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Our very own Wendy Skinner appeared live on Sky News at the weekend as a sports injury expert.

 

Our very own Wendy Skinner appeared live on Sky News at the weekend as a sports injury expert to talk about hip problems in sports in light of Andy Murray’s announcement about his potential retirement. Wendy said it was an honour to be asked to be able to talk about an area where early management is so important to manage the pain and prevent loss of range of movement and muscle around the area. Wendy and her team at Wimbledon and AquaPhysio work in close conjunction with many of the leading London young adult hip Consultants using land and hydro based treatment to rehab patients on both the non-surgery and surgical route. Wendy has written a piece on the sporting hip below.

 

Pain in the hip with sport

Hip or groin pain is fairly common amongst sports individuals in particular if your sport involves lots of pivoting, changes of direction and acceleration and deceleration. The hip joint receives large forces as forces are dissipated from the trunk to the limbs.

People with hip problems will often complain of either a gradual build up of pain in and around the hip for months or more of a sudden sharp pain, this is normally more traumatic in nature. Pain from the hip can also refer into the buttock and thigh.

Hip pain is normally described as a constant deep dull ache but with an occasional sharp pain with running or twisting. People with hip pain often make a ‘C’ hand sign around the top of their hip and occasionally describe a locking sensation. Activities like putting shoes and socks on, climbing up and down stairs, in and out of the car, sitting for long periods often are described as aggravating factors to their pain.

The hip is a ball and socket joint. The socket is called the acetabulum and this is where the ball of the femur (the head) joins into. The acetabulum isn’t very deep so a structure called a labrum deepens the socket and makes the joint more stable. The joint is then covered by a capsule made up a multitude of ligaments. On the surface of the acetabulum and the head of the femur is cartilage and this cartilage is kept healthy by the sweeping of fluid across the surfaces, contained within the labrum. This lubrication helps reduce friction forces when the joint moves and helps prevent wear and tear. In summary the stability of the joint comes from this bony configuration, depth of acetabulum and labrum and the strong reinforcing ligaments.

There can be many causes of hip pain in sporting individuals. The pain in the joint can be due to impingement of structures around the hip due to changes in muscle patterning around the joint, leading to increased hip translation in the socket causing pressure on pain generating structures. Pain can be due to excessive bony areas on the edge of the acetabulum or on the head of the femur, pain can be due to a tear in the labrum either suddenly due to sporting trauma or over a longer period of time due to the repetitive nature of twisting, pivoting sports. If the labrum becomes damaged and muscle imbalances around the joint aren’t corrected then the joint may become predisposed to developing early OA. With a labral tear the key is to address muscle imbalance earlier to slow progression.

Physiotherapy Management

A good thorough assessment of the hip is required, to ascertain the cause of the hip pain and then the following must be addressed:

1.       Pain management including positions to avoid letting the joint settle. In this phase we may use our hydrotherapy pool to enable early maintain of muscle activation with less force through the joint.

2.       Collect any deficits in range of the joint with manual therapy and exercises

3.       Strengthen around the joint to try and correct joint mechanics

4.       Activate deep hip stabilisers

5.       Coordination and proprioceptive skill based drills

6.       Plan for return to sport

If there is no improvement in symptoms after a number of sessions then onward referral is required to a specialist young hip surgeon / sports medicine doctor for scanning and further investigations.