Runner’s Guide to Hip Dislocation

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Running is a very physically intensive exercise that uses the entire body. For this reason, it is very important to be safe when running, as there are many potential injuries that can come about as a result of improper running techniques. Fortunately, many of the most common running injuries are very mild, causing inflammation and being treatable with noninvasive methods. However, there is always the possibility of more severe injury when engaging in full-body exercises like running.

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Hip dislocation is one of the most severe injuries that can come about from running. Fortunately, it’s very rare, but if it does occur, the effects it has on your running ability and general well-being are devastating. Incredible pain and a complete inability to run or walk will come as a result, and a trip to the hospital is needed to treat it. This article will explain what hip dislocation is, how runners become afflicted with it, and how it is treated. It will also cover some tips for easing back into a running routine after dislocating a hip.

What is Hip Dislocation?

Your femur, or leg bone, is connected to your hip with a ball and socket joint. When your hip is dislocated, the ball shape on the tip of your femur pops out of the socket joint of your pelvis, or hip bone. This socket is referred to as the acetabulum. Depending on how the femur becomes dislocated from the hip, the dislocation is referred to as either posterior hip dislocation or anterior hip dislocation. Posterior hip dislocation refers to the femur shifting backwards from the hip, and anterior hip dislocation refers to the femur shifting forwards.

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Posterior Hip Dislocation

The most common form of hip dislocation is posterior dislocation, making up about 90% of hip dislocation injuries. With posterior hip dislocation, the femur is pushed backward; your leg will be fixed in a straight position, and your foot may be bent inward. Depending on the severity of the dislocation, you may still be able to bear weight and walk around, but more severe dislocations may have fractures, rendering walking impossible.

Degrees of severity in posterior hip dislocation:

There are a few different methods of measuring the degrees of posterior hip dislocation severity. The Thompson-Epstein model of posterior hip dislocation classifies severity as such:

  • Grade 1: Dislocation with no fracture or minor fracture
  • Grade 2: Dislocation with fracture on rim of acetabulum
  • Grade 3: Dislocation with comminution (grinding into small particles) on rim of acetabulum
  • Grade 4: Dislocation with fracture on floor of acetabulum
  • Grade 5: Dislocation with fracture on femoral ball

An alternate method of determining posterior hip dislocation severity comes from the Steward and Millford model of classification. This method only features four grades instead of five:

  • Grade 1: No fracture or minor fracture
  • Grade 2: Fracturing or comminution with full range of motion
  • Grade 3: Hip joint is unstable, structural support lost
  • Grade 4: Femoral head fracture

In either method of grading, the purpose isn’t entirely for determining the severity of the dislocation. It is also used to accurately determine the correct treatment procedure: a damaged femur will require different treatment to a damaged pelvis, and treatments vary when repairing either a fractured pelvic rim or pelvic floor.

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Anterior Hip Dislocation

In the case of anterior hip dislocation, the femur slips out of the pelvic socket forwards, causing the leg to bend outward. This is the less likely condition of hip dislocation, occurring only 10% of the time on average. It is possible that nerve damage can develop as a result of anterior hip dislocation, mainly in the sciatic nerve or femoral nerve. In one extreme case, nerve palsy developed as a result of delayed treatment for anterior hip dislocation.

Superior and Inferior Anterior Hip Dislocation

While the severity of anterior hip dislocation is not graded on a similar scale to posterior hip dislocation, there are still different classifications for it. Anterior superior hip dislocation is caused by extension of the hip, and can often be confused for posterior hip dislocation due to its position. Anterior inferior hip dislocation is caused by hip flexion, and causes the femur to jut out toward the front pelvic muscle, or obturator.

What Causes Hip Dislocation?

There are a few conditions that, when they arise, can be a harbinger of hip dislocation. In addition, certain bad habits can also increase the likelihood of hip dislocation occurring. For the most part, hip dislocations occur from accidents, such as being hit by a car or falling from a great height. However, it is still possible to dislocate your hip from ordinary physical activity.

  • Labral Tears

The labrum is a ring of cartilage that acts as a cushion and seal for the connecting joint of the pelvis and femur. It serves an important role in maintaining structural integrity of the hip; if it tears, the likelihood of dislocation greatly increases. In cases of excessive running over extended periods of time, many runners have developed hip labral tears, making this a real concern for high intensity runners.

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  • Sports

In high intensity sports, many injuries are likely to occur, including sprains, broken bones, and dislocations. Hip dislocations have been observed in contact sports such as football, but non-contact sports such as soccer and baseball have also been the culprit of such injuries. Anterior hip dislocation is especially common in skiing, due to the strain placed on the hip through the skiing movement.

  • Genetic Factors

Some people are genetically predisposed to hip mutations, known as hip dysplasia. This is a condition that has been identified as genetic, being passed on to children through heredity. While hip dysplasia does not always cause hip dislocation, it does increase the likelihood of it occurring, especially among young children and pregnant women.

