Hip clicking in dancers: glute medius pain or a labral problem?

Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, it's Dr. Sebastian Gonzales again from the Performance Place Sports Care Podcast. This is going to be a case study again today about the second most popular YouTube video that I have and one of the comments in there. So, in case you didn't listen to the other case study we did, it was on another YouTube video comment. And the idea of these is to give you guys an insight into the way we would typically assess cases like this and the questions that people have.

One thing I noticed with the amount of people I have commenting and viewing on these YouTube videos is that people really need guidance on their conditions. And, you know, my heart really goes out to them that I would really, really like to help more, but it's really my hands are tied a little bit in regards to what I can do because I haven't seen these people physically. So, I'm going to do my best here when we go through this comment and just mainly give the audience a guidance, some guidance to see what we should be considering when people have conditions like this. Because, I'm actually picking the ones that are the longest because, to me, it tells me that it really is a real comment.

And they're taking the time to make more than about five, six lines on the Internet, so it must be really, really important to them. But also, too, there's more detail that we can actually go through. So, this one, this video that this comment came through on is actually called Glute Medius Pain at Iliac Crest on Runners. And you'll find this on YouTube. It's our second most popular video. If you search that one directly or if you put in Performance Play Sports Care, you will find that one as well. Before we start, if you would like to have one of your questions as one of the topics of these case studies, feel free to go to the P2 Sports Care website.

There is going to be a voicemail button right there that you don't need any phone to actually use. You just talk right to your computer. It is through a website called SpeakPipe. And that goes straight to me and my staff. And we screen out the ones that are the best questions and calls and best things that I think the audience can learn from. So, here we go. This one, again, is in regards to glute medius pain. And if you don't know where the glute medius is, it's on the outer back portion of the hip. I guess if you put your hands on your hip, it would be where your thumb kind of lies. And this video is basically intended for people to be able to feel bony structures and feel the muscles and tenets around them and get an idea of how to talk to their health care provider.

This question, I'm going to read it roughly verbatim just because I want you to know that because there are some grammatical things in here. So, I'm a ballet dancer and I'm having some pain in my hip for quite a long time. I got it while I was dancing and it hurts when I put weight on it and also walking. I can hear clicking sounds. It's kind of weird. Previously, I sprained my left foot and went to get adjusted. But the pain kept coming back as my hip problem. What could be the problem? How do I heal it so it won't affect my dancing? And the reason I picked this one is actually because I've noticed that there are conditions a lot of times that are misdiagnosed.

And I don't know how old this person is, but I know that ballet dancers or dancers in general need to have a lot of range of motion. And because of that, they are susceptible for some of these joint issues, even at a young age. And I would venture to say, first off, that with large range of motion in a joint, even if the joint is a ball and socket joint, the larger the range of motion, the more control you have to have of it. And dancers are something that are, I mean, they're very flexible, but also, too, they're very lean. And I don't know a bunch about dance, but I have talked to quite a few dancers, and a lot of them don't spend a lot of time doing stabilization stuff.

They spend a lot of time practicing, and I've heard up to 12 to 16 hours of practicing, and that just, I would imagine it would just start eroding things away. If there's any types of instability or form issues or strength issues, I guess we can generally say muscle imbalances in an area. Now, this question makes me think that, number one, I don't think it's glumidus pain, because it sounds like it's deeper. And one of the things that draws my attention is clicking sounds, especially while putting weight on it. And I'm sure there's clicking sounds with different things that she's doing. But clicking sounds in the hip, the first thing we have to consider is the possibility of a labral tear.

And if you don't know what a labrum is, it is a cartilage, almost gasket, in the ball and socket of the hip. And cartilages are injuries that you really don't want to, I mean, you don't want to have at all. I mean, they're very problematic. Many of them turn into surgical cases, depending upon the grade. There are conditions, if this was a labral tear, which obviously we can't say for sure, because I've never seen her. By the way, before I get too far, she should probably go see somebody to see a doctor to get a proper eval, because this does not take the place of an eval. There you go, there's my disclaimer.

