A Guide To Hip Injuries And Lower Extremity Ramifications In Female Athletes

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John F. Connors, DPM, and Ana J. Sanz, DPM

   Iliotibial band syndrome. This is a fascia strip that passes down the lateral aspect of the thigh from the crest of the ilium and inserts into the lateral tibial condyle. As the knee flexes and extends during running, this band repeatedly rubs over the lateral femoral condyle. This causes inflammation and pain. There is direct correlation between hip abductor (gluteus medius) weakness and iliotibial band syndrome.

Essential Insights On Fractures

   Stress fractures. When a stress fracture of the hip occurs in females, one must consider contributing factors such as hormone levels, bone density, diet, the patient’s training program and biomechanical abnormalities. (See “Key Points To Consider When Assessing Female Athletes” below.)

   Stress fractures in the pelvis account for 1 to 5 percent of all stress fractures that occur as a result of running. Within the pelvis, stress fractures occur most often in the inferior pubic ramus medially close to the pubic symphysis. Studies have shown that the differences in gait between men and women may account for the increase in tension in the pubic rami. The female runner relies on hip extension forces more than the male runner. This leads to more stress on the area, thus increasing the likelihood of a stress fracture.

   Sacral stress fractures. In runners, sacral stress fractures are believed to be the result of cyclic loading of the sacrum. One should consider sacral stress fractures if the female athlete complains of low back pain or pain radiating into the buttocks or groin, or down the leg.

   Femoral neck stress fractures. During running, loads on the femoral head can exceed three to five times the body weight. During prolonged or repetitive activity, the hip musculature becomes weakened and fatigued, and can no longer provide a protective shock absorbing effect. This leads to increased stress on the femoral neck. There are two types of femoral neck stress fractures: compression and tension. A compression stress fracture occurs on the inferiomedial aspect of the femoral neck and is considered stable. These fractures heal with conservative treatment.

   A tension femoral neck stress fracture occurs on the superolateral aspect of the neck and is at increased risk for fracture displacement. These fractures require internal fixation.

In Conclusion

   To prevent injuries about the hip and pelvis from becoming chronic, it is important to facilitate a precise and early diagnosis. Ensuring appropriate referrals is key. For example, it is imperative to obtain a MRI on the female athlete’s hip if she presents with “vague hip pain.”

   Institution of a core strengthening program is very important. The prevention of lower extremity injuries may involve strengthening the pelvis and dealing with any biomechanical imbalances in the foot, ankle and leg.

Dr. Connors and Dr. Sanz have a sports medicine practice with offices in New York City and in Little Silver, N.J.

Dr. Richie is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt College. He is a Fellow of the American Academy of Podiatric Sports Medicine.


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