GROIN PAIN WHAT YOU NEED TO KNOW  / FEMORAL HIP IMPINGMENT

The groin pain requires the common medical consultation, both at the level of general medicine, specialties physicians, professional Sports physiotherapists and sports therapists in Manchester.

When the hip impingement causes the first symptoms, it might be announced as a hip impingement syndrome, the principal symptoms are pain in the groin zone, particularly at the moment when you flexing the hip or walking and it’s reduced the range of movement in the hip.

Meanwhile, at first time you can just feel the pain when you move the hip close to its limits.

(Jack Grealish: Aston Villa Midfielder – Copyright)

There are different kinds of hip impingement CAM, PINCER AND FAI, they can also be treated at MY Sport Injury & Osteopathy | Manchester City Centre with the assistance of certified professionals, guaranteed specialists on www.mysportsinjury.co.uk The Team can assist in providing specialized treatment from a sports physio Manchester through conducting full medical assessment and customized approach to rehabilitation in the elite field of sports.

How could I know or suspect if I am suffering of a hip impingement?

·      Pain in the groin or gluteal region.

·      Sciatic and knee pain after sports.

·      Cracks in the hip with movement.

·      Limitation of hip movements.

If you are feeling these symptoms first of all you may attend to a professional medical consultation, after a medical examination the procedure to follow and the treatment will be indicated with a customized sports injury rehabilitation program.

One of these plans of action could be to have direct sports therapy with a professional Sports physiotherapist including a sports therapy or sports massage in Manchester.

What happens with my body when a hip impingement occurs?

Actually, hip impingement occurs when the ball and socket of the hip joint do not fit properly. Limited movement damages the cartilage and can lead to pain and arthritis in young adults.

Furthermore, femoro-acetabular or hip impingement is an anatomical disturbances or hassle of the hip, brought about by a deformity or an abnormality of the femur bone, acetabulum or both that causes an unnatural contact between both structures during  motion and gliding of the joints.

Which other causes can inguinal pain be confused with?   

It can be mistaken with several other causes such as facet syndromes, renal colic, hernias, etc.

Patients at MY sport Injury & Osteopathy Manchester with this condition are generally young people or sports athletes with groin pain that may show up after a minor trauma.

Types of hip impingement

PINCER

It is the result of a linear contact between the acetabular rim and the femoral head-neck junction. The first structure to fail in these cases is the acetabular labrum. The continuous impact leads to degeneration of the labrum, and ganglions or ossification of the rim leading to a deepening of the acetabulum, worsening the over-coverage.

Pinching "in pincers" has a frequency of 9% and is more common in middle-aged women with some degree of sports activity.

CAM

It is caused by entrapment of an abnormal femoral head with an increasing radius in extreme motion, especially flexion. The underlying cause for the abnormal morphology in cam pinching (cam) is not clearly understood.

The resulting frictional forces lead to an outside-to-inside abrasion of the acetabular cartilage or avulsion of the labrum and subchondral bone in a relatively constant anterior superior area. Cam pinching, with a frequency of about 6%, is more common in young, athletic males.

How to diagnose a hip impingement?

Advances in recent years, especially in the study of images, have made it possible to identify anatomical abnormalities that until now had been underdiagnosed or unknown, such as those found in femoroacetabular impingement syndrome.

Imaging studies

The complementary study of images is very important for the identification of anatomical abnormalities associated with impingement and to rule out other pathologies.

Plain radiographs remain the most accessible and widespread method for the diagnosis of this pathology and should always be the initial examination.

Magnetic resonance imaging is very useful to evaluate the acetabular labrum and articular cartilage.

Treatment of hip impingement

In a palliative way, anti-inflammatories and kinesiotherapy at sports therapy Manchester can be prescribed with emphasis on exercises to strengthen the periarticular muscles.

In the first instance, a kinesiotherapy program is recommended based on sports physio Manchester, especially in acute cases where there is no advanced damage. Having a Sports Massage is highly recommended to loosen the gluteal muscles around the hip joint which can be effective in treating the overall symptoms of the Hip.

(Mykonos Performance: Kyle Walker Peters: Southampton Footballer Strength & Conditoning) Copyright

Rehabilitation focuses on improving hip stability and muscle management of the segment characterized by the presence of contractures or altered patterns. It is accompanied with activation exercises and stretching that seek to improve hip mobility.

