At Production Physiotherapy we want to give you access to reliable information from exceptional practitioners, so for those that do not know him already please can we present Mem Gem who is known in social media circles as @the.hip.physio and I must say, Mem is incredibly generous with the information he supplies so he’s definitely worth a follow and if you’re a practitioner get on his hip course. As the handle suggests Mem is a hip specialist physio with vast knowledge that applies to multiple populations, one of which is performers. We asked him his thoughts on the dancers hip, and if he could shed some light on what he sees in clinic and he kindly created this post for us.
I’ll be honest, it took me far too long into my physio career to appreciate the dancer. My naivety around this was no doubt driven by my complete lack of rhythm and inability to move like anything other than an ironing board. Nonetheless as my career developed, so did my love for hips, and alongside that an appreciation for the dancing community grew too. Dancers, for me, are the underrated athletes of the world. There aren’t many athletes that can train as long and hard as dancers do whilst continually pushing their bodies to the limits both figuratively and physically. It’s mightily impressive. However like any sport, injuries come hand in hand with this intensity and volume of work, there prevalence increases as the quality increases (level of performing), just like in elite sports.
A big passion of mine these days is teaching health care professionals all the in’s and out’s of the hip and pelvis, and although I’m not here to bore you with my life story, I wanted to set the scene. Within my teaching some of the common bits that I like to highlight is just how certain injuries tend to present in certain ways and how certain patient demographics are a little predisposed to certain injuries too. For example, we commonly see older patients with hip arthritis, so if someone walks through my door of a certain age, I may have that on my list of things I would want to assess and rule in/out. In that instance I’ve used age as my marker that raises my suspicions, (though that it not exclusive as I’m seeing more and more younger athletes with osteoarthritis, but that’s for another time). Within the performing arts world it’s a fair assumption that a large number of the population will be young active females, so let’s keep that in mind. This also reflects in the demographics of the performersI see in clinic.
So if you don’t mind I’ll focus here on this occasion. So, what is it that the young active female dancer may be presenting with if they start to develop hip pain? Well for me there is always one thing that I’m always keen to not miss. Hip Dysplasia. As you can see in figure 1, the noticeably shallower hip joint can be seen in the dysplasic hip joint when compared to the "healthy" hip, in this instance.
What is hip dysplasia? In short, our hip is a ball and socket. In a dysplastic hip, the socket is not giving enough coverage around the ball. All of a sudden instead of a ball and socket, you have a ball and an oversized golf tee. It isn’t that dramatic though. People have dysplasia and manage absolutely fine. Dancers have dysplasia and manage absolutely fine. If anything, some of the traits that you get from having dysplasia are actually desirable for a dancer, such as access to excessive ranges of movement that usually would be unattainable with ease and this can be a huge bonus for elite level dancers. However, there are a select few though where sometimes it can cause an issue after a while. So it’s worth understanding as it can help you program your conditioning work to optimise this trait.
Here are some quick fire hip dysplasia key facts to keep in mind
- Highly prevalent in females
- 12% increased risk if parent has dysplasia
- 6% increased risk of siblings have dysplasia
- More prevalent in those that were in the breached position at birth
- Caucasian females have a higher prevalence
- Hip range of motion will normally present with excessive ranges of movements and joint laxity
- May present with hip flexor issues where these structures are working overtime to make up for a lack of deeper stability
- May present like other hip conditions
- Often seen in those with prolonged sitting at work, standing and axial loading of the hip.
- 50% of hip dysplasia patients have hypermobility
- If misdiagnosed or undiagnosed may lead to hip arthritis
The socket itself gives the hip it’s deep structural stability, so without that stability from the joint (like in a dyplastic hip), we need it from somewhere else….step up the labrum (a lip around the edge of the joint made of cartilage), ligamentum teres and capsule ligaments. Now, the capsule ligaments are some serious bit of kit. They can manage pretty well at controlling the dysplastic hip without any issues, nonetheless if the level of athletic performance increases, the volume of training increases and the hip is put under more load for a longer period of time, sometimes these ligaments can’t keep up. They’re being used above and beyond their normal capacity, and on some occasions it can mean that the labrum(the part that lines some of the socket) can get breached, and in some cases this is when the hip can become painful. Now I’m being vague and saying some, and that’s because most active hips will have labral tears and have no pain.However, this is when we need to be vigilant and why dysplasia must always be high on the index of suspicion for a young active female hip.
Hip dysplasia can often be missed. It not only presents like other injuries (GTPS, Iliopsoas related groin pain, FAISyndrome), it can also co-exist with these conditions too. If a clinician doesn’t see dysplasia that often, it can often be missed, with a time to diagnoses cited in literature taking up to 5 years on average. For a hip that is essentially deteriorating both physically and functionally that’s really concerning especially if it is delaying a patient from potentially having vital hip preservation surgery. Highlighting the need for early detection and appropriate strengthening.
Thanks so much for reading
If you'd like to hear more from Mem you can following him on social media @the.hip.physio, and if you're a therapist or trainer and want to learn more from Mem, then you can book onto his courses at HPDN.