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I love going to research seminars and this weekend was no exception. One of the topics of interest was FAI Hip & Labral Tears, which is a very common finding in many athletes. I am amazed every day as I have been using MSK ultrasound in more of our athletes.
In the past, hip joint conditions such as FAI Hip & Labral tears have been thought to be associated with trauma or some kind of textbook version of pain in the front of the hip, but it turns out that it can come in a ton in different ways … and even be non-painful! Once again in the past people associate it with pain in the deep front of the hip, but as I have seen athletes of all kinds, from runners to dancers, they can have this variety of places:
The front of the hip
Piriformis spasm (back of the buttock area)
TFL spasm that never goes away
YES joint pain
These are just to name a few
I will go through some concepts in hip rehabilitation that I want to emphasize:
# 1: Acetabular Labral Tear Not Only Occurs With Trauma
One study that I found interesting highlighted the tears of Acetabular Labral (or again the deep hip pain to everyone who did not read it) in high-level corridors. Each runner / triathlete ran more than 10 miles a week for more than 5 years and the X-rays showed no hip degeneration or abnormal angles, which may usually indicate predisposition to labral tears (the alpha angle was found to be normal to 36.7 ° on average). 75% of athletes in this study had to undergo labral surgery due to changes in cartilage. Their hip was "cleaned" as they say.
Understanding hip pain with activities like running is not the typical mechanism of injury to hip tears and is often misdiagnosed. A common misdiagnosis can be the tight hip flexors or the psoas muscle or some other narrow muscle.
# 2: Patients with Femoroacetabular Impact (FAI Hip) adopt abnormal patterns of gait and muscle activation
This aspect is a little more common sense, but without regard to it must be stated for those who might have forgotten. Femoroacetabular shock is a condition commonly associated with labral tears and pinching of the hip. It is logical to think that the range of motion of the hip will decrease, but realize if the limited range of motion and gait is altered more than a week (usually speaking) becomes a habit.
Recognizing a "habit" or motor pattern may take about a week, but unless it is tried it will not change. One study found that by inducing pain in healthy athletes muscle activation is altered. Duh … but the interesting part is when the pain stimulus was removed and the athlete was not in pain that still moved with the altered pattern.
That's a huge find considering there was no pathological or damaged tissue to start with. Athletes or people in general with a torn cartilage have a reason to stay guarded with walking and running, but it seems from this research that they could surgically repair the joint and still would not change the habits.
The activation of the muscle pattern or the way it moves has to be changed with simple signals over a period of time. You do not learn to do anything overnight.
# 3 Correction of a "broken joint" or muscle does not correct the problem with FAI Hip
Lazy … people are generally lazy unless they have motivation and a reason to do something. (By the way, I realize that my typographical errors indicate my lazy proof reading) This is a cry to all of you people who think that a surgical correction of a joint or labrum will solve their problems. You are very wrong and although this article is about the hip the same applies to the rest of the body. As Grandma said "if you do not use it, you lose it".
By the way, I know that my words sound harsh, but they are meant to motivate … No sugar coating the truth.
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Video credits to Sebastian Gonzales YouTube channel