to learn more.
Prevention methods. We specialize in sports injuries and getting athletes back to their sports fast (running injuries, shoulder tendonitis, IT Band, Runners Knee, Hip Flexor tightness). We see athletes anywhere from baseball, triathletes, golfers, basketball, cyclist, runners and so on. We provide Active Release Techniques (ART), chiropractic care, strength training and corrective exercises. The Performance Place Sports Care is located in Huntington Beach, CA. 714-502-4243
I love going to research based seminars and this weekend was no exception. One of the topics of interest was FAI Hip & Labral tears, which is an extremely common finding in many athletes. I am surprised everyday as I have been using MSK ultrasound on more of our athletes.
In the past hip joint conditions such as FAI Hip & Labral tears have been thought to be associated with trauma or some type of textbook version of pain in the front portion of the hip but as it turns out it can present in a ton of different ways… and even be non-painful! Again in the past people associate it with pain in the deep front part of the hip but as I have seen athletes of all types, from runners to dancers, can have these variety of places:
The front of the hip
Piriformis spasm (back part of the buttocks area)
TFL spasm, which never goes away
Low Back pain
SI joint pain
These are just to name a few
I’ll go through a few concepts in rehab of the hip I want to emphasis:
#1: Acetabular Labral Tear do not only occur with trauma
One study I thought was interesting highlighted Acetabular Labral tears (or again deep hip pain to everyone non-medical reading this) in high-level runners. Each runner/ triathlete ran more than 10 miles a week for more than 5 years and had x-rays showed no degeneration of the hip or abnormal angles, which can usually indicate predisposition for labral tears (alpha angle was found to be normal at 36.7° on average). 75% of the athletes in this study had to undergo labral surgery due to changes in the cartilage. They had the hip “cleaned out” as they say.1
Understand hip pain with activities such as running is not the typical mechanism for injury of hip labral tears and will often be misdiagnosed. A common misdiagnosis can be tight hip flexors or psoas muscle or some other tight muscle.
#2: Femoroacetabular Impingement (FAI Hip) patients adopt abnormal gait and muscle activation patterns
This aspect is a little more common sense but regardless it needs to be stated for those whom might have forgotten. Femoroacetabular impingement is a condition commonly associated with labral tears and pinching in the hip. It’s only logical to think range of motion of the hip will decrease BUT realize if the limited range of motion and gait is altered more than a week (generally speaking) it becomes a habit.
Retraining a “habit” or motor pattern can take about a week but unless addressed it will not change. One study noted when inducing pain in healthy athletes muscle activation is altered. Duh… but the interesting part is when the pain stimulus was taken away and the athlete was no longer in pain they STILL MOVED WITH THE ALTERED PATTERN.2
That is a huge finding considering there was no pathological or damaged tissue to start with. Athletes or people in general with a torn cartilage have a reason to keep guarded with walking and running but seems by this research you could surgically repair the joint and it still wouldn’t change habits.3
Muscle pattern activation or the way you move has to be changed with simple cues over a period of time. You don’t learn how to do anything overnight.
#3 Correction of a “broken joint” or muscle does not correct the problem with FAI Hip
Lazy… people are generally lazy unless they have motivation and a reason to do something. (By the way I realize my typos indicate my laziness of proof-reading) This is a shout out to all of you people whom think a surgical correction of a joint or labrum will solve your problems. You are very wrong and although this article is about the hip the same thing applies to the rest of the body. As Grandma put it “if you don’t use it you lose it.”
By the way, I know my words sound harsh but they are intended to motivate… I don’t sugar coat the truth.
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