Saturday, May 12, 2018

Diagnosed With Hip Impingement But Still Completed the 6 Majors

My patient came and showed me her Abbott World Marathon Majors medal today. Yes, she's completed all the six AbbottWMM races in Tokyo, Boston, London, Berlin, Chicago and New York City. All this while having hip and low back pain and being diagnosed with FAI or femoralacetabular impingement (or simply hip impingement). She was actually contemplating surgery to "solve" her problem. 

You must be wondering what FAI is. It is a hip condition which occurs when there is a mechanical mismatch in the ball and socket hip joint between the "ball" in the hip and "socket" know as the acetabulum. There are usually three types of hip impingement as drawn by Aized below.

2 of the three types of hip impingement - CAM, Pincer 
Many normal people have "bumps" or slightly deeper sockets and these can potentially cause femoroacetabular impingement. This is the way we are made and develop. With sports or other aggravating movements, there can be increased friction between the acetabular socket and the femoral head leading to pain and decrease in range of motion.

FAI often presents as hip/ groin pain and limited range of hip motion, which is exactly what my patient has. Pain is often provoked with prolonged sitting, crossing legs, walking as well as during and after sports or exercise depending on the type of impingement. Pain can be felt deep in the groin and sometimes at the side of the hip or buttock.  There is usually a restriction in hip flexion and internal hip rotation.

Physiotherapists reading this will think of the L1-2 lumbar distribution to the lower back can cause similar pain and symptoms in the hip and groin. At least that was what I thought of straight away when checking and treating her lumbar spine made her better. Instead of treating her pain, I tried to find the cause of the problem and treat it instead. That's what we always do in our clinics.

To make the long story short, she didn't have her hip surgery. Laura was able to finish the 2018 London marathon to complete her 6 majors in a speedy 3:42 hrs (though she thought it was "slow").
She was the center of attention our clinic earlier today when everyone present admired her medal after she took her picture with me.

Here's a close up of her medal.

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