Most famously you might be aware that Andy Murray has been struggling with hip pain for the past few years which is likely due to his tennis career. Whilst it is unclear exactly what injury Andy Murray had we do know he has a hip resurfacing operation earlier this year and it’s great to see him back on Central Court at Wimbledon this year with Serena Williams.
Hip injuries account for 3-4% of ALL sport injuries and are not only seen in tennis.
The Hip Joint
The hip joint is a highly congruent ball-and-socket joint meaning it’s a fairly stable structure. The socket or ‘acetabulum’ develops from birth until the age of 16-18 years old unless in cases such as hip dysplasia where the socket does not develop properly.
The hip socket provides coverage to the femoral head (the top of the thigh bone) and is covered in a cartilage that forms a horseshoe configuration.
Ligaments strengthen the ball and socket joint adding to the stability.
Mechanism of Injury
There are a number of ways we can injure the hip joint and these are only a few…
- Cutting / Kicking
- Recurrence often as a results of incomplete rehab
- Inadequate skill within sport or activity
- Micro-trauma from repetitive motions
- Biomechanical overload
Femoral Acetabular Impingement
Hip impingement occurs when either the hip socket is deepened (pincer deformity) and overhanging the ball OR the neck of the femur has a bone growth on it (cam deformity) that pinches on the socket with certain movements. Cam lesions are most often seen in young males. Pincer lesions are most commonly seen in middle aged females. The majority of people have both!
- Pain with high flexion activities e.g. lunges, squats…
- C-sign distribution of pain (pain around the outside hip / upper thigh)
- Over coverage of the femoral head or aspherical femoral head as seen on XRAY
- Buttock pain
- Difficulty going from sit to stand
What causes FAI?
Some patients have a previous history of hip problems (such as injury or childhood hip conditions) and develop FAI as a secondary consequence. For the vast majority of patients however, there is no obvious reason why FAI occurs. There are likely to be a number of factorsthat determine whether symptoms occur. The primary problem is the subtle deformity in the joint shape, but this may or may not cause problems depending on the activity level of the patient and how easily their cartilage and labrum are damaged. Recent research from Oxford has shown a strong genetic predisposition to the condition.
There are a number of treatments available, some are non – surgical, others surgical.
1) Analgesia – Anti-inflammatories can be taken just before you perform an activity that brings on your hip pain so that it reduces pain and inflammation.
2) Activity modification – This involves avoiding activities that cause your symptoms and may involve avoiding particular sporting activity or changing your daily routine.
3) Physiotherapy – This can help to strengthen muscles around the joint and improve the range of motion.
4) Injection – This accomplishes two things; if the pain is a result of FAI and originating from the hip joint it can provides pain relief. If successful it also rules out pain originating from the back, or any other potential source around the hip area.
6) Arthroplasty. This refers to joint replacement and can take the form of re-surfacing arthroplasty or total hip replacement. Arthroplasty is carried out when the articular cartilage surface is significantly worn out.
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To book an appointment with one of our Physiotherapy Team give us a call on 01189462299.