Hip labral tears!!!
🫀Anatomy: the hip acetabulum is surrounded by a band of cartilage known as a labrum or labral (Cianci et al. 2017).
🤔So your labrum is cartilage surrounding your hip joint, we know from previous knee posts that cartilage is aneural therefore cannot be painful.
🤷♂️yet there is a high incidence of hip arthroscopy surgery in athletes experiencing hip related groin pain.
🤓Hips that were experiencing pain 97% had a labral tear but 43% of non-painful hips had a labral tear in the same person (Vahedi et al. 2018).
🔭The incidence may have been ⬆️ if both hips were scanned the same. The painful hip they used an MRA which has ⬆️ incidence at identifying a labral tear than an MRI.
🤓This was seen where 62% people with hip pain had labral tears & 54% of people without pain had a labral tear (Heerey et al 2019)
✅labral tears are common in both painful and non painful hips
✅maybe labral tear isn’t to blame
✅should surgery be first protocol
Femoroacetabular impingement (FAI).
🤓Warwick agreement has now defined this as femoracetabular impingement syndrome (FAI), individual presenting with a number of symptoms with both clinical and imaging findings positive (Griffen et al. 2016).
🤓FAI previously was defined as abnormal changes of the femur and/or acetabulum & abnormal contact between these two structures resulting in soft tissue injury (Ganz et al 2003).
🔭Cam is the changes seen to the femur & Pincer is the changes seen to the acetabulum.
🤷♂️But just like the labral tear are these changes normal changes? Cam & Pincer morphology changes have been seen in people with no hip pain (Dickerson et al 2013).
Primary symptom of FAI
✅motion related groin pain
✅pain may also be felt in the buttock, back or thigh.
✅patients may describe pain with clicking, catching, locking
✅stiffness & restricted range of movement.
🤷♂️so are these changes occurring naturally due to the sport we play?
🤷♂️If people with the same changes have no hip pain what is responsible??
🤷♂️Are these individuals with pain strong enough to take the load of there sport?
🤷♂️do they move differently?
🤷♂️do they play in different positions where more cutting is required?
🤷♂️is this cutting been reduced at training sessions to manage the load?
🤔Lots of questions still to be answered?
Femoroacetabular impingement syndrome (FAI)!!!
Now that we know what FAI is (see previous post if you missed😉).How does one treat🤷♂️
🤔The person is the most important factor, not the morphology or not the scan results. An MRA/MRI are important to get but we know many people see changes on their scan results both cam & pincer morphology (Frank et al. 2015).
🤷♂️Now that you know your scan results what’s best treatment, this we cannot say for 100% but what we do know is both physiotherapy and surgery improve FAI symptoms.
🏋️♀️Physiotherapy led rehabilitation is associated with an improvement for at least 2 years (Mansell et al 2018).
💉Surgery has also been shown to reduce symptoms (Palmer et al 2012).
🏋️♀️try physiotherapy led exercises for at least 12 weeks as with surgery you are changing the morphology and we know these changes are seen in people with no hip pain.
✅These changes may not be causing your pain, ⬇️ hip strength, ⬆️training overload, ⬆️ repetitive cutting may be responsible.
✅Eliminate all of these before thinking about surgery, surgery may not be necessary.
Femoroacetabular impingement syndrome (FAI) physiotherapy!!!
✅The goal is to ⬆️ hip strength without sensitising the hip joint!!!
✅Finding a comfortable range of movement to ⬆️ hip strength is key.
✅End range hip flexion movements can be aggravating initially i.e. squat depth may have to alter
✅Hip stability is altered this should be an important part of your rehab i.e. split squat & RDL great exercise for this
🔑calm things down and build things up.
FAI hip flexion!!!
🤕Hip flexion & anterior hip pain often the most irritable area & avoided movement!!!
🤸♂️Just like any area of our body experiencing pain, graded exposure to the movement is very important to get the function back.
✅I’d recommend find one hip flexion movement you can manage and build on it.
🤸♂️Every individual is different, some people may have to alter range of movement and gradually build on this when doing these exercises.
✅it’s not about forcing the hip movement it’s about exposing the movement to your hip and gradually build a tolerance.
🤓 @dralisongrimaldi has some excellent work on this area.
Time to stop claming claims!!!
🤔Many people think that clams are excellent exercise for the hip abductor muscles & isolate them the most but this is not the case!
🤔Clams have been shown to activate the hip abductors very little (38% EMG Low activation). Clams are a repetitive movement that can put compression stress on the gluteal tendon.
🏋️♀️Exercises like hip abduction in standing and side plank have the highest EMG activation (74%) with less stress on the gluteal tendon.