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With the change of seasons upon us, training regimens are adapted to shorter daylight hours and cooler temperatures. Often this means transitioning to indoor facilities for conditioning, and cross training in winter sports. Changes such as these can place increased stress on the hip joints reducing performance and increasing the risk of injury to the spine, pelvis, and lower extremities. To avoid the problems associated with hip injury, one should build and enhance core and peripelvic strengthening, maintain cardiovascular fitness, and avoid maneuvers that might result in hip inflammation.
In the case of an emerging or chronic hip injury, one must effectively identify the source of the problem and develop a “return to sport” program. Before pursuing a therapy program, the correct diagnosis is essential to shortening recovery time and effectively returning to a desired level of performance. Common hip diagnoses include muscle pulls, tendonitis, bursitis, sacroiliitis, and arthritis. The common denominators of all of these conditions are pain and inflammation. Typically, this cycle of pain and inflammation interferes with athletic performance. The goal of treatment is to address the fundamental cause of the inflammation often with lower impact activities, antiinflammatories, and a structured program of conditioning that restores proper core and peripelvic biomechanics. Certain training regimens such as treadmill work-outs or peripelvic yoga positions may exacerbate underlying hip inflammation and should be avoided.
Occasionally, the cause of hip pain is more difficult to pinpoint and further evaluation is needed. It is common to have pain in the back or lower extremity that originates from the hips. Fortunately, most hip problems can be assessed with a proper history, physical examination, and radiology studies. Relying on a treatment team is one’s best bet toward the correct diagnosis and treatment plan. Typically, one’s physician in concert with one’s trainer, coach, and therapist can act as a core team to return one to competition.
What does one do about hip pain that does not resolve over time? Studies over the last decade have identified certain individuals to be at risk for abnormal friction within their hip joints. Early identification of these individuals may prevent or delay the early onset of arthritis and need for a total hip replacement. This condition called femoroacetabular impingement (“FAI” for short) is common in very active individuals and often goes undiagnosed or misdiagnosed until there is “bone on bone” arthritis. More commonly, the athlete will tear cartilage in the hip necessitating arthroscopic hip surgery. This surgery repairs the torn cartilage and relieves the FAI friction component. Fortunately, an early diagnosis and treatment of FAI may avoid the longer term complications of joint destruction.
Ultimately, hip joint health begins with maintaining core and peripelvic strengthening across seasonal changes of training environment and activity. A support team of health professionals can make the difference between competing to win and falling short of one’s goals. More recent knowledge suggests that early diagnosis and treatment of hip FAI may reduce the chances of degenerative hip disease in an active population. Maintaining one’s hip health is instrumental in champion level performance. |
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Hip Injury Management
Allston J. Stubbs, MD
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The North Carolina Sports Medicine Institute is an orthopaedic sports medicine clinic based in Winston-Salem, North Carolina. Its philosophy is to provide premium orthopaedic treatment “For the Athlete in All of Us”. Allston J. Stubbs, M.D., an attending surgeon at the clinic, has the highest level of orthopaedic sports medicine training and is the only orthopaedic surgeon in North Carolina with a formal fellowship in hip arthroscopy. |
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Copyright © 2006, 2007, 2008 NCSMI PLLC All Rights Reserved |
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Endurance Magazine November 2006 |
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