Early Specialization and Hip Injuries

The New York Times wrote about the increasing frequency of hip injuries, and while no long term studies have explained the new frequency of injuries, some blame the early start to youth sports.

Dr. Bryan T. Kelly, a surgeon at the Hospital for Special Surgery in Manhattan…said he did not believe it was a coincidence that “I get 40 hockey players in a six-week period at the end of the season all coming into my office with the same-looking bone structure in their hips, all saying that they have been skating since they were 3 years old.”

Kelly added, “I believe we are seeing some consequences from having our kids over the past few decades playing sports more at younger ages.”

I read an article recently (can’t remember where) that basically said that your joints are good for 10,000 miles (can’t remember the exact number, but it was a big, round number), so you can use those miles whenever or however you want.

In the current early specialization system where kids train as mini-professionals from a young age, the length of one’s competitive career extends significantly. Imagine a typical player in the 70’s: he specializes in one sport in college and maybe has a 10-year pro career. That’s a 14-year specialized competitive career. Today’s professional athletes specialized as 8-year-olds – they’re reaching the 14th year of their competitive career at 22-years-old and their bodies start to breakdown at 26, 28, 31 years of age as they near 20 years of specialized training.

Basically, if you believe the theory, the early specialization expedites the number of miles wearing down your joints.

Problems with labral tears occur when the head of the femur does not fit correctly in the hip socket. If it is not a good fit, the labrum is squeezed between the ball and the socket when the hip is flexed. Over time, the labrum can become irritated and tear.

The problem with an adolescent, doctors said, is that the head of the femur is still growing. Stress on the hip can cause the bone to become misshapen. As the athlete continues to play sports into adulthood, the improperly shaped bone rubs against the labrum.

“I believe the situation with the hips is similar to Little League baseball, where there is a high awareness to elbow injuries from pitching too much because the joints are still developing,” Kelly said. “But with the hips, nothing is said. There is nothing done to try and prevent damage from being done.”

When ankle sprains were the problem years ago, we designed ankle braces and more supportive high tops. Then, knee problems, especially tendinitis and ACL tears, dominated the injuries and we started to implement performance programs to prevent knee injuries.

“In soccer, they train harder than they used to train 10 to 15 to 20 years ago, when soccer had had a lot of A.C.L. tears,” said Dr. Andreas H. Gomoll, an associate professor of orthopedic surgery at Harvard Medical School and a surgeon at Brigham and Women’s Hospital.

“They started worrying much more about knees; they now do special training to protect the knee. And one belief is that this is why we have more of these injuries because the strength is putting more pressure on the hips.”

Now, the hips are starting to take over as the big injury issue. Expect to see new precautions and programs aimed at preventing hip injuries.

“No matter what we do, as complex as we try and make workouts and training methods, we lose sight of other things,” said Mackie Shilstone, a trainer based in New Orleans, who works with baseball, football and hockey players who are rehabilitating injuries. “We tend to concentrate on what is directly in front of us.