Hips Are Bringing More Athletes to Their Knees

The New York Times—May 31, 2009

The quest to build ever more proficient athletes keeps hitting unexpected snags, and perhaps nowhere is this more vivid than in Major League Baseball. Several top players have been hampered by a hip ailment that was unheard of in the sport a decade ago.

Knee injuries to countless recreational and professional athletes in recent years made anterior cruciate ligament a household phrase and compelled trainers to emphasize building leg strength. Sports medicine experts now say that approach, while mitigating knee injuries, may be making hips vulnerable.

Dr. Bryan T. Kelly, a surgeon at Hospital for Special Surgery in Manhattan, performed Chase Utley’s operation and is scheduled to operate on Brett Myers. He said he did not believe it was a coincidence that “I get 40 hockey players in a six-week period at the end of the season all coming into my office with the same-looking bone structure in their hips, all saying that they have been skating since they were 3 years old.”

Kelly added, “I believe we are seeing some consequences from having our kids over the past few decades playing sports more at younger ages.”

As magnetic imaging has become more sophisticated, doctors have gained the ability to see inside the hip and identify labral tears.

“We are doing a much better job at imaging the injuries, and we are also seeing athletes with bigger bodies that are working harder on strength and conditioning, and the bigger, stronger muscles are allowing athletes to torque faster and more pressure is being put on the hip,” said Dr. Jordan Metzl, a sports medicine specialist at Hospital for Special Surgery.

Problems with labral tears occur when the head of the femur does not fit correctly in the hip socket. If it is not a good fit, the labrum is squeezed between the ball and the socket when the hip is flexed. Over time, the labrum can become irritated and tear.

The problem with an adolescent, doctors said, is that the head of the femur is still growing. Stress on the hip can cause the bone to become misshapen. As the athlete continues to play sports into adulthood, the improperly shaped bone rubs against the labrum.

“I believe the situation with the hips is similar to Little League baseball, where there is a high awareness to elbow injuries from pitching too much because the joints are still developing,” Kelly said. “But with the hips, nothing is said. There is nothing done to try and prevent damage from being done.”

Read the full story at nytimes.com.