Physiotherapy and training

• Mobilization exercises for the hips and pelvis.
• Stretching the adductors and hip flexors.
• Strengthening the core muscles for better grip in the saddle.

3. Manual Therapy / Osteopathy

Blockages in the pelvis or sacroiliac joint can be resolved.

4. Painkillers or injections

Anti-inflammatory medications or targeted injections can provide temporary relief.

5. Load adaptation

Often, temporarily reducing the training intensity is enough to help:

• More walking, less galloping.
• Shorter units.
• Complementary sports such as swimming or cycling.

Training tips for riders with hip pain

Here are some simple exercises you can do yourself:

• Pelvic tilt : While sitting or lying down, slowly move your pelvis forwards and backwards.
• Adductor stretch : While sitting, place the soles of your feet together and let your knees fall outwards.
• Plank (forearm support) : Strengthens the core muscles.
• Balance exercises on the exercise ball : Promotes sitting stability.

Important: These exercises do not replace physiotherapy, but can support the healing process.

When hip surgery or hip replacement is advisable

If pain is persistent and impairs quality of life, surgery may be necessary. Reasons include, for example:

• Advanced osteoarthritis.
• Labral tears or FAI that cannot be treated conservatively.
• Severe limitations in movement.

Hip replacement (hip prosthesis)

A total hip replacement (THR) is an artificial hip joint that is implanted when the patient's own joint is too severely damaged. The goal is to be pain-free and restore mobility.

Many patients can ride again after a total hip replacement – ​​usually after a rehabilitation period of several months. Studies show that recreational riding is possible after a prosthesis, but intensive competitive riding should be discussed on an individual basis.

Riding after a hip replacement

The most frequently asked questions are: "Can I get back in the saddle after the surgery?" and "How long will it take?"

• First rehabilitation phase : Physiotherapy begins on the first day after surgery.
• After 6–12 weeks : Everyday activities are usually possible again.
• After 3–6 months : A cautious return to riding is possible – depending on the healing process, muscle strength and type of sport.
• In the long term : Many riders report that they can ride pain-free again at a walk, trot and even canter.

However, risks such as falls or extreme stress should definitely be taken into account. Consultation with the surgeon is mandatory.

Case studies

• Recreational rider, 45 years old : Hip pain in the groin, cause: adductor tension. Therapy: Physiotherapy + riding position training. Pain-free again after 2 months.
• Show jumper, 32 years old : Diagnosis: Hip impingement. After unsuccessful conservative therapy, arthroscopic surgery. Back in competition after 6 months.
• Female rider, 65 years old : Advanced osteoarthritis, severe pain even in everyday life. Solution: Total hip replacement. After rehabilitation, regular recreational riding in the countryside is possible again.

Conclusion: What to do about hip pain in equestrian sports

• Hip pain is a common problem among riders.
• Causes range from muscle tension to osteoarthritis.
• A thorough diagnosis is crucial.
• Conservative measures such as posture training, physiotherapy and exercise help many sufferers.
• If necessary, hip surgery or a total hip replacement can restore quality of life.
• Riding is possible again in many cases after a hip replacement – ​​with patience and targeted rehabilitation.

Recommendation: Consultation at Endoprotheticum Rhein-Main

If you are suffering from hip pain that is affecting your riding, you should seek specialized help.

At Endoprostheticum Rhein-Main in Mainz you will find:

• Prof. Kutzner is an experienced specialist in hip diseases,
• state-of-the-art diagnostics,
• and comprehensive care – from conservative therapy to hip replacement.

Your athletic goals are taken into account here. Because the goal is not only freedom from pain in everyday life, but also a return to riding.