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Hip joint anatomy
The hip is a ball and socket joint which is inherently very stable. The femur (thigh bone) being the ball and the acetabulum (pelvis) the socket. It also has a ring of cartilage, called the labrum, which increases the depth of the joint and therefore makes it more stable.
Hip joint injuries
As with any joint, the hip can suffer from a number of different injuries.
Arthritis of the hip is fairly common, affecting around 1 in 9 adults over the age of 45 in the UK (1). It is a condition that can be managed in a number of ways but is likely to gradually worsen over time.
Hip impingement, known as femoracetabular impingement or FAI, is a common condition in sports people and is often considered to be a condition pre-disposing individuals to arthritis. Those suffering with FAI will often complain of a pinching sensation and pain deep in the groin.
There are two types of FAI; cam impingement and pincer impingement. Cam impingement occurs when the head of the femur isn’t perfectly round and this prevents the femur from moving smoothly in he acetabulum. Pincer impingement when the acetabulum covers the head of femur excessivley, often due to osteophytes, causing the neck of the femur to impinge on the acetabulum . This often causes pinching and can indeed lead to tearing of the labrum.
A torn labrum has recently gained notoriety as the most likely diagnosis for Andy Murray’s ongoing hip issues (2). A torn lbraum can cause significant pain and disability, particularly during sports and activities that involve twisting and turning movements.
Treatment of hip injuries
Rheabilitation of hip injuries involves considering a number of possible causative factors such as:
- training loads
- previous injury
It is possible that more than one of these factors combined is the root cause of hip issues and it requires evaluation from a qualified healthcare professional. Radiological investigations may also be useful in identifying the cause.
Rehabilitation should consider the causative factors and aim to address them in order to alleviate the symptoms, although it may not fix the problem. Treatments may include massage, manual therapy, stretches and strengthening exercises with r pharmacological interventions. Dealing with hip and groin problems can be difficult as can be seen with Andy Murray’s struggles over the past 9 months. Other high profile athletes to have hip issues include Leyton Hewitt and Steven Gerrard. Even Lady Gaga cancelled a tour due to a torn labrum!
Surgery of the hip, or any joint, is usually a last resort after conservative treatment and rehabilitation has failed.
Keyhole surgery to treat labrum related problems is usually successful in allowing return to sport and exercise. Obviously rehabilitation is extensive and hugely important for long-term joint health.
For serious arthritis problems, a full joint replacement may be necessary. This is now a relatively common and successful operation but does have its limitations. Exercise for example, will be limited to activities such as cycling, walking and running (with some restrictions) once recovery is complete.
Overall, you should never suffer with hip pain in silence and seek appropriate advice as soon as possible.