So the possibility of having a labral tear, I think, is higher in this case. And as I was saying, there's other conditions that you can kind of see a possibility of labral tears starting to occur. You can almost guess them happening. One of the conditions is called femoral acetabular impingement, which I've actually done some podcasts and videos on before. And the reason why I started to do more research on this one is because I found so many having this pinching pain and deep groin pain while going into deep squats. Crossfitters will get it. Dancers will get it. It is a very, very common thing.

And when they have only impingement, that's where stuff's starting to get caught, but it's not really torn in there. And it's a really, really good condition to know early on that you have an issue with, because you can really save yourself a lot of grief. When these turn into labral tears, they typically do not respond quickly. And you should do some research on my site, p2sportscare.com. There's a whole write-up on labral tears and femoral acetabular impingement on the site. It is one of the best articles I've written, and I'm coming out with an authority page really soon where it's accumulation of everything you'll find on WebMD and ortho.net and all those things, and the current research that you could possibly find on the Internet all on one page, plus infographics and pictures and all that kind of stuff.

So the first thing I want to go off with this as well is I would question how strong her core is. And the reason is, is because the hip is controlled mainly by the ilium, and the ilium is the crest bone that you put your hand on when you're putting your hand on your hip. And the ilium is controlled by the core, which I guess we can generally say the muscles in the front side of the abdominal area, as well as the side, as well as the back side. And we can include some other muscles of the pelvis as well. There is current research now, at least, that the, it's a very, this, femoral acetabular impingement or labral tears are, I don't think we have a certain, we don't have an exact consensus yet of what is causing them or how to prevent them.

But we do have a couple good ideas, and I'll at least state the things that we do know, or at least currently what we're saying. And the first off is there with young athletes, and dancers would be no exception to this, is that when you're young and you're very active at that early age and your growth plates have not fused yet, there's a possibility of a bony area forming extra in the femur or the femoral head-neck area. And these are called cam deformities. And the reason why they're called cam deformities is because usually the head of that bone down there should look like a ball that goes inside a socket.

But it doesn't look like a ball. It looks like a cam of a car, or it's oblong-shaped. So for that reason, a lot of times it crushes onto other structures such as carledges and labrums and other parts of the bony area down there. And this is something where they found that it's commonly found in very young athletes, mainly because we're theorizing that it's the growth, it's happening when the growth plate isn't closed yet because it's right next to the growth plate. And it's just extra bone forming there because we're demanding so much out of our young kids to be so active at that age. And I think that's a huge issue in regards to club sports now and so on.

And I would strongly suggest that if you have a kid playing club sports, really figure out if year-round sports is a good idea, and especially year-round of the same sport. Mixing it up, I know that's what we did when I was a kid. And so I played soccer one year, and then I played baseball, and then we eventually started going to baseball, baseball, baseball, baseball. And then I know that we had—I wasn't on a club team, but I was on a summer team. I was on a regular team. And we had an off-season. There was plenty of time off where we didn't have a lot of mileage on us. So really assess whether your kid needs to play these games and whether it's worth risking their health because they can have hip problems for a long time.

Now, the next thing we know about hip labrums or how the hip functions is that before we thought a certain direction of the hip was better, and we call this retroversion and antroversion. And I know it doesn't mean anything to you guys, but mainly it kind of means just forward or backwards. Like, what's better? What's a better position for it optimally? And we used to think it was one way, but really, we don't really know anymore. And what we did find out, though, was that the ilium— again, I'll go back to the ilium, the hand-on-hip muscle, or the hand-on-hip bone. If you control the ilium, you control the femur, or you'll control the hip.

