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My Hip Hurts! Now What Do I Do?

The hip joint is a complex joint made to allow many degrees of movement that are required for daily activities and high-level athletic movements. The hip is intimately connected to the core and is responsible for producing high amounts of force that are required for change of direction, acceleration, and other sport-specific stresses. With this great demand on the hip joint, it is not uncommon for athletes to develop hip pain. There are a variety of pain generators at the hip and finding the specific pain generator is imperative for fixing the problem. Many athletes that I have worked with have been misdiagnosed, which has led to chronic pain because they were not managing the primary pain contributor.

Anatomy of The Hip

The hip joint is like the shoulder joint in that it is a ball and socket joint. The ball and socket-style joints allow for great mobility in all directions. The hip joint is made up of the femoral head (the ball) and the acetabulum (socket). On each surface, the femoral head and acetabulum lie cartilage that allows the ball and socket to glide freely over each. Another structure that is important for the hip joint is the labrum, which serves as a suction seal for the joint. Think of the labrum as like an O-ring that used to increase the seal on pipes. Of course, the hip joint, like all joints, relies on a variety of muscles to create movement throughout the available range of motion. The majority of anatomists agree there are 17 muscles that are recognized as the “hip muscles.”

So What is Causing My Hip Pain

After that brief review of the anatomy, you can see that there are quite a few structures that can be responsible for pain. It could be related to the cartilage in the joint, the labrum that is torn, the muscles that move the hip, along with a few other pain generators such as pain that is actually coming from the back or from nearby nerves. Today though, I want to focus on one of the most common causes of hip pain and that is Femoroacetabular Impingement (FAI).

What is Femoroacetabular Impingement (FAI)?

Femoroacetabular Impingement (FAI) is a mouthful and can cause people to be scared about their pain because it sounds daunting. FAI in everyday terms means that the ball and socket are bumping up against each other because the normal shape of the ball and socket have changed over time due to sporting activities. FAI happens when one or both of the following things happen: a CAM lesion and/or Pincer Deformity. A CAM lesion is when the ball of the joint is bigger than normal; this happens during our younger years when we play a lot of rotational, cutting sports like hockey, lacrosse, football, etc. The ball tries to protect itself when we are doing a lot of cutting by laying down excess bone. This excess bone causes the ball to turn from a nice spherical shape to a more asymmetrical shape. This misshaped ball can lead to cartilage damage, labrum tears, and thus pain. A Pincer deformity is when the socket is too deep or rotated too far forward which causes the labrum to be pinched, or impinged, between the socket and the ball. FAI is predominantly an issue for athletes and is uncommon in the sedentary population.

How Do I Know If I Have FAI?

There are three criteria you must have to get a diagnosis of FAI. The first is to have pain with certain movements, most notably the combination of hip flexion, and internal rotation. This means when you go into a deep squat, sit in a low chair, or try to do the splits you get hip pain. The next criteria would be X-rays that show the misshaped ball or the oversized socket. The last of the criteria is a cluster of tests and measures completed by a medical provider (usually an Orthopedic Physician or Physical Therapist) to confirm FAI. These signs include decreased range of motion or flexibility of the hip, as well examination tests that re-create your pain.

How Do I Treat FAI?

There are a few treatment options for those who have a diagnosis of FAI. One option is conservative management with Physical Therapy. Physical Therapists can: design exercise programs that help maximize a patients’ mobility, increase patients’ hip strength with hip-friendly exercises, and educate patients on activities/positions to limit the pain. Beyond physical therapy, there are times when injections into the hip joint are necessary to calm down the pain. After an injection is performed, oftentimes the patients will again try physical therapy to help manage their pain. The last line of treatment and most invasive treatment is surgery. Surgery for FAI has shown to have favorable outcomes for athletes and is indicated in those athletes who are unable to cope with the conservative measures. With all that said, studies have shown that PT and surgery for FAI lead to significant improvements in athletes’ quality of life and significant pain reduction.


What Should I do If I Think I have FAI Pain?

I recommend people who think they have FAI should see a Sports Physical Therapist or Sports Medicine Doctor/Surgeon. These individuals are known to have a good grasp of examination and history taking that is required to reach the FAI diagnosis. Furthermore, you may want to find a PT or MD who has a special interest in treating hip pain because not all hip pain is FAI as we discussed earlier, thus someone with vast experience in treating hip disorders can help you reach the right diagnosis and thus get you better care for your injury. At Aviator we pride ourselves on getting the best outcomes for our patients even if that means sending you to an MD for your pain. We offer 15 min exploratory assessments to see if your hip pain is something that our PTs can handle or if it is an issue that may require more invasive procedures from an MD.

Aviator Sports Performance and Rehabilitation is deeply rooted in the scientific study of human movement and the innovative integration of technology into practice, ultimately aiming to help patients, athletes/clients in maintaining healthy, fit lifestyles, reduce injury risk, and achieve higher levels of sports performance. Our highly trained staff (Composed of Doctors of Physical Therapy, Certified Strength & Conditioning Specialists & Biomechanic Specialists) & state-of-the-art movement screening services can help identify any significant abnormal movement patterns or strength limitations present, and work to provide our clients with a fully customized corrective action plan to mitigate injury risk and help improve performance.

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