A hip injury and pain can often get in the way of us enjoying life and doing all of the things we love to do. In this article, we will talk about the hip, how it works, the types of hip injuries, and how to best repair them so you can get back to what you love.
The hip joint is a ball-and-socket joint with massive ligaments, making the hip quite stable. The bony anatomy, muscles, labrum, and ligaments of the hip contribute to its strength and stability.
The ball and socket are sealed by the hip labrum, a ring of cartilage that helps with movement between the leg and the pelvis. The hip ligaments are primarily responsible for maintaining smooth hip motion. And they keep the hip in place while it moves in a pain-free, strong and stable fashion.
Even though the hip has been known for its strength and stability, hip injuries have become increasingly recognized as a source of pain and disability. This makes sense when one considers we move our hips at least one million times per year during activities of daily living. The high rates of wear and tear attributable to normal use of the hip alone can result in long-term problems.
Add to that sports activities, and the requirements on athletes to become bigger and stronger places more and more force on the hip. The increased requirements place tremendous forces year after year. And that adds to the growth in hip injuries. When the hip’s soft tissue structures, such as the labrum, tendons, and ligaments, are subjected to forces beyond their normal range, injury and failure occur, resulting in hip injury and instability.
Hip injuries are common in sports activities like soccer, ice hockey, and football. But they also include overuse injuries from repetitive use in activities like cycling, yoga, hiking, aerobics, and more. Symptoms from overuse injuries often have an insidious onset and become residual and chronic.
Hip injuries cause instability of the hip, which results in abnormal movement between the structures of the hip joint. And it is associated with an array of hip conditions, including labral tears, femoroacetabular impingement, ligament tears, dislocations, and osteoarthritis.
One of the most common conditions is dislocation of the hip. Hip dislocations are seen in sports like football, rugby, hurling, and soccer. And they commonly occur posteriorly due to the greater strength of the anterior capsule of the joint. In this situation, the individual is hit in the front of the thigh, forcing the thigh/hip complex backward. The result is hip dislocation and injury to the ligamentum teres and the posterior capsule.
A joint dislocation significantly disrupts all the structures that support the joint. Long-term consequences of posterior hip dislocations can include sciatic nerve injury, avascular necrosis of the femoral head, and significant arthritis and cartilage damage.
Laxity of the anterior hip capsule is seen in sports injuries and overuse injuries. Activities that demand supraphysiologic joint motion such as figure skating, dance, and gymnastics are causative factors. The ileofemoral ligament of the anterior hip capsule may stretch out, causing a focal rotational type of instability. This type of instability can cause labral tears and associated pain.
Stances repeatedly taken by athletes such as hockey goalies and baseball catchers can cause overuse injuries and lead to femoroacetabular impingement (FAI). However, the most common cause of FAI is simply some soft tissue injury, such as an iliofemoral or ischiofemoral ligament injury.
Over time, hip instability from ligament injuries and a hip labral tear can cause premature arthritis and FAI. The association between hip instability from athletic injuries and the development of arthritis has been well documented.
A thorough understanding of hip anatomy and instability is essential to managing hip instability and initiation of treatment. In most cases, the physician should be able to find the correct cause of instability with history taking, clinical examination, and radiographs.
Imaging such as MRI and MRI arthrography is also helpful. The evaluation of the hip range of motion, including flexion, internal/external rotation in flexion, abduction, and adduction, should be performed compared to the contralateral hip to confirm the presence of instability.
The majority of hip injury and instability cases can be managed non-surgically. Surgical intervention is required in cases of large acetabular fractures. Standard therapeutic approaches (pain medications, corticosteroid injections, and arthroscopy) employed to address hip instability have often been ineffective. That’s because they do not repair the underlying cause of the problem, the injured ligaments and labrum.
Non-surgical regenerative therapies, including Stem Cell Therapy, PRP, and Prolotherapy, are alternative modalities that can repair the instability by stimulating the natural regenerative processes in and around the hip joint. These treatments facilitate the restoration of the degenerated ligaments and labrum to a healthy state, improving joint support, function and reducing pain and symptoms.
Plus, they get you back to doing what you love without the need for surgery and extended time off.