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Introduction

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Bo says he felt his hip come out of the socket, so he popped it back in, but that’s just impossible, no one’s that strong.

Bo Jackson’s trainer after the American football and baseball All-Star dislocated his hip when tackled during the 1990 NFL playoffs

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Until recently, the hip joint was not thought to be a significant cause of problems in the athletic population, although hip disorders have long been recognized in the pediatric population (Perthes disease, slipped femoral epiphysis) and older people (osteoarthritis). It was not until the advent of, firstly, MRI, and then hip arthroscopy, that it was realized that the incidence of hip labral and acetabular rim pathology was high, and that anatomical variants such as femoroacetabular impingement (FAI) were a common underlying cause of groin pain.

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Hip pain is a common cause of activity restriction in sportspeople. Hip and groin pain is the third most common injury reported in the Australian Football League (AFL),1 accounting for between 5 and 15% of all football-related injuries;2 it is also prevalent in many other sports, including tennis, football of all codes, and hockey.

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The likelihood of a sportsperson sustaining an injury to the hip joint can be increased by the demands of the sport, in particular, sports that require repetitive hip flexion, adduction, and rotation.24 Hip joint injury can also be caused by the inherent individual anatomical variations within the joint, such as FAI or developmental dysplasia of the hip (DDH).511

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The range of motion of the hip is critical in determining the likelihood of intra-articular damage during sporting activity. The demands of range of motion vary between all sporting activities and the levels of activity. As range of motion decreases, the risk of impingement-related damage increases, especially with contact sports.

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Intra-articular hip pathologies contribute to both a reduced ability to participate in sporting or physical activities as well as pain and also reduced function during activities of daily living. There is also considerable evidence that hip pathologies are strong contributors to hip, groin, and pelvic pain in young adults.12, 13

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Burnett et al.14 demonstrated that 92% of patients with an arthroscopically confirmed labral tear complained of moderate to severe groin pain. Philippon et al.10 described labral tears and FAI in 100% of professional National Hockey League (NHL) ice hockey players presenting for hip arthroscopy or the treatment of longstanding hip and groin pain. Injury to the ligamentum teres of the hip has been cited as the third most common cause of hip and groin pain in the sportsperson.1517

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In this chapter, we:

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  • review the functional anatomy of the hip

  • provide a clinical approach to assessment of what is often a longstanding problem

  • detail the pathologies and management of the many important ...

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