Neuromuscular Hip Biomechanics and Pathology in the Athlete

Michael R. Torry, PhDa'*, Mara L. Schenker, BSa, Hal D. Martin, DOb, Doug Hogoboom, BSa, Marc J. Philippon, MDa aBiomechanics Research Laboratory, Steadman-Hawkins Research Foundation, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, USA

hOklahoma Sports Science and Orthopedics, 6205 N. Santa Fe, Suite 200, Oklahoma City, OK 73118, USA

Dynamic movement occurs at the hip joint and is characterized and constrained by the anatomy of the region, including osseous, ligamen-tous, and musculotendonous structures. The majority of patients who require hip arthroscopy are young, active individuals with a history of hip or groin pain. In some athletes, the onset of hip pain may be due to a traumatic event such as a fall, tackle, or collision. However, in many sports, athletes suffer a minor hip injury or perform repetitive motions that exacerbate a chronic pathologic or congenital hip condition that leads to increased capsular laxity and labral tears over time. One of the obvious benefits of arthroscopic hip surgery in this population is that it allows the surgeon to perform procedures within the hip joint with a minimal amount of postoperative morbidity, allowing for a return to sporting activities in a shorter time period. This type of surgery is relatively new, with only a few experts advancing in the field worldwide. However, this surgery is gaining popularity among sports medicine/orthopedic surgeons, and is being performed more and more on all levels of athletes and in the nonarthritic, hip-injured population alike.

Although joint mechanics for total hip joint replacements (THR) are well described, little is known with regard to hip joint mechanics in injuries such as hip labral tears that are observed in younger athletes; and although hip arthro-scopic techniques have been developed and evolved over the last 5 years, the mechanisms of these injuries across various sports are not well understood. Moreover, rehabilitation protocols associated with hip arthroscopy remain rooted in THR theories and paradigms. It is evident from the literature that rehabilitation after hip arthroscopic surgery requires a mechanical foundation for its implementation during initial, intermediate, and return to sport/agility protocols. Without such a scientific foundation, the risk of an unsuccessful surgery or reinjury is greatly enhanced.

* Corresponding author. E-mail address: [email protected] (M.R. Torry).

0278-5919/06/$ - see front matter © 2006 Elsevier Inc. All rights reserved.

doi:10.1016/j.csm.2005.12.002 sportsmed.theclinics.com

The purpose of this article is to review the literature related to the osseous, ligamentous support as well as the neuromuscular control strategies associated with hip joint mechanics. The neuromuscular contributions to hip stability and mobility with respect to gait will be provided because the data related to gait represents the largest body of knowledge regarding hip function. Further, this article will describe the probable mechanisms of injury in sporting activities most often associated with hip injury in the young athlete.

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