Hip Sports Injuries
socket). Treatment options vary from conservative treatment to arthroscopic and open surgery.
What Causes Femoroacetabular Impingement?
It is believed that many normal people have ‘bumps’ or slightly over-deep sockets and could potentially develop femoroacetabular impingement – this is just the way we are built and develop.
The result of these deformities is increased friction between the acetabular socket and femoral head, which may result in pain and decreased range of motion.
However, the hip has to also be provoked in some way to cause damage. This explains the tendency for athletes, sporting professionals and active people to be more susceptible to this form of injury.
FAI often presents as hip and groin pain with restricted range of hip motion.
Symptom onset can be acute, following injury, or insidious after prolonged exertion.
Pain is often provoked with prolonged sitting, walking, crossing the legs as well as during and after sport and exercise.
There will typically be a restriction in hip flexion and internal rotation range of motion.
Pain is primarily felt deep in the groin at the front of the hip, more rarely it can be on the side of the hip or the buttock.
How is Femoroacetabular Impingement Diagnosed?
Physical examination involves a series of hip tests.
Diagnosis is 90% positive with reproduction of symptoms on the impingement test – flexion adduction and internal rotation of the hip.
When testing hip range of motion there may be restriction in hip flexion and internal rotation.
Provocation of pain by flexion abduction and external rotation (FABER test) may provoke pain but is generally non-specific.
How is Femoroacetabular Impingement Treated?
An initial trial of non-operative treatment is advocated for most patients, as the pain is relatively self-limiting.
Physiotherapy can assist FAI by using a variety of techniques to:
• mobilise the hip joint that stretch any tight structures eg joint capsule or muscles
improve soft tissue flexibility and length
• strengthen the deep, intermediate and superficial hip muscles
• progress hip muscle, proprioception, joint position sense and functional control to dynamically control your hip
Use of painkillers and anti-inflammatories may temporarily help the pain reduce the local anti-inflammatory reaction.
Hip Surgery for Femoroacetabular Impingement?
If your symptoms continue to remain unchanged on return to sport, then referral to an orthopaedic surgeon is recommended.
Surgical treatment for FAI is performed either by arthroscopic debridement or can be performed by open surgical debridement. While the techniques are quite different, the operations both aim to address the mechanical and pathological changes around the neck/acetabulum junction.
Post-FAI Hip Surgery Rehabilitation
A supervised hip rehabilitation program with your physiotherapist is an essential part of your post-surgical FAI recovery. Recovery from hip arthroscopy typically takes 3-4 months, while open hip debridement is typically 12 months. Hip arthroscopy has been the preferred method in recent years and has reported excellent results with 80% of patients asymptomatic by 3-4 months and up to 95% having improved symptoms by one year.
For more advice about femoroacetabular impingement, please ask your physiotherapist or doctor.
What causes labral tears?Active athletes are at risk for labral tears because of the extremes of motion imposed by training and competition. The wear and tear of everyday movements like walking and bending in certain ways can contribute to labral tears, as well. Current research is focusing on exploring whether people with abnormally-shaped hips (e.g., hip dysplasia or femoroacetabular impingement) are at greater risk for labral tears.Signs and Symptoms
Labral tears may cause a sharp catching pain, popping, and a sensation of locking of the hip. Most people with this injury experience more subtle, dull pain. Patients describe a deep discomfort in the anterior groin or deep within the buttocks.Treatment: Non-Surgical
For labral tears that do not require surgery, physiotherapists work with patients on developing a conservative rehabilitation plan, starting with a comprehensive examination to determine factors contributing to hip pain.
During rehabilitation, activity modification or rest from sports activities may be recommended to decrease stress on the hip joint. The rehabilitation provider will design a customized exercise program to address muscle imbalances, pelvic position and postural and movement patterns which can put increased demands on the hip joint.
Treatment may include:
• Gentle hip joint mobilizations for pain relief
•Stretching and range-of-motion exercises
•Exercises to increase hip muscle strength
Although most labral tears are unlikely to fully heal due to lack of blood supply, conservative treatment can reduce symptoms and pain, and progressive exercise programs may make a return to sports activities possible.
Surgical Treatment: Hip Arthroscopy
For hip labral tears that do not respond to non-surgical treatment, hip arthroscopy, a minimally invasive outpatient procedure performed under general anesthesia, may be required. The common course of the procedure includes:
Placing the hip in traction to open up the hip joint
Making an incision in the hip joint to insert a camera that displays the inside of the hip on a television monitor
Making two or three other incisions to insert the surgical instruments used for excising labral tears and repairing or removing loose bodies
Making two additional incisions through which the surgeon may remove the torn piece of labrum or repair the torn cartilage
After arthroscopic hip surgery, rehabilitation with a physical therapist or athletic trainer focuses on regaining full hip joint motion, strength and movement control. The rehabilitation provider identifies and addresses any predisposing factors to hip injury and discusses strategies to prevent future injury.
General points about rehabilitation:
Patients can expect to use crutches for about two weeks after surgery or longer depending on the type of surgery performed.
Rehabilitation will be progressive as patients meet certain criteria and move toward a return to full activities, including sports.
Return to high-impact sports will take eight to 12 weeks.
Rehabilitation exercises may include muscle strengthening and range-of-motion activities, and are started soon after surgery and according to the patient’s tolerance.
For any of these hip injuries, contact us for a free assessment