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INTRODUCTION

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. .Lionel Messi returned to Barcelona early from international break due to an inflammation in his hip, pain that has also plagued other players such as Raul, Xabi Alonso, Aduriz, Busquets and a host of Athletic Club’s current squad. There are different options in terms of treatment, and each player has undergone their own decision towards recovery to get back onto the pitch as quickly as possible.

www.Marca.com, 4 September 2016

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Recently, the hip joint has been recognised as a possible cause of problems in the athletic population. This is reflected in the published literature describing hip pathology and its treatment. The advent of magnetic resonance imaging (MRI) and then hip arthroscopy increased the awareness of hip labral pathology and anatomical variants that can lead to femoroacetabular impingement (FAI) syndrome as a potential underlying cause of hip and groin pain in young and middle-aged people. Lateral hip pain is also increasingly recognised as a substantial clinical problem.

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EPIDEMIOLOGY

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Pain reported by patients as being in the hip region (‘hip pain’ for convenience in this chapter) is a common cause of activity restriction in athletes. Hip and groin pain is the third most common injury reported in the Australian Football League (AFL),1 accounting for between 5–15% of all AFL-related injuries,2 and is commonly seen in many other sports, including tennis, football of all codes and hockey. People with ‘cam’-type FAI are four times more likely to develop hip pain over 4 years than those without this morphological variant.3 Burnett et al. demonstrated that 92% of patients with arthroscopically confirmed labral tears complained of moderate to severe groin pain.4 Philippon et al. described labral tears and FAI in 100% of professional National Hockey League ice hockey players presenting for hip arthroscopy for the treatment of longstanding hip and groin pain.5 However, cam-type morphology is also associated with labral and cartilage hip damage in asymptomatic males where adjusted odds ratios range from 2.45 to 2.77.6 Therefore the relationship between activity, pain, morphology and pathology is complex and not fully understood.

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The likelihood of an athlete 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,7 but may also be caused by inherent or acquired individual anatomical variations within the joint, such as FAI or developmental dysplasia of the hip.5, 8, 9, 10, 11, 12, 13

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Intra-articular hip pathologies, including chondral and labral pathology contribute to a reduced ability to participate in sporting or physical activities as well as pain and reduced function during activities of daily living.14 In addition, people with pathology such as FAI, labral tears and chondral pathology have impairments in hip range of motion, hip muscle strength, balance and functional task performance.14...

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