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They say prevention is better than cure and that is certainly true in hips! Having said that you can’t change your genetics. Some people have a certain shape to their hip which seems to predispose to early hip osteoarthritis. These ‘CAM’ and ‘Pincer’ shaped hips predispose to pinching (impingement) of the hip against its socket, leading to damaged cartilage and eventually arthritis. Hip Arthroscopy surgery can be used to reshape the hip and may prevent early arthritis progressing to advanced stages.

The most important modifiable risk factors for arthritis is your weight and activity level. Being even slightly overweight leads to increased load on the hip joint. Over time the hip can be squashed down and change shape permanently. The increased angle leads to more pinching and the hip wears down more quickly. Losing weight can slow the whole process down. Other people have illnesses in childhood such as Hip Dysplasia (the hip and socket are too shallow, having not formed properly), Perthes disease (the blood supply to the hip gets cut off in childhood), or Slipped capital femoral epiphysis (the growth plate of the bone slips out of place). All of these conditions need to be spotted in childhood so something can be done about it and potentially prevent adult hip osteoarthritis.

Early hip OA is much easier to fix than advanced OA. Sometimes X-rays can miss the early features, MRI or CT scans are more reliable. If you are sure that you have hip or groin pain, but the X-ray is normal, you will need to speak to your doctor about a specialist opinion or scan.

Sometimes a steroid injection done under X-ray guidance can give temporary relief, and provide clarification around whether pain in the groin or buttock area is truly coming from the hip joint, however, they generally wear off after 2-3 months, so it is not a long-term option. Other substances such as hyaluronic acid (an artificial version of your natural joint fluid) and PRP are also being used but need to be further evaluated to see if they have long-term benefit.

It is important to do regular strengthening exercise (such as core stability and pilates) and maintain a healthy weight, if hip pain is becoming intrusive, ask to see one of our specialists.

Dr Leon Creaney
www.sportandexercisemedicine.co.uk



As a sports physiotherapist I work in a number of diverse settings which gives me access to a wide range of clients from the elite professional footballer to the office worker who is a keen triathlete at the weekends. For each client the need is the same “how can I get the most out of my sporting hip and groin following injury in order to improve my performance.” Pain at the hip and groin region particularly can be very debilitating for the athlete, quite often it is very poorly understood area and as a consequence the problem can become chronic and result in an extended period on the sideline’s.

Diagnostics & Collaborative working
Diagnostics play an important role as the hip and groin is a very complex area and problems can be difficult to diagnose. Orthopaedic consultant opinion together with radiographic imaging and specialist reporting is important in pinning down the correct diagnosis. A collaborative approach in assessment from leading specialists in Sports Medicine and the Sports Physiotherapist is the most effective route in treating the athlete in terms of getting them back to action as soon as is safely possible and providing a solution to ensure their long term fitness.

Focused & Progressive Rehabilitation
First of all it is important to educate the athlete about their injury, the mechanism of injury often involving video analysis and the rehabilitation plan that will allow them to return to sport and avoid any injury reoccurrence. It requires a ‘buy in’ from both the therapist and the athlete to commit to a rehabilitation programme which will allow them to return to full fitness.
Hip and groin injury can be multifactorial in nature but it is important to focus targeted rehabilitation at the region initially and then progress to more dynamic loading as symptoms improve. I have found the following progressive stages of rehabilitation to be most effective within the sporting population:

  • Intersegmental control and strength (such as a deadlift or double leg squat)
  • Linear mechanics and running load (such as barbell/overhead running and leg change drills)
  • Multidirectional mechanics and sprinting (such as a lateral shuffle or Zig Zag cutting)

Within these 3 phases the therapist encourages correct execution in technique and correct lumbo-pelvic form. Furthermore, a gradual increase in load progression, speed intensity and multi-directional movement patterns is also encouraged. Other treatment methods may also be incorporated if deemed necessary, such as improving the mobility of the lower extremities and spine with manual therapy and sports yoga, application of strength and conditioning principles, Shockwave therapy and clinical Pilates.

It is also important to keep the athlete focused and interested within rehabilitation. In order to achieve this outcome the therapist must make rehab specific to their sport; jointly develop drills with the athlete to mirror scenarios encountered within a game situation and make rehab proprioceptively demanding in order to retrain reaction timing and load response.

Profiling & injury prevention
There is now a growing trend towards profiling of the athlete to highlight any injury risk factors and movement dysfunction that may predispose the athlete to injury.
A specific screening tool devised by the therapist specific to the demands of the sport and/or the athletes overall physical capabilities is generally used twice a year in both a squad environment or on an individual basis to measure athletic performance. The screen may broadly include the following battery of tests:

  • Range of motion eg. Shoulder mobility
  • Strength testing eg. Adductor Squeeze test
  • Balance testing eg. Single leg landing
  • Work Capacity testing eg. Push up to failure
  • Movement Patten analysis eg. Squat form
  • Outcome measure eg. Triple hop for distance

Data produced from the screen allows us to flag up any potential weaknesses that could be a contributing factor to injury and have an adverse effect on overall physical performance.
In order to nullify these weaknesses the athlete who presents as a high injury risk is given outlined bespoke action points to work on and then they are assessed more regularly, every few months throughout the year on key tests relevant to their profiling findings. This detailed monitoring allows us to prevent potential injury occurrence in key area’s such as the hip and groin and ensures the athlete remains fit, strong and pain free in order to achieve optimal performance.

Mike Kennedy MSc BSc (Hons) MHCPC MCSP MACPSEM

Manchester United Football Club Academy Physiotherapist
Lead Physiotherapist, Mike Kennedy Chartered Physiotherapy & Pilates
Highly Specialist Musculoskeletal & Sports Physiotherapist, Spire Perform Manchester
Consultant Physiotherapist to the Professional Footballers’ Association (PFA)
Associate Research Physiotherapist to the FASHIoN trial – Studying Hip Impingement

You can find more information on the services Mike provides at the following web resources:
Wigan Physiotherapy
Spire Healthcare


The Manchester Hip Clinic is committed to helping all kinds of people with hip problems to be free from pain and often to resume near-normal levels of physical activity – even those who may have thought that such relief would never be possible.

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