Hip Injuries in Professional Athletes

The hip joint is one of the largest joints in the body. The hip joint is made up of the femur and pelvic bone. The rounded head of the femur articulates with the cup-shaped socket of the acetabulum (a part of the pelvic bone) to form the ball and socket joint of the hip. Smooth friction-free movement of the hip bones is facilitated by the cushion-like cartilage tissue that lines the joint surfaces of the femur and acetabulum. The joint is further stabilized by soft tissue that surrounds the joint. A considerable amount of force or pressure is required to damage this very sturdy joint and is commonly seen during various sports activities.

Injury can occur to the bones of the joint, cartilage, muscles or other soft tissues of the hip. Some of the common hip injuries seen in athletes include:

  • Labral tears: Tearing of the cartilage that forms a rim around the acetabulum
  • Loose bodies: Piece of bone or cartilage that moves around in the joint
  • Cartilage defects: Injury or degeneration of the cartilage, which may lead to arthritis
  • Gluteus medius tears: Tearing of the gluteus medius tendon, which helps one stand upright
  • Proximal hamstring tears: Tearing of the tendons that attach to the thigh muscles

The hip is a very stable joint that carries 8 times the body's weight during activities such as jogging, and potentially greater force during vigorous sports. The hip is well adapted to transfer these forces. Despite this, the hip is prone to many injuries during sports activities.

Injury can result from trauma such as a fall or collision. It may also occur from overuse, excessive strain or repetitive trauma. Hip injuries may be specific to different ages. While adolescents are more prone to injuries related to the growth plate and the presence of structural deformities, wear-and-tear of the joint cartilage is usually seen in aged athletes.

In general, there are two major factors that can increase your risk for sports injuries to the hip. These include inadequate conditioning in the form of warmup before the sport and increasing the training program too quickly.

The most common complaint of athletes when they injure their hip is pain. Symptoms can be acute or chronic. The type, intensity, duration and region of pain is different from person to person.

Hip pain may be felt:

  • In the back or front of the hip while kicking or running
  • Along the knee while walking
  • While sleeping on the injured hip
  • In the groin region, radiating into thigh or leg
  • With prolonged sitting

Other general symptoms of hip injuries in athletes include:

  • Stiffness
  • Loss of strength
  • Loss of range of motion
  • Clicking or locking of the joint
  • Feelings of instability or giving way
  • Weakness

Timely and accurate diagnosis is the key to gaining optimal results. When you present to the clinic with hip pain or other symptoms of hip injury, your doctor will review your medical history and perform a thorough physical examination. This will provide information about posture, gait, extent of range of motion and muscular strength.

Your health care provider may also order imaging studies such as bone scans, CT scans, CT arthrography, MRI scans, MRI arthrography or sonography to view the area of injury more clearly. This helps to confirm the diagnosis.

Hip injuries in athletes can be treated with either conservative or surgical treatments.

Conservative treatment

Non-surgical treatment is the first line of treatment and may include:

  • Rest, ice application, compression shorts and protected weight-bearing to reduce swelling and relieve pain
  • Pain and anti-inflammatory medication to control pain and inflammation
  • Physical therapy, including exercises and massages to increase flexibility, decrease inflammation, improve range of motion and strengthen muscles
  • Cortisone injections administered under ultrasound guidance to relieve pain
  • Platelet rich plasma (PRP), the injection of platelets and growth factors extracted from your own blood, to help in the healing of the injured hip

Surgical treatment

When conservative treatments do not relieve symptoms, surgical treatment may be recommended. With the advances in technology, and the need for a speedy recovery in athletes, most hip treatments are performed minimally invasively.

One type of minimally invasive hip surgery is called hip arthroscopy. This involves creating 3 to 4 small incisions to view the hip joint. An arthroscope, a narrow tube with a camera and light source, is inserted through one of these incisions. This provides a clear view of the surgical site on a large monitor. Based on the diagnosis of the hip problem, special instruments are inserted through the other incisions and the damaged structure repaired.

This may include:

  • Trimming extra or diseased tissue
  • Removing loose bodies or pieces of bone
  • Drilling holes in the underlying bone (microfracture) to allow localized bleeding; this helps with healing and repairing some forms of damaged cartilage
  • Securing torn tissue with sutures

Once the hip has been treated, the surgical instruments and arthroscope are removed, and the incisions closed.

Hip arthroscopy is performed as an outpatient procedure. It is associated with fewer complications, shorter hospital stay, faster recovery, and accelerated return to normal and sports activities. Professional athletes who have undergone hip arthroscopy under the skilled hands of Dr. Benjamin Domb include:

Football:

  • Corey Wooton, NFL Defensive Tackle, Chicago Bears
  • Brandon Marshall, NFL Wide Receiver, Chicago Bears
  • Kurt Warner, NFL quarterback, Arizona Cardinals
  • Priest Holmes, NFL running back, Kansas City Chiefs

Baseball:

  • Brian Roberts, MLB second baseman, Baltimore Orioles
  • Alex Rodriguez, MLB third baseman, New York Yankees
  • Mike Lowell, MLB third baseman, Boston Red Sox
  • Carlos Delgado, MLB first baseman, Boston Red Sox
  • Chase Utley, MLB second baseman, Philadelphia Phillies
  • Darren O'day, MLB pitcher, Baltimore Orioles

Basketball:

  • Troy Hudson, NBA point guard, most recently played with Golden State Warriors
  • Theo Raliffe, former NBA center forward for Atlanta Hawks and Los Angeles Lakers

Golf:

  • Greg Norman, PGA

Figure skating:

  • Tara Lapinski, Olympic figure skater

Hockey:

  • Mario Lemieux, Former NHL player, Canada

Tennis:

  • Magnus Norman, ATP World Tour