Cheryl Martin (Host): Do your hips hurt as a result of an injury and you're sidelined as an athlete? Well stay tuned for some preventive strategies and treatment options from Dr. Spencer Stein, Associate Director of Sports Medicine at Jamaica Hospital Medical Center. He specializes in helping patients return to sports after hip injuries

This is Jamaica Hospital Med Talk, the podcast from Jamaica Hospital Medical Center. I'm Cheryl Martin, Dr. Stein, delighted to have you on.

Spencer Stein, MD: Thanks, Cheryl. Happy to be here.

Host: This episode, we're talking about hip pain, so describe how the hip works.

Spencer Stein, MD: Yeah, sure. So back to the basics of the hip joint. The hip joint is a ball and socket joint, and it basically works through a gliding mechanism where the ball side is gliding in the socket. And through that, that allows range of motion. There's obviously two hips and so two balls and socket, and they balance the body out and it's an extremely important joint.

I love this joint because your whole body is centered around these two joints, so there's a lot of force going through it. And for that reason, it, they're important. They bear weight and they are prone to injury.

Host: I'm glad you brought up injuries. So what are some common injuries that may affect the functionality of the hip or cause pain?

Spencer Stein, MD: The injuries about the hip depends on what type of patient we're dealing with. So for younger, more athletic patients, one of the most common injuries that I see is femoral acetabular impingement or hip impingement. You know, I can describe what that is. That's when the ball hits the socket during range of motion.And oftentimes the ball is not perfectly spherical. It may have an extra bump or extra bone formation, and so when that bone hits the socket, it can cause pain and it can tear surrounding tissue known as the labrum. So that's called hip impingement.

There's some other pathologies or issues around the hip. Those can be hamstring injuries, those can be flexor tendon injuries. Those can be glute tendon injuries. And the glutemedius is one of the, it's the intermediate glute muscle. It helps stabilize the entire pelvis. Those glute tendon injuries can be seen a little bit more common in a middle aged athletic population.

There could also be cartilage injuries and of course, in middle to more senior patients, hip arthritis can be a concern, and that's loss of cartilage, and that's what we're trying to prevent in the field of sports medicine and joint preservation.

Host: So a lot of different people experience hip pain. Who is most at risk, would you say?

Spencer Stein, MD: Well, really, anybody can be at risk. Now some certain sports are higher risk. Those are ones that require a lot of squatting. So that could be things like weightlifters, hockey goalies is a common one. Hockey players in general put a lot of force on the hip joint. Catchers tend to have hip issues. There is also a pretty high prevalence of hip injuries in like dancers and gymnasts, people that are putting their hips through large range of motion, but really any athlete, runners, even basketball can get hip injuries.

Host: So what can athletes do to limit your chances of developing a hip injury?

Spencer Stein, MD: Well, in general, we can talk about some general concepts of preventing injury in athletes and that would be starting at a young age, avoiding single sports specialization. So what that is, is not just doing one sport, like for the parents, like have your children do multiple sports. So that's been shown to decrease injury.

Because you're not overloading one joint. So if you just have your child being a catcher their entire life, that's going to be a little higher risk. But if you have them doing other sports, gymnastics, swimming, you know, it kind of like spreads out the forces on the body. So that's generally good practice.

Other things would be, always stretching, warming up and warming down as well. So when I spent time with the Dodgers as a fellow in sports medicine, I noticed the athletes of course, would warm up before the games, but afterwards they would warm down as well. Like they would cycle, they would do band workouts.

So that's all part of injury prevention. And the last thing is don't ignore your pain. I mean, if you're having pain in your hip, about 10 years ago, 20, about 20 years ago, it would be owed up to a groin sprain. Well, now we don't ignore it. We check it out, we get evaluated, we get X-rays, and if we find signs of let's say, hip impeachment or a labrum tear, it's pretty important to get that addressed early.

So there's multiple studies showing that addressing hip or fixing your labrum and addressing hip issues early, can lead to better outcomes and potentially can prevent arthritis or certainly delay the need hip replacement.

Host: Now you mentioned that there is a probability of hip injuries across the board when it comes to athletes and sports. Is there any particular group more at risk than others when you look at athletes?