In those cases where there is not response to the kinesiological treatment at MY sports therapy | Manchester or in those patients where there is an advanced pathological process, surgical resolution is indicated by means of a hip arthroscopy that seeks to restore normal morphology in the hip with an opinion by an orthopedic hip consultant.

Physiotherapy treatment pre-medical operation

The rehabilitation program must be developed in a specific and comprehensive way for each patient, and from a very complete analysis of the history, the operation, the clinical charts and evolution, all this to define the approach with appropriate methods and techniques by a Sports physiotherapist at MY Sports Injury & Osteopathy | Manchester city Centre.

Kinesiotherapy Program

·      Isometric exercises, both quadriceps and glutes, the patient in a supine position with a towel in the popliteal region, the physiotherapist will ask the patient to press the towel and the tip of the foot upwards, so that they perform exercises isometric quadriceps holding a contraction for 6 seconds and relaxation for 3 seconds.

·      Isometric adductor exercises with a ball between the knees, the patient is asked to press the ball for 8 seconds, repeating the exercise 10 times, leaving 10 seconds of rest between contractions, the physiotherapist checks that there are no compensations.

·      Likewise, it is important to know that there are certain devices to perform aerobic physical activity that imply greater stress on the hip and knee joints, being the cases of the stationary bicycle.

(Deli Ali & Kyle Walker Peters: Footballers Mykonos Performance Elite Sports)

·      Patient in a standing position leaning on the stretcher will perform hip extension with resistance from the theraband, while the physiotherapist stabilizes hips avoiding compensations for medius gluteus (3 series of 10 repetitions each).

·      Active ankle mobilizations both flexion-extension, abduction-adduction and inversion-eversion, the physiotherapist at sports massage Manchester city Centre applies resistance to each movement respectively. In addition, the patient will perform circumduction movements. Perform 3 sets of 10 repetitions each.

·      Accelerate the learning process of rehabilitation, for a correct preoperative education consists of: carrying out functional activities, going up and down stairs, moving from your chair to the bathroom, transfers and independent ambulation.

Physiotherapy treatment post-medical operation

Kinesiotherapy Program

·      In a sitting position we will perform progressive quadriceps toning exercises, requesting the patient to perform knee flexion-extensions, hip elevation with knee in extension, triple reflection to tone anterior tibialis and psoas, with the placement of manual resistances by the physiotherapist.

·      Isometric ankle exercises (no adduction and internal rotation).

·      Isometric hip abduction-adduction exercises. It is considered the most important type of exercise (especially abduction), since they help the patient to walk without lameness, however, they should be avoided if the patient has undergone a trochanteric osteotomy.

·      It is recommended to start doing them in supine position, with a ball between the knees, performing adductor isometrics and maintaining a contraction of the same for 3 seconds and relaxation for 3 seconds, while the physiotherapist controls that there are no compensations.

·      Both active and assisted hip abduction exercises will be performed.

·      Advanced training, specificity for return to sport.

High demand single limb dynamic lumbo-pelvic stability and optimize functional strength, endurance and power within the lower kinetic chain.

References

Leunig M, Ganz R. Femoroacetabular impingement: a common cause of hip complaints leading to arthrosis. Unfallchirurg 2005; 108: 9-17. 

Kassarjian A, Yoon L, Belzile E, Connolly S, Millis M, Palmer W.Triad of MR arthrographic findings in patients with Cam type femoroacetabular impingement. Radiology 2005; 236: 588-92.      

Ganz R, Gill TI, Gautier E, Ganz K, Krugel L, Berlemann U. Surgical Dislocation of the adult hip: a technique with full access to femoral head and acetabulum, without the risk of avascular necrosis. J Bone Joint Surg Am 2001; 83: 1119-24.   

Beall Dp, Sweet CF, Martin HD. Imaging finding of femoroacetabular impingement syndrome. Skeletal Radiol 2005; 34:691-701.     

Jager M, Wild A, Westhoff B, KrauspeR. Femoroacetabular impingement cause by a femoral osseous head-neck bump deformity: clinical, radiological and experimental results. J Orthop Sci 2004, 9:256-263.

Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J: The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002; 84: 556-560.

Blankenbaker DG, Tuite MJ. The painful hip: new concepts. Skeletal Radiol. 2006; 35 (6): 352-70.

Schmid MR, Notzli HP, Zanetti M, Wyss TF, Hodler J. Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography. Radiology. 2003; 226(2):382-6.

Byrd JWT. Physical examination. In: Byrd JWT, editor. Operative hip arthroscopy. 2nd edition. New York: Springer; 2005. p. 36-50.