Guest post by Dr. Sebastian Gonzales of Performance Place.
Deep ache in the front of your hip?
Worse with moguls?
Painful to sit down for a drink at the chalet?
Pain in the front of the hip while skiing is more common than you’d think. Hip impingement is the leading diagnosis of anterior (front side) hip pain in skiers.
In this article, I’ll share 2 self-tests and unravel the mechanics of why it may be happening. Here’s a hint, it’s not old age.
The three types of femoroacetabular impingement: The pincer type, the cam type and the mixed type. 8 February 2011. Peter Krekel. https://commons.wikimedia.org/w/index.php?title=File%3AFAI.theora.ogv
What is hip impingement?
Hip impingement is exactly what it sounds like, pinchy hips. There are 3 types of hip impingement, CAM, pincer and mixed.
If you’ve been an athlete since you were a young boy, chances are you have a CAM. A CAM is when there is an oblong “cam” shaped bony change to the head of the thigh bone.
If you’ve been a female dancer or gymnast, chances are you have a pincer or mixed type of hip impingement. Pincer is a bony change to the pelvic component to the hip, not the thigh bone. Mixed is a mix of both changes.
Both types of impingement can be seen on medical images, yet their presence does not mean you will have hip pain forever. Hip pain also presents with poor leg mechanics, collapsed arches, knocked knees, etc.
Groin/ front of hip pain has a substantial biomechanics cause. Many people without imaging finding CAM or pincers can have hip pain. Your x-rays and MRIs will be normal in this situation, yet you will still have hip pain.
Recovery is very possible with the proper treatment plan.
What causes hip impingement in skiers?
One prevalent cause of hip impingement comes from below the hip. The collapse of the foot’s arch can create a cascade of events up the leg. Everything in the human body is connected and changes based on what its neighboring joints and muscles are doing. This concept is called the Kinetic Chain.
This concept is widely accepted by healthcare providers and trainers around the world. In 1955, Dr. Arthur Steindler curated the theories of Franz Reuleaux, a mechanical engineer, into what we know as the kinetic chain today. Looking at human movement with the insight that everything is connected assists us to unravel the mysteries of hip impingement and other aches and pain that come from “nowhere.”
Gradual overload of the bony structures of the hip creates hip pain and growth of bone that can be seen in imaging. Reducing overload by simply reverse-engineering the mechanics creating the injury is our goal at JH Backcountry Health.
Biomechanically here is what is happening.
- The collapse of the arch leads to rotation of your shin bone (internal tibial rotation)
- This shift in the shin bone couples with inward (valgus) drift of the knee joint
- Inward drift (valgus) of the knee couples with the thigh bone drifting towards the midline of the body
Many of the orthopedic tests we use for hip impingement involve bringing the hip joint across the midline, which tends to trigger groin/ front of hip pain.
Arch collapse affects the rest of the lower limb (and the body), leading to hip impingement and lower back pain. The arch’s collapse can also cause osteoarthritis of the hip or knee, meniscus tears, and patellar/ knee cap pain.
You may have been told that your hip pain is because this is the shorter leg. Biomechanically, this is true, but this does not mean you are destined to have one leg that is shorter forever. It doesn’t mean you need a bigger shoe to accommodate. The leg is not indeed shorter, it is simply more compact at the moment.
How to know if your hip pain is from arch collapse?
The easiest way is to have us evaluate you! But for you DIYers out there, here are two simple tests that could help you.
Remember that self-care works for some people, but it tends to be less efficient. It’s like doing your own taxes. It can be done, but it takes longer, and there is a high probability it is incorrect.
Test 1: Single Leg Balance Test
Take off your shoes and socks. Stand on one leg without holding anything.
Do you last more than 10 seconds?
Inability to balance for more than 10 seconds may indicate the need for a complete examination. While this is more common to lose balance when we age, this can also be due to alterations in the spinal cord, brainstem, or cerebellar function. A good sports chiropractor can assist you in performing a detailed examination and refer you higher up the medical ladder.
Do you feel a deep groin/ front of a hip pinch on the up leg?
This is common with hip impingement but is far from a smoking gun.
Is your upper body leaning over the leg you are standing on?
Poor core and hip stability is a common finding with hip impingement, which may make it hard to correct the kinetics chain from the “top downward.”
A stable core and strong hip external rotators (glute max) assist in “pulling upward” on the chain, which may reduce arch collapse.
Test 2a: Squat Test
Shoeless and sockless, squat as deep as possible with your heels attached to the floor.
Do you have hip pain?
This is a very classic hip impingement sign.
Test 2b: Squat Test Correction
Before squatting, we will create tension through the foot and arch. This supports the arch to see if it positively affects your hip.
Imagine you are at the beach on the deep soft sand. As the waves come up to your ankles, I want you to screw your feet deeper into the sand. It should feel like you are “rooted” to the Earth at this point.
Now imagine there is a seam in the floor between your feet. Without moving your feet (remember you are rooted to the Earth), attempt to spread the seam as you pull your body into the deep squat position.
Does it still hurt your hip?
We are testing to see if forcing tension through the lower limb assists your symptoms. Tension squats are a simple way to improve your arch, knee movement, and hip symptoms.
At JH Backcountry Health, we specialize in helping skiers with hip impingement associated with collapsed arches.
Using thorough examination and customized treatment approaches, our goal is to get you out skiing before the snow melts. All of our chiropractors are experienced in treating hip impingement.
Reach out today to schedule your first session. Call 307-203-2318
