By Dev K. Mishra, M.D.
President, Sideline Sports Doc
The recently concluded Australian Open Tennis Championship produced some fantastic tennis, with a number of phenomenal teenage up-and-coming stars. Like every other sport that requires countless hours of dedication and physical effort, subjecting a young body to repetitive stress can take a toll. A particular type of hip problem called “femoroacetabular impingement” (FAI) may be on the rise and related to number of years playing competitive tennis.
A study was presented at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress in Geneva, Switzerland. Investigators found a risk for femoroacetabular impingement (FAI) was highest among players who first started playing tennis at an early age, which lends support to the idea that increased years in sports at a young age may predispose athletes to this risk.
“Femoroacetabular impingement (FAI) has been well described in the literature as a source of hip pain in elite-level athletes,”noted Robert E. Boykin MD, the lead author of the presentation. “It is associated with structural abnormalities including cam lesions of the femur and pincer lesions of the acetabulum. [The] injuries seen may be due to repetitive motion and overuse in sports.”
The researchers enrolled 148 tennis players from an elite academy in Barcelona, Spain. The players averaged 15 years old at the time of the study and stated they started playing at about 6 years old. Overall, they played in 20 tournaments a year and averaged 47 weeks per year of playing competitively.
Comparing at-risk hips with those not found to be at risk, Boykin and colleagues found no difference in age, tournaments played per year or weeks played per year. However, “the subjects with an at-risk hip had played tennis longer — on average 9.5 years compared with those without any clinical signs of risk at 8.6 years — and this was statistically significant,” he said.
“We believe this study further supports the idea that increased years in sports at a young age may predispose athletes to a risk for developing FAI,” he said.
Boykin and his colleagues plan to continue enrolling patients and studying the risk in this population to develop modified techniques and training regimens to prevent hip injuries.
While I agree that overexposure to repetitive stress may predispose a young tennis player to hip problems, the number of factors leading to development of hip impingement is complex. Inherited factors, the speed and power combined with torque that makes up competitive tennis today, and likely some factors yet to be discovered all play a role in developing hip impingement. Not all elite level young players are destined for hip impingement. This area is not the black box it once was but we still have much to learn.
Hip impingement can be treated a number of ways but for elite level players who have failed nonsurgical treatment, hip arthroscopy is a reliable way to treat the problem. Tennis players Gustavo Kuerten, Lleyton Hewitt, Tommy Haas, and Brian Baker have all had hip arthroscopies, with varying “success” in return to top-level tennis.
While surgery is becoming an increasingly reliable way to treat the problem this is yet another developmental or overuse issue that’s best prevented. If you’re a young tennis player with persistent hip pain get proper evaluation and treatment early. You may just be able to avoid further problems with changes in your training regimen, avoid surgery, and enjoy a high level of tennis for a long time.