Over the last 10-15 years we’ve seen a sharp increase in the awareness of hip problems in young, and, in particular, sports people. It’s an area that I’m particularly interested in as I too struggle with these issues. My hip problems started in my early twenties, when I started working as a junior physio. I would have periods of time where sitting more than 20 minutes was a problem. It should be noted, at this stage in my life, I was somewhat heavier and doing very little in terms of sport and exercise! The gym was lucky to see me more than once a week and if you’d told me to go for a run I would’ve laughed in your face!
Anyhow, I struggled on with pain for the best part of a year, not really knowing what was causing my problems until I sought the advice of one of my seniors. They diagnosed me with hip impingement, which was not a term I was familiar with as a newly qualified physio. They recommended x-rays which confirmed I had a CAM defect on my femur which would certainly account for my struggles.
So what does this all mean? Its full technical term is femoral acetabular impingement (FAI) which is essentially when the head of the femur (thigh bone) causes irritation or friction within and around the acetabulum (hip socket) due to a structural difference in one or both component parts of the joint.
In more detail, it is often categorised into two main forms: ”Cam” and “Pincer”. A CAM defect is when the femoral head and neck is not perfectly round, which results in increased or abnormal contact, typically at the anterior (front) surface of the socket. A PINCER impingement refers to a difference in the socket component, typically when the socket is orientated in such a way that it covers too much of the femoral head, so causes a pinching effect between the rim and the head/ neck junction. (See diagrams below.) You can hopefully appreciate that these changes in the joint mechanics can, in time, lead to an inflammatory cycle and in turn changes to the articular surfaces (cartilage) within the joint.
So what can we do? Firstly, it is important to ensure that we are dealing with a hip problem. These issues can commonly present themselves in a multitude of aches and pains. Some of the typical presentations we see are: hip and groin pain, low back, sacroiliac or buttock pain and even thigh and knee pain. This is often due to how our bodies compensate for the changes in our movement patterns and the consequent muscle imbalances that we use to allow us to keep going. Seeking advice from a specialist is always a good starting point.
Dependent on the type of impingement and the associated changes, you can opt for either a conservative or surgical approach. Medical advances now mean that surgeons can perform key hole surgery on the hip to rectify the structural issues in and around the hip. Although this option is now largely successful, it will require a rehabilitative period within which you are often reduced weight bearing and then a period where you are gradually reintroduced to your sports and activities. You should seek physio advice within this period to ensure everything is heading in the right direction. Typically hydrotherapy and water based exercise can be extremely useful in these early phases to ensure normal movement patterns are achieved and early strengthening implemented.
Alternatively, these problems can also be managed conservatively through a period of relative rest and offload (again hydrotherapy can be helpful) and a progressive rehabilitative programme of exercises to address the imbalances around the hip. Now obviously we cannot change what happens structurally within the hip but sometimes by strengthening and stretching the component parts it can offer pain relief and return to full function. Speaking from personal and clinical experience, a conservative approach can be very effective. I manage to complete 15-20 hours of training per week with little to no problems at all.
So what can you do to help yourself? The answer is usually the gluts! Your gluts (buttocks) muscles are the ‘power houses’ of your Iower limb and play a majorly stability role in the hip. If you can improve the strength and functional firing of your gluts and hip flexors I believe that you can start to reduce some of the load or overload through the hip and lower limb. It was no surprise to me that as I started to increase my exercise levels four years ago, my hip pain started to significantly improve. As I’ve continued to address weak and tight areas, this has only got better. I am very strict about what I do. I follow a weekly programme of core and gluts strengthening (2-3 sessions) and I regularly stretch and use the foam roller. I am under no illusion that if I did not do my homework, I would not be able to do what I do in terms of racing and training.
Although I strongly believe that conservative management should always be considered, I do accept that every person is different and there is no miracle cure to these problems. Sometimes if the structural changes are advanced enough within the joint, conservative management alone may not be enough. But rest assured that recovery following these surgical procedures is often fairly straightforward if you’re sensible with your return to activity and have a good physiotherapist to help guide you through the process.