There is general agreement amongst hip surgeons that a trial of non-operative treatment should be undertaken, by any athlete with hip related pain, for a period of at least 3 months before surgical intervention should be considered.
Initially, a period of rest and activity modification, with medication (anti-inflammatory) should be advised. Avoidance of simple day-to-day aggravating factors such as squatting, stooping, crossing the legs, getting in and out of a car, rapid twisting and turning, sitting slouched forward, etc., may be helpful. As the initial pain begins to settle, more specific physical therapy guidelines can be introduced.
There is no evidence to support specific physical therapy treatments but it is considered important to avoid extremes of hip range of motion and attempting to improve passive movements of the hip by stretching may be counter-productive. Emphasis should be placed rather, on addressing muscle tightness (Ilio-psoas, hamstrings, rectus femoris) and weakness (core stability and posture, and optimise the alignment and functional mobility of the joint.
In some cases, athletes’ pain associated with specific twisting/turning movements, starting/stopping, squatting etc. may become so intense that players are given unnecessary steroid injections in an attempt to mask the pain.
We believe that giving steroid injections into the hip in young athletes with hip impingement is inappropriate and completely counter-productive. While it will temporarily mask symptoms and permit players to feel less pain during sports, in the long term it will permit the continued and potentially accelerated damage to the cartilage of the joint as an athlete continues playing high intensity sports.
There is an overwhelming body of evidence that demonstrates the successful results of keyhole surgery in the treatment of athletes with symptoms from hip impingement. Hundreds of good quality peer-reviewed research papers in the most respected sports and orthopaedic journals from around the world support the success of surgery.
In our clinic in Waterford, we have a 93% success rate in treating athletes and have performed over 1500 ‘sports hip repair’ surgeries in athletes from many sports (including GAA football, hurling, rugby, soccer, tennis, boxing, running, etc.) at every level (professional, international, national, inter-county and competitive).
In every case, there has been a failure of non-surgical treatment before making the decision to operate.
The benefits of surgery include:
Resolving the chronic pain and stiffness in and around the hip and groin
Players returning to GAA football and hurling symptom free
Removing the abnormal bony deformities which will cause irreversible damage to the hip joint leading to arthritis
Resection of CAM deformity
Resection of a Pincer Deformity
In order to access the joint and remove the bony deformities the capsule of the hip joint must be opened. This is an important stabilising structure of the hip joint and should always be repaired during surgery. The Hip and Groin Clinic is one of the few units in the world, which routinely performs capsular repair as part of this preservation surgery.