Spencer Stein, MD: Yeah, it's really those hockey players, those squatting positions, catchers. And male versus female. That's interesting. They both are at risk. Men tend to have a little more extra bone formation on the ball socket, whereas women can typically have more overhang on their cup side, but either way they can impinge and get labrum tears.

Dancers, like I said as well. So there are some specific sports that are a bit higher risk.

Host: So if an athlete sustains a hip injury, what types of non-surgical interventions are there?

Spencer Stein, MD: For almost every injury I see, we can try a course of non-operative treatment. So now this of course, is not like a fracture or maybe like a displaced piece of cartilage. You know, those may require something more aggressive. For hip impingement, labrum tears, even glute tears or hamstring partial tears; we try physical therapy, we try anti-inflammatory medication. We potentially can try different injection options, use cortisone less and less in my practice. Although it can help with inflammation, it can portend a risk of worsening or thinning out tissue. So there are other injection options. Platelet-rich plasma is an injection option. What platelet-rich plasma is, is taking your blood and spinning it. The growth factors in the centrifuge machine we have, it's a small one we have in the office. The growth factors come to the top. We isolate the growth factors and we inject the growth factors and that can have some regenerative properties.

Host: So for those that require surgery, what are those options and what's involved?

Spencer Stein, MD: Okay. Yeah. Surgical discussion. That's my favorite discussion as a surgeon. So it depends what the pathology is, but we have some very powerful treatment options surgically. So focusing on that hip impingement, which is probably the most common athletic injury around the hip we see; there is a surgery called hip arthroscopy, which is a hip scope or using a camera to go inside the hip joint.

And with a camera and other specialized instruments, we can fix the labrum with stitches and we can shave down any extra bone formation. So that's hip arthroscopy. And the medical term is camera section labrum repair, but basically it is removing extra bone and fixing the labrum, and it's done through typically three poke hole incisions.

Host: So what can an athlete requiring surgery expect during recovery, and how long does it typically take to recover?

Spencer Stein, MD: I'll tell our patients and athletes that the hard part of the surgery is my job, but the hardest part is the recovery and that's therapy and strengthening. And so for a typical hip arthroscopy, it's about two to four weeks on crutches, about six weeks, to kind of be feeling better to get your normal walking back.

And that's pretty typical in a lot of orthopedics. Kind of be weight bearing as tolerated. In other words, walking with more normal pattern at about six weeks, then at three months, patients typically start jogging and full recovery is somewhere between six to nine months. and that's a stepwise return to sports.

Host: So what do you say to athletes what they need to do to prevent injuries?

Spencer Stein, MD: As far as preventation of injuries, that's extremely important. So we need to try things like not specializing in one sport, making sure you're warming up, you're stretching, potentially getting evaluated by a professional from a sports performance center. So around the country, there are sports performance specialists that can kind of put you through a battery of tests, including things like video landing mechanics.

So we'll see how you land on a video monitor to make sure your legs aren't going inwards or outwards. If, let's say your legs are going inwards, then that could put you increased risk for an injury around the hip or the knee. And they can give you exercises and they can work on that. So it's stretching, it's strengthening, it's having an understanding of your mechanics.

And you know, at the end of the day, there is some genetic involvement. Some people are just at risk for hip injuries, and that's okay. That's what we're here for.

Host: How can someone make an appointment with one of our doctors to determine their options?

Spencer Stein, MD: Sure. Yeah. So you can see me through visiting orthomedisys.org or you can call our office. That's 929-429-3222.

Host: Dr. Spencer Stein, thank you so much for educating us on how to prevent hip injuries, as well as how to treat them. Thank you. Great information.

Spencer Stein, MD: My pleasure. Thanks for having me.

Host: As Dr. Stein mentioned, you can reach out for an appointment to discuss your options by calling  929-429-3222 or visiting Orthomedisys.org. Now, for more information about the services Jamaica Hospital offers, just visit our website, Jamaicahospital.org/podcasts. If you enjoyed this episode, please share it on your social channels and check out the entire podcast library for other topics of interest to you. This is Jamaica Hospital Med Talk. Thanks for listening.

All content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. So please consult a medical professional before adopting any of the suggestions discussed on this podcast.