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Let’s talk about hips! I won’t lie—this is my favorite topic.
Hip pain and dysfunction are incredibly common, yet often overlooked or misdiagnosed by medical professionals. Many people struggling with pain and performance issues are told it’s something else—or worse, their symptoms are simply ignored. And the pain isn’t always just in the hip itself.
Hip-related issues are frequently mistaken for problems in the back, pelvis, knee, foot, or ankle. Many don’t show up on X-rays or MRIs, and when they do, the findings might only tell part of the story. This can lead to misdirected treatments, unnecessary surgeries, or no treatment at all.
Now, imagine dealing with pain for 8 to 10 years—sometimes even longer—without real answers. Unfortunately, for certain types of hip pain, this is a far too common reality.
The first thing to understand about hip joint pain is that it falls into two main categories: arthritic and nonarthritic conditions. Nonarthritic hip pain is common in adolescents and young adults and is further classified into femoroacetabular impingement (FAI), dysplasia, and chondral/labral conditions.
Hip impingement and dysplasia exist on a spectrum of joint structure, ranging from too much coverage of the hip socket (impingement) to too little (dysplasia). These differences can be influenced by genetics or fetal positioning in the womb, but they also develop throughout growth and adolescence, shaped by our activities and training. A striking example of this adaptation is seen in elite baseball players—over years of intense throwing, their shoulder joints remodel to enhance mobility, with changes in both the upper arm bone (humerus) and the socket (glenoid). The same principle applies to the hip, but studying it is more complex. Unlike the shoulder, we can’t compare a “control” hip that remains unaffected by activity, making research in this area particularly challenging and fascinating..
FAI and labral tears get a lot of attention, and many people are familiar with these conditions—but dysplasia? Most people associate the term with dogs when they hear “hip dysplasia.”
Hip dysplasia affects approximately 1 in 1,000 newborns, with a higher prevalence in females, first-born children, and premature babies. However, it isn’t always present at birth—some cases develop later during growth and development. While researchers are still uncovering the factors that contribute to dysplasia after age two, current thinking suggests that loading patterns and activity during rapid growth phases may play a significant role. Understanding these influences could help improve early detection and prevention strategies.
The hip socket, called the acetabulum, develops in a fascinating way. The three parts of the pelvic bone fuse at different times during adolescence—first at the back, then at the front, and finally at the top. Like all growth plates, these three areas are sensitive to mechanical loads and the activities we do during adolescence influence their growth trajectory and shape. This process ultimately shapes the adult acetabulum, forming the socket of the hip joint.
In highly athletic individuals, hip dysplasia symptoms may not appear until training loads decrease—often in college or early adulthood—when discomfort begins in the hip or lower back. The sport-specific mobility and strength developed through years of training help stabilize the hip, but this stability can diminish with increased sitting and reduced high-level activity.
Diagnosing dysplasia is challenging, and the criteria are still evolving. In fact, unless evaluated by a highly specialized orthopedic surgeon known as a hip preservation specialist, many cases go undiagnosed. Proper diagnosis requires a specific set of imaging studies beyond the standard front-to-back (AP) X-ray, making awareness and specialized care essential for early detection and treatment.
Think your hip pain is due to a labral tear? You’re not alone—labral tears are present in up to 80% of patients with hip dysplasia and 94% of those with femoroacetabular impingement (FAI). But here’s the twist: some research questions whether labral tears themselves actually cause pain.
Labral tears and cartilage injuries are common in both dysplasia and FAI, but for different reasons. In dysplasia, excessive joint mobility leads to shearing forces on the cartilage and labrum. In FAI, tears result from mechanical impingement—where the rim of the socket repeatedly abuts the labrum. Both conditions can lead to early hip degeneration, and without early diagnosis and treatment, many individuals with hip dysplasia require joint replacements as early as their 20s or 30s.
If you’ve made it this far—congratulations! You now know more about nonarthritic hip conditions than most of the medical profession. Unfortunately, dysplasia is frequently overlooked. One study found that radiology reports failed to mention dysplasia in 91 of 98 reviewed cases. Yet, dysplasia is more common than you might think—especially in athletes. Research has identified dysplasia in:
- 66% of elite female soccer players
- 41% of Division I athletes, including track and field competitors
- 89% of elite ballet dancers
This gap in recognition is what drives Libby’s dissertation research, which links clinical findings—like hip range of motion and strength—with imaging in adults with hip pain due to dysplasia. Collaborating with a hip preservation specialist and a team of physical therapists, her goal is to improve early detection and treatment.
Want to learn more about hip conditions? Libby and Steve are always up for a hip chat! If you’ve been in the clinic long enough, you’ve probably overheard one. Libby has lived with dysplasia since age 16, and her deep understanding of growth plate mechanics helped guide her own son’s hip development—strategically using cross-country and downhill skiing to influence his hip joint development (he’s no longer pigeon-toed! 😁).
Steve and Libby work with highly specialized physicians and hip preservation specialists to ensure that when surgical intervention or evaluation is needed, we can get you the best care for your hip condition whether that’s non-operatively or post-operatively.
| Mechanisms of labral tears in FAI and dysplasia (Kraeutler, Matthew J., et al. “The “outside-in” lesion of hip impingement and the “inside-out” lesion of hip dysplasia: two distinct patterns of acetabular chondral injury.” The American Journal of Sports Medicine 47.12 (2019): 2978-2984.) |
PS+R In The News | March 2025
Where in the world is Steve and the USMNT?
PS+R is proud to announce a partnership with Ancient City Soccer! Steve and Max will be designing and executing technical development and physical preparation for our local soccer club throughout the full year soccer season.
PS+R Client Spotlight | Kayla Lynn
PSR is proud to spotlight Kayla Lynn! Kayla plays lacrosse for Young Harris college in Georgia. After being sidelined by a fibular stress fracture last year, she began to exhibit symptoms of compartment syndrome and suffered from several failed attempts to return to her sport. With team intervention lead by PS+R, she’s back to full play and scoring goals (see below!). Kayla needed a precise mechanical diagnosis and evaluation of her sport specific capacities as an accurate starting point to understand her tissue loading capacities and identify road blocks that prevented her from returning to sport. Once we understood this, we were able to work with her coaching staff and athletic trainers to move her from early to end stage rehab and successfully return her to crushing goals on the field! Kayla was fully dedicated to the process and the work it took to regain her fitness, strength and movement capacity to perform at her best- congratulations Kayla, well done!!
Watch Kayla (#10) back from injury and scoring!
Thanks for staying connected with us! See you around!!
