Think Twice Before Going Under the Knife for Hip Pain

Image source www.stuff.co.uk

With the current coverage of the Australian Open and Andy Murray’s early exit, there is a lot of talk about hip operations. We all would have seen Andy Murray hobbling around the court, interviews about ending his career and the need for surgery to ease his pain. Andy is a world class athlete and the reason for his hip pain usually only occurs in elite athletes. With a 3-6 month structured physiotherapy program, most of the average population will avoid or significantly delay the need for surgery.

Murray’s hip pain is most likely caused by a CAM deformity.

This is a bump in the ball part of the hip joint that forms with repeated stress in the growth plate of the hip bone between the ages of 11-16 years. The growth plate is stressed by high level and repeated jumping and twisting movements, slowly over time this deformity will build up and become extremely problematic.

But let’s face it, while most of us like and enjoy the benefits of being active, we are not world class athletes. So it is very unlikely we have a CAM deformity, as our early teenage years were not belting a tennis ball for 5 hours a day.

What can be the reason for hip pain in the average person?

Labral Tears usually start gradually over time and give groin pain with a catching. Along with the catching there is a tight feeling that can never be fixed no matter how much stretching.

We now know Hip Bursae are secondary to Gluteal or Hamstring muscle and tendon problems.

This is the reason cortisone only helps for the short term.

Unless the muscles and tendons are specifically strengthened then the pain keeps coming back or alternatively you do less and get very frustrated with life.

Hip arthritis is the equivalent to wrinkles and grey hair but on the inside – a normal part of aging. Muscles are capable of getting stronger your whole lifespan. So have stronger hip muscles as it takes the pressure off the arthritis in the hip joint.

Before contemplating surgery, a 3 – 6 month Structured Physiotherapy Rehabilitation Physiotherapy program should be performed by anyone with hip pain. This involves:

Manual therapy – massage, joint mobilisation and dry needling.

Specific Strengthening – Gluteus medius and minimus, quadriceps and hip external rotators.

Analysis of Posture and Habitual movements – Change the movements to take the pressure off the hip.

Graduated training – Progressive exercises to return to sport.

Why bother with Physio when you can go and have surgery and just get rid of the pain?

Exactly! Why not just go and have surgery?

Because the reality is, it is not that simple. You rarely can just go in for surgery and chop out the source of the pain and/or return to your previous level of sport. You need to identify the cause of the pain and address it.

In the case of Andy Murray the surgery needed to smooth out, clean up and/or resurface his hip will weaken the hip joint so that he couldn’t return to an elite level (they have to cut things to operate in the hip!).

Any operation to ‘clean out’ a hip with early signs of arthritis, may reduce pain in the short term, but will simply accelerate the arthritis and lead to a hip replacement sooner. Pain mostly returns or worsens when labral damage is operated on as you need to change the way you move to take the pressure off the labrum or it will retear. Bursae or Tendinopathy are not solved with surgery as it is a muscle weakness and movement problem. Yes, with moderate-severe hip arthritis a joint replacement can relieve pain. However, surgeons usually only want to operate when pain is so bad that sleep is affected significantly. There are a lot of months of reduced fitness, getting weak/overweight and pain medications building up before you reach the point of “I can’t handle this anymore, please operate”.

In Summary

While Andy Murray might have had his career cut short by a CAM deformity, this condition is not generally seen in the non-elite athletic population. Most sources of hip pain like Labral Tears, Hip Bursae, Gluteal/Hamstring Tendinopathy or Arthritis are successfully treated with a 3-6-month hip specific rehabilitation program.

Get Physiotherapy treatment, do some exercises, fix your posture and modify impact training.

Then if the hip pain has not been satisfactorily improved and surgery is absolutely required, then you can confidently go under the knife with your eyes wide open knowing it is the right solution ….. and with good posture and strong hip muscles which will improve the recovery from surgery.