For this month’s Physio Window I would like to give a nod to Chris Mallac, editor of the Sports Injury Bulletin.
The anatomy and architecture of the hip joint has been a subject of increasing interest in sports
medicine over the past few years. Femoro-Acetabular Impingement (FAI) is a condition where there
is bony overgrowth of the neck of the femur (CAM deformity) and/or bony overgrowth of the
acetabular rim (Pincer lesion).
Here is the problem with FAI in the young athlete: FAI can lead to damage of the acetabular labrum
which can lead to architectural changes in the joint later on when the growth plates fuse. Adults with
large CAM lesions have a 10 fold increased risk of osteoarthritis in the involved hip, especially if the
lesion is associated with a decrease in hip internal rotation.
Young soccer players exposed to high frequency training loads (≥4 times per week) before age 12
were found to have a 64% incidence of FAI compared to 40% of those whose training began after
age 12.
There are 3 take away messages:
1. We still do not know what causes FAI and CAM deformities however they may be modifiable risk
factors to development of osteoarthritis.
2. We should probably exercise caution when exposing athletes under 12 to high frequency training
regimes. Parents of superb young athletes will tell us that this can be a very hard sell indeed.
3. When we see any young person with signs of hip pain and FAI, we should probably begin a multidirectional
hip stabilization program in order to minimize shearing forces through the hip and to
decrease chances of joint wear and tear down the road.
References:
1. Agricola R., Weinans H. What causes CAM deformity and femoroactebular impingement? Too many
questions to provide clear answers. British Journal of Sports Medicine. Mar 2016; 50(5): 263-264
2. Agricola R., et al. CAM Impingement causes osteoarthritis of the hip: a nationwide prospective cohort
study. Annals of the Rheumatic Diseases. Jun 2013; 72(6): 918-923
3. Tak I, Weir A, Langhout R, et al. The relationship between the frequency of football practice during skeletal
growth and the presence of a cam deformity in adult elite football players. British Journal of Sports
Medicine. 2015; 49(9):630–634.