Sports are healthy, but soccer, ballet, karate, kickboxing, powerlifting and even yoga can lead to hip problems. Sports medicine specialist Dr. Alexander Moser, head physician of hip surgery and sports orthopedics from the Center for Musculoskeletal Medicine at Vivantes Friedrichshain Hospital explains why.
The 2021 European Football Championship is just getting underway. Instead of kicking a ball themselves, most people will probably be watching the goals on the screen. This is probably also less dangerous - because "especially competitive soccer players have hip problems more often than one might think," says sports physician Dr. Alexander Moser, head of hip surgery and sports orthopedics at the Center for Musculoskeletal Medicine at Vivantes Friedrichshain Hospital. He regularly operates on top athletes such as professional soccer players, sometimes even players from the national team and the premier league, and is a specialist in joint-preserving hip surgery.
When people think of sports injuries in soccer, they tend to think of knee problems like a meniscus tear. Why is soccer bad for the hip?
Dr. Alexander Moser: "The hip joint also has soft tissue structures, similar to the meniscus in the knee joint, for example, which can be injured during sports. If left untreated, injuries to the joint lead to premature hip wear (coxarthrosis). Soccer players are twice as likely to suffer premature hip wear, and professional players are six times more likely.
Injured hip? Mostly underestimated
Injuries to the hip joint are common and sometimes serious, but they are usually underestimated and dismissed by sufferers and doctors. Many people first think of pain in the hip region as a pulled groin or other muscle strain. Because the hip lies deep in the body, diagnosis is challenging. That makes it all the more important to take pain seriously and see a specialist."
The hip is a stable joint after all – how do hip injuries occur?
Moser: "The typical pattern of damage is wide movements, such as when shooting a soccer ball. It's not for nothing that the joint of the shooting leg is more frequently affected in soccer players. But hip injuries also occur very often in sports such as yoga, ballet, karate, kickboxing and powerlifting."
Yoga, karate, bodybuilding and ballet also put a strain on the hips.
But yoga tends to be perceived as a low-impact sport. What do these sports have in common?
Moser: "In all these examples, the range of motion of the hip is overstressed. The hip does need movement, but unlike the shoulder, which is muscle- and ligament-guided, the hip is guided by bone and has less range of motion. That's why, for example, the high kick of a karate fighter, the splits in ballet, or the deep squat and leg press in bodybuilding can damage the hip over time."
Hip problems are most often associated with age-related wear and tear. In contrast, you also operate on very young people - how come?
Moser: "In addition to the hip injuries mentioned, hip deformities can occur in children as young as about 10 to 14 years old as a result of intensive training. In children and adolescents who are still growing, the bones are very sensitive, especially the growth plate between the femoral neck and femoral head."
Strong mechanical forces: how the femoral head deforms
"During sports, strong mechanical forces act and there can be a slight, slipping of the femoral head that goes unnoticed. This can cause the femoral head to deform awkwardly and no longer fit the joint partner in the ball-and-socket joint. This can then, depending on how the hip is loaded, lead to damage in the hip joint after a few years. The typical symptom of hip damage is groin pain and limited motion."
How should prolonged hip and groin pain in young people be treated?
Moser: "Surgery should always be a last resort; conservative treatment is preferable in the early stages of the symptoms. Sometimes a change in training or a change in sport can help. However, we often see that soccer players are always out of action because of hip and groin pain and are no longer able to play.
In any case, injuries to the joint must be treated early to avoid lasting damage. Especially in the case of more severe movement restrictions, such as deformities of the hip bones, this can only be achieved through surgical intervention."
Which operations does your clinic specialize in?
Moser:"We offer the entire spectrum of treatment for hip joint disorders in the adolescent and adult. Starting with targeted conservative treatment, through minimally invasive arthroscopies, in which corrections of the acetabulum and femoral head are performed and soft tissue structures can also be repaired, to pelvic realignments for dysplasia, or the use of a minimally invasive hip prosthesis."
Last resort: surgery – even professional soccer players successfully treated
However, people often complain of discomfort even after hip surgery....
Moser: "Of course, hip surgery for athletes belongs in specialist hands – many years of experience are necessary. In my department we have been performing up to 4 hip operations a day for many years. With good diagnostics and the right operation by an experienced sports orthopedist, very good results can be achieved after hip operations.
Last year alone, we operated on several professional soccer players who had previously been unable to play for months due to pain despite conservative treatment. Fortunately, all of them were able to return to their clubs after surgery and completed rehabilitation."