Hip Pain vs. Ovarian Cyst Differential: Week in Review 34
When Hip Pain Isn’t Just Hip Pain: A Functional Approach to Women’s Health
Musculoskeletal pain rarely tells the whole story. While aches and injuries often stem from movement dysfunction or tissue overload, there are times when deeper layers of health reveal themselves through seemingly routine cases. In this episode of The FARM Podcast, Dr. Beau and the team unpack a case that began as straightforward hip pain but ultimately pointed toward a broader, systemic issue.
The Case: A 34-Year-Old Female Athlete
The patient is a 34-year-old woman, active in CrossFit and other high-intensity training. She presents with right anterior hip pain, especially noticeable during squatting, running, and jumping. At first glance, the clinical picture looks typical: an athletic female with a background in heavy training and a history of low back pain.
The onset of symptoms had been gradual, building over several months and intensifying in recent weeks. The pain was limiting her ability to train, recover, and maintain the fitness routine that was central to her lifestyle.
Initial Hypothesis: A Local Musculoskeletal Problem
Based on her activity profile and pain presentation, the team initially suspected an internal hip issue—possibly involving the hip capsule, labrum, or flexor musculature. Their early focus was on:
Stabilizing the lumbar spine to reduce compensatory overload.
Calming down the irritated hip joint with mobility modification and controlled loading.
Evaluating squat and running mechanics for dysfunctional movement patterns.
These strategies fit the typical triage process for athletes: identify local drivers of pain, reduce irritation, and build stability around the joint.
A Key Discovery: Beyond the Hip
As the clinicians dug deeper into her medical history, new information came to light: the patient had a history of ovarian cysts and possible endometriosis. This revelation shifted the lens entirely.
Why? Because both conditions can cause referred pain into the hip and pelvis. Endometriosis, in particular, often mimics musculoskeletal dysfunction. Tissue growth outside the uterus can irritate nerves, inflame surrounding structures, and lead to cyclical or chronic pain that shows up in unexpected regions—such as the anterior hip or lower back.
Red Flags and Clinical Reasoning
The case illustrates the importance of zooming out. Hip pain in a CrossFitter often tempts clinicians to dive straight into biomechanics, soft tissue, or orthopedic concerns. But ignoring broader health factors can miss the true driver of symptoms.
Red flags in this case included:
Pain disproportionate to loading—her hip discomfort was flaring even with modest activity.
Chronic history of gynecological issues—ovarian cysts, possible endometriosis.
Non-mechanical pain patterns—symptoms didn’t fully align with movement-based provocation.
The Referral: OB/GYN and Functional Medicine
Recognizing the complexity, Dr. Beau and his team recommended she see an OB/GYN for further evaluation of possible endometriosis and ovarian cysts. This wasn’t just about ruling out pathology—it was about ensuring she received comprehensive care that addressed both her musculoskeletal system and hormonal health.
The team also suggested exploring functional medicine as part of her recovery plan. Hormonal dysregulation plays a key role in conditions like endometriosis, and addressing factors such as inflammation, diet, and stress physiology can complement conventional medical treatment.
Why Functional Integration Matters
This case shines a spotlight on the intersection of musculoskeletal care and women’s health. Too often, athletes—especially women—are funneled into narrow treatment silos. A hip complaint is treated only as a hip problem, or hormonal irregularities are addressed without considering their biomechanical consequences.
At The FARM, the emphasis is on integrated thinking:
A musculoskeletal injury may be worsened by systemic inflammation.
A chronic pain complaint may be amplified by hormonal fluctuations.
A seemingly mechanical limitation may trace back to gynecological health.
By connecting these dots, clinicians can move beyond short-term symptom relief and toward long-term health and performance.
Lessons for Athletes and Clinicians
For athletes:
Listen to your body—persistent pain that doesn’t respond to typical rehab deserves deeper investigation.
Track your health holistically—menstrual cycles, hormonal shifts, and systemic conditions can all influence performance.
Don’t compartmentalize—your hip, back, and reproductive health are interconnected.
For clinicians:
Expand the history-taking process—ask questions about menstrual health, hormonal symptoms, and systemic conditions, even when patients present with orthopedic complaints.
Recognize referral patterns—not all anterior hip pain is musculoskeletal.
Collaborate across specialties—true patient care often requires partnership between chiropractic, gynecology, and functional medicine.
Final Thoughts
What began as a textbook case of hip pain in a CrossFit athlete turned into a revealing lesson in the complexity of women’s health. By widening the diagnostic lens, Dr. Beau and his team avoided the trap of treating symptoms in isolation and instead guided the patient toward the right care pathway.
This episode underscores a powerful truth: the body is an interconnected system. Pain in one region often reflects influences from another. For female athletes especially, understanding the relationship between hormonal health and musculoskeletal function can mean the difference between ongoing frustration and lasting recovery.
At The FARM, the goal is not just to get athletes back to sport—it’s to help them build resilient, thriving bodies that honor the full complexity of their health.