And they've done studies to show that when you move the ilium even a few degrees in one direction, it helps bring pressure off of the possibility of pinching onto the structures of the hip deep inside the hip. So because of that, I typically recommend people who have a large range of motion, such as dancers, do a lot of core stabilization work. And it's not just whether they have a six-pack or not. It's more so, can they— do they have the awareness to bring their pelvis into the correct position? Can they hold it there? Are they strong enough when they're doing motions to do it? So a lot of it is just awareness as well.

And a couple things you can probably do to help out is I know there's a system out there called gyrotonics, which is supposed to be really helpful and actually very targeted to dancers. I've known quite a few people who have done gyrotonics, and it is similar to Pilates, but they—I believe the processes are working mainly in spiral patterns, but they're working to control the trunk and pelvis. And for that reason, I think Pilates would also be good as well. I have a really good friend. His name is Tim Fleischer. He's out of Austin, Texas right now. And he's one of the most well-rounded people that I know in regards to fitness as well as anatomy and so on.

And he's an anatomy professor at one of the universities down there. He does diagnostic ultrasound. He does massage. He does active release technique. And he is also a stop Pilates instructor. So, I mean, that is a lot of stuff. I mean, I don't know any Pilates instructor who knows more anatomy than he does. And he even liked me last time that we had a beer together. He was telling me about some of the muscles of the hip that I had no idea existed. And that is—I mean, I don't remember the last time someone blew my mind saying, you know, this is actually a portion of the hip because I feel like I know pretty much all of them.

Not to sound cocky, but I mean, I really—I mean, anatomy doesn't change much over the years. So, it's something—biomechanics will change a little bit or how the body moves or how we theorize it. But really, I mean, it's like someone telling me that all of a sudden there are tails. We do have tails, you know. I would just be surprised to hear it. So, back to this case. I think what the takeaway is, when you hear it clicking and popping, you think there's a possibility of something catching. And when there's something catching and it's not going away and it feels like it's deep, perhaps you need an image to confirm.

And when you do find a confirming image and there's something getting caught, that might be a surgical procedure. But I would always suggest that we try to rehab things first. It's less invasive. It'll be more helpful to the person over the long term. And I know in rotator cuffs, because of the extreme range of motion, especially in pitchers, we really don't want any surgery really quickly. We'd rather have some looseness or the normal range of motion for that pitcher in the jointer or else we're going to really damage their career. So, the takeaway as well, you cannot have extreme range of motion safely unless you have the strength and coordination to control it.

So, if you are striving for larger ranges of motion, you better darn well be spending time doing some trunk stabilization, some resistance training, or whatever it might be. And we won't go into techniques of it today because that would tangent us off really far. But I do suggest you look into gyrotonics, you look into Pilates, and I'm not the experts in either of those. So, if you do have comments on them, please feel free to share. I'd love to hear actually interview people from either of those professions as well. So, I hope this was helpful. If you want to put your comment on to or your question on to the podcast, and I'll answer it if you hopefully elaborate a little bit and give me more information to go off of rather than one line of my hip hurts or something of that nature, just go on to p2sportscare.com.

Again, there is a button there which will show you how to leave a voicemail. If you do choose to leave it on YouTube, that's okay as well. But YouTube is not very organized in the way at least I get the comments. And as I'm looking through here, when I was looking through some of the comments to talk about, there's some of them I have not even seen. And, yeah, I mean even some of them, there are people that are just being very rude on here to each other. I would have deleted these things a long time ago. So, but yes, the fastest way is through the website. So, p2sportscare.com. If you're looking for any courses as well, we do have, I do offer courses, online courses of theory of how to rehab certain things.

Right now we have a shoulder rotator cuff one for pitchers available, and that one's free. All you have to do is put your information in plus your email so we can contact you and ask you how you're doing with it. But we do have advanced programs. Those are paid ones, and I promise you, you will not be disappointed with those. And there always is a money-back guarantee with any of the information that I put out. So I hope it's helpful. I will talk to you guys soon.