Hip impingement and labral tears: A new Epidemic or a symptom of overloading and undertraining?
In the build up to the King of Greystones Triathlon this weekend, Ben our Clinical Director here in Platinum Physio discusses the epidemic of hip pain and dysfunction in endurance events such as Triathlons and field sports such as soccer, rugby and Gaelic games.
Hip pain and dysfunction is the third most common loss of injury related game/training time for endurance events and field sports such as Soccer, Gaelic games and Rugby. As a Physiotherapist with an inter-county football team I have seen first-hand the level of hip and groin dysfunction involved in day to day Gaelic games. Whilst working with professional long-distance runners some years ago in the UK, I also encountered numerous junior athletes with hip pain and dysfunction, however these athletes were involved in professional associations and therefore had exposure to in-depth physiotherapy treatment and Mobility/S&C which included regular Reformer Pilates sessions.
Thus, there underlying dysfunction and pain was always resolved before it became a long-term issue. However associated hip and groin pain is not only relevant for the sporting population it is also a major concern for many of the clinical patients I see on a weekly basis who are in sedentary jobs and are relatively active outside of their working environment.
In my first year working with inter-county Gaelic footballers I was inundated with Players who were suffering from Hip and groin dysfunction of some kind. The pain and discomfort had been ongoing for some time. It was now beginning to affect many of the players in their normal daily lives. In my first year we registered 8 Players with hip and groin pain/dysfunction which had been ongoing for 2+years. Out of those 8 players only one was treated with injection therapy and subsequent rehabilitation. Every other player was managed conservatively and is continuing to play inter-county football at an elite level to this day. In fact, this year through the correct management of player injuries we had an injury free panel for both the league and championship campaigns (Not accounting for one traumatic leg fracture suffered in our first league game).
Unfortunately, however the simplest answer is often to refer our patients for a surgical consultation to try get them back to their sporting activity as quickly and effectively as possible. This statement is backed up the statistics that the surgical rate for Hip impingement has increased by over 600% for newly trained surgeons between 2006-2010.
So why has hip impingement become so pronounced in recent years?
The answer is simple it is as a direct result of overtraining and the training methods applied in our adolescent years as confirmed by numerous recent studies in the Netherlands. In the GAA there has been a rise of 392% in the amount of hip surgeries completed between 2007 & 2014. So, what has caused such a dramatic increase in the amount of surgical procedures carried out on our sporting stars.
The relative ease of access to surgical intervention and the pressure that is often applied from the Patient’s and their Management teams in elite sport to be back in their sporting environment leaves many physiotherapists and medical teams with no other option but to refer for surgical intervention. However, there is an alternative to both preventing Impingement becoming a problem and to allowing the athletic and non-athletic population alike continue with their sporting endeavours without excruciating pain. The answer is simple but time consuming and involves the modification of training loads and rehabilitation of the supporting structures around the hip joint.
So, what exactly is FAI and a labral tear?
FAI is the difference in shape between what is recognised as a normal Hip ball and socket joint and one which has some excessive bony growth around the ball or socket itself. However, the occurrence of an abnormal hip ball or socket does not equate to hip pain and resultant future degeneration in the form of Osteo arthritis as so often claimed.
There are many factors which must present together to allow for hip impingement related pain. These factors include altered neuromuscular control, Poor mobility resulting in biomechanical overload, continuous mechanical overload and related soft tissue damage such as labral tears.
The labrum is a shock absorber in the hip and thus does not respond well to surgical intervention. Recent studies have shown that in fact a large percentage of the athletic population have a- symptomatic or non-painful labral tears. Thus, the presence of a labral tear once again does not equate to necessity for surgical intervention. In fact, it is hypothesised that surgical intervention is likely to increase the chances of OA related changes in the hip due to altering the force distribution across the joint. Like the meniscus in the knee joint, pain does not always equate to necessary surgical intervention.
How do I treat or prevent Hip impingement and labral tears?
Hip impingement and labral tears are not generic pathologies and only presents as a painful dysfunction if many different biomechanical and physiological elements combine. Thus, a hip impingement or labral tear does not mean surgical intervention is necessary and most importantly does not mean you will require a hip replacement in years to come. There are however incidences that a surgical opinion is required to assess if intra articular injection therapy is required to reduce pain and thus allow your physiotherapist to design a specific programme to help address some of the variables that have resulted in the occurrence of pain. The most important factor to consider for me in these incidences is to refer the patient to the most appropriate consultant to help alleviate their pain and dysfunction.
In a nut shell, labral tears and hip impingement are not a simplistic pathology that can be fixed with surgical intervention alone. It is a multi-factorial dysfunction which can often be addressed with simple measures such as load modification/improved mobility and appropriate rehabilitation of the surrounding musculature.
If you already have hip pain why not make an appointment with our Specialist physiotherapy team here in Platinum to see what variables are accounting for the presence of your hip pain and more importantly how to resolve those variables to allow you to return to activity pain free. As discussed previously two such variables associated with the development of hip pain are reduced hip mobility and neuromuscular control. If you want to prevent hip pain becoming an issue have a look at our simple hip mobility and neuromuscular control home exercise videos as a starting point to pick up some ideas of how to prevent hip pain.
Alternatively join our amazing reformer Pilates classes to help improve both your hip mobility and control. It’s no co-incidence that one of the major areas we work on with the Leinster rugby players in their weekly Reformer Pilates class is hip mobility and control. If you have any further question’s in relation to your hip pain, please feel free to pop along to our stand at the King of Greystones this weekend or make an appointment to see one of our amazing physiotherapy team.