By Dr. Mohammed Amjad Khan (PT), M.I.A.P, CDNP, CKTP
Senior Physical therapist,
Physio Plans Rehabilitation Center,
Medina Al Munawwarah, Saudi Arabia
Hip dysplasia is a medical condition marked by abnormal development of the hip joint. While it is commonly associated with infants and young children, it can also affect young athletes who engage in activities that require repetitive stress on the hip joint such as running, jumping and pivoting. Timely evaluation, assessment, and clinical diagnosis are crucial to prevent further complications and ensure proper treatment for these athletes.
Evaluation for hip dysplasia in young athletes begins with a comprehensive medical history and physical examination. The medical history should include questions about any hip pain, previous injuries, family history of hip dysplasia and the athlete's training regimen. The physical examination usually involves assessing the range of motion, hip stability, gait analysis, and muscle strength around the hip joint.
Imaging studies play a crucial role in the evaluation process. X-rays are typically the initial imaging modality used, providing detailed information about the shape and alignment of the hip joint. Radiographic findings that may indicate hip dysplasia include a shallow acetabulum (the socket portion of the hip joint), increased femoral head coverage, and abnormal morphology of the pelvis and femur.
In some cases, additional imaging studies may be required. Magnetic resonance imaging (MRI) can provide more detailed information about the cartilage labrum and other soft tissues within the hip joint. This can help identify associated injuries such as labral tears, cartilage damage, or loose bodies.
Once the evaluation and imaging studies are completed, a clinical diagnosis of hip dysplasia can be made. It is important to differentiate between developmental hip dysplasia and acquired hip dysplasia. Developmental hip dysplasia refers to a congenital condition where the hip joint fails to develop normally. On the other hand, acquired hip dysplasia may occur due to repetitive stress or trauma to the hip joint leading to abnormal development over time.
Treatment options for hip dysplasia in young athletes depend on several factors, including the severity of the condition, the age of the athlete and the presence of associated injuries. Conservative management is often the first line of treatment which includes physical therapy activity modification and anti-inflammatory medications to alleviate symptoms and improve muscle strength and joint stability.
Role of physiotherapy in hip dysplasia in athletes
Physical therapy can help adults with hip dysplasia in:
* Improve coordination and balance.
* Decreasing Pain and inflammation
* Educate the player on how to manage their condition and avoid further injury.
Depending on the individual's demands and the severity of their condition, various exercises and therapies will be performed. But frequent workouts that could be advised include:
Exercises for hip abduction: By moving the leg out to the side, these exercises can aid the hip joint's stability and range of motion.
Exercises for strengthening the hips: By strengthening the muscles that surround the hip joint, these exercises can assist to support the joint and lessen discomfort.
Exercises that enhance balance and coordination can assist to reduce the risk of falls and injuries.
Stretching activities: By increasing hip joint flexibility, these exercises can lessen discomfort and increase range of motion.
Physical therapy may also involve various forms of treatment in addition to exercises, including:
Hands-on techniques are used in manual therapy to increase range of motion, lessen discomfort, and enhance muscular function.
Pain and inflammation can be lessened with the aid of heat treatment.
Ice treatment can aid in reducing inflammation and discomfort.
Electrical stimulation can assist to strengthen muscles and lessen discomfort.
Hip dysplasia in adult athletes can be effectively treated with physical therapy. It can aid in reducing discomfort, increasing range of motion, restoring function, and averting additional harm. If you are an adult athlete with hip dysplasia, discuss physical therapy as a potential treatment option with your team's doctor.
Here are some additional tips for adult athletes with hip dysplasia:
When you need to rest, pay attention to your body's signals.
Avoid doing anything that place too much strain on your hip joint.
When working out, use good form.
Before and after exercise, you should warm up and cool down.
Put on supportive shoes.
If you are fat or overweight, you should lose weight.
By using these suggestions, you may manage your hip dysplasia and carry on with the activities you love.
In cases where conservative treatment fails to provide relief, surgical intervention may be considered. The type of surgical procedure will depend on the specific abnormalities present in the hip joint. Common surgical procedures for hip dysplasia include periacetabular osteotomy (PAO) and hip arthroscopy. PAO aims to realign the hip joint and improve stability while hip arthroscopy is used to address associated intra-articular pathologies such as labral tears or cartilage damage.
Regular follow-up and monitoring are essential to ensure the effectiveness of treatment and prevent complications. This includes regular physical examinations, imaging studies and assessments of pain and functional improvement.
In conclusion, hip dysplasia in young athletes requires a thorough evaluation, assessment and clinical diagnosis to determine the severity of the condition and facilitate appropriate treatment. Early intervention and proper management can help alleviate symptoms, improve function and prevent further complications, allowing athletes to continue their athletic pursuits safely. Physical therapy can be an effective technique to treat hip dysplasia in adult athletes. It can assist in improving pain, range of motion, and function, as well as avoiding additional damage. The specific exercises and treatments performed will vary based on the individual's demands and the severity of their disease. Hip abduction exercises, hip strengthening activities, balancing exercises, and stretching exercises are some of the most typical exercises that may be suggested. Physical therapy may also include manual therapy, heat therapy, ice therapy, and electrical stimulation in addition to exercises.
References:
1. Vaquero-Picado A, González-Morán G, Garay EG, Moraleda L. Developmental dysplasia of the hip: update of management. EFORT Open Rev. 2019 Sep 17;4(9):548–556.
2. Weber AE, Bedi A, Tibor LM. et al., The hyperflexible hip: managing hip pain in the dancer and gymnast. Sports Health 2015; 7: 346–58.
3. Reiman MP, Thorborg K. Clinical examination and physical assessment of hip joint-related pain in athletes. Int J Sports Phys Ther. 2014 Nov;9(6):737-55.
4. Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: What has changed in the last 20 years? World J Orthop. 2015 Dec 18;6(11):886-901.
5. Byrd JWT, Clohisy JC, Kim YJ, Gwathmey FW, Jones KS, Millis MB. Hip
dysplasia in wrestlers: three lessons learned. J Hip Preserv Surg. 2017 Aug
2;4(4):332-336.
6. Estberger A, Kemp JL, Thorborg K, Pålsson A, Ageberg E. Are Exercise Therapy Protocols for The Treatment of Hip-Related Pain Adequately Described? A Systematic Review of Intervention Descriptions. Int J Sports Phys Ther. 2023 Feb 1;18(1):38-54.
7. Kemp JL, Mosler AB, Hart H, et al Improving function in people with hip-related pain: a systematic review and meta-analysis of physiotherapist-led interventions for hip-related pain British Journal of Sports Medicine 2020;54:1382-1394.
8. Guss M, Youm T. Accelerated Degenerative Joint Disease After Staged Hip Arthroscopy and Periacetabular Osteotomy in a Patient with Hip Dysplasia. Bull Hosp Jt Dis (2013) 2017 May;75(3):220-224.
9. Curley AJ, Padmanabhan S, Chishti Z, Parsa A, Jimenez AE, Domb BG. Periacetabular Osteotomy in Athletes with Symptomatic Hip Dysplasia Allows for Participation in Low-, Moderate-, and High-Impact Sports, With Greater Than 70% Return to Sport for Competitive Athletes: A Systematic Review. Arthroscopy. 2023 March;39(3):868–880.
10. Jimenez AE, Lee MS, Owens JS, Maldonado DR, LaReau JM, Domb BG. Athletes Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy Demonstrate Greater Than 80% Return-to-Sport Rate at 2-Year Minimum Follow- Up. Arthroscopy. 2022 Sep;38(9):2649–2658.