 

Risk Factors

There are some preexisting conditions that can exacerbate the possibility of hip dislocation. Aside from the causes listed above, these are separate conditions that have their own causes and methods of treatment, but the mere presence of them in a runner’s body can potentially increase the likelihood of hip dislocation. If any of these traits apply to you, you are at a greater risk of dislocating your hip and should exercise proper caution.

  • Gender: Instances of hip dislocation are more likely in women than in men. This is due to differences in bone structure around the pelvis as well as muscular strength and distribution. This statistic is skewed slightly due to the process of childbirth, especially when babies exit the womb legs first.
  • Age: There are two age groups that make up the majority of hip dislocation cases, and they are the very young and the very old. Children in the womb or in early stages of infancy are at risk of developmental hip dysplasia, up to a short time past walking age. The elderly are also at risk of breaking or dislocating a hip past the age of 60, and are also more likely to develop repeat instances of hip injury. In both cases, the reason for the higher likelihood of dislocation is due to weaker bones and muscles: in the case of infants, the weakness is due to continuing development, and in the case of the elderly, the weakness is due to degeneration of bone and tissue.
  • Prior Injury: Repeat injuries are common among sufferers of dislocated hips in all age groups, even though the elderly are still more susceptible to them. This means extra caution needs to be taken when running after one hip injury, as the majority of hip dislocations are recurring cases. Also, any other running injuries that come about as a result of poor running habits or equipment, such as plantar fasciitis or shin splints, can lead to hip dislocation, as these are often indicative of deeper untreated running problems.
  • Diet and Lifestyle: If you fail to properly take care of your body, your likelihood of getting any injury increases. This includes eating a diet with an insufficient supply of vitamins and minerals, spending too much time sitting, drinking excessive alcohol, or smoking cigarettes. Engaging in these bad habits too much will degrade the resilience of your body, weakening your bones and causing you to adopt poor posture.

Treating Hip Dislocation

Diagnosis

In general, it should be obvious when your hip is dislocated. However, a doctor may need to perform a standard diagnostic process to determine what type of dislocation you’ve suffered from and how severe the damage is. Some standard symptoms of hip dislocation include:

  1. Numbness in the legs and thighs
  2. Limited mobility in legs and thighs
  3. Pain or tingling sensation when moving legs
  4. Swelling or bruises near hip
  5. Deformed shape around hip and pelvis

When determining if the hip dislocation is anterior or posterior, X-rays are required. However, there are some signifiers on the surface level that a doctor can use to determine this as well. Anterior dislocation can cause a deformation from the femur popping out toward the front of the body, as well as the affected foot pointing outward. In the case of posterior dislocation, no bulging deformities are usually observed, but the foot will point inward instead.

Surgery

There are a few surgical methods that medical professionals use for treating dislocated hips. Initial attempts at resetting the hip bones are done without invasive surgery, but it is a method used when necessary. These procedures are in order from least to most severe.

  1. Closed reduction: This is a non-invasive surgical procedure where the goal is to physically manipulate the hip from the outside in order to restore the joint connection. Although no incision is made, anesthesia is still given to the patient due to the intense pain from this procedure.
  2. Open reduction: In the event that the hip dislocation resulted in fractures or comminution, such as Stage 2 and greater posterior hip dislocation, open hip reduction may be necessary. Under full anesthesia, surgeons will make an incision, remove any particles or fragments, and use screws, pins, and/or plates to secure the hip joint.
  3. Open hip dislocation: For patients that have hip mutations such as hip dysplasia, or for other individuals who are at risk for hip injury, open hip dislocation may be required. This procedure involves manually dislocating the hip in order to repair the connecting bones, then resetting them.

All of these procedures require an extended period of rest for full recovery, and may also require the use of a splint or cast in order to prevent the bones from dislocating again soon after.

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Recovering From Hip Dislocation

After surgery is performed to repair the dislocation, some rest is required. After an extended period of inactivity, however, your muscles will be weaker. This can make running more difficult, and you will definitely lose any progress you have made in any physical training routine. The best way to quickly recover and bounce back into your regular workout regimen is through physical therapy.

Physical Therapy for Hip Dislocation

After performing surgery to correct hip dislocation, a period of readjustment is required. This will allow your hip muscles to become reacquainted with movement and weight bearing, preventing further hip damage from occurring. The following are some typical techniques used in the physical therapy process for hip dislocation recovery. Some may require the use of additional materials, such as a resistance band.

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Stretching

In order to retrain the muscles and ligaments in your hip for a wide range of motion, some regular stretches are required. These will start at a very low intensity, with the goal being to increase the intensity gradually until a wider range of motion is capable once more. Try some of these stretches in your physical therapy routine in order to speed up recovery.

  • Knee Raises: Start from a prone position, lying down face up. Slowly lift the knee of one leg toward your torso, bending so that your lower leg is parallel to the ground. Wrap your arms around the knee and hold for ten seconds, then slowly return to the starting position. Perform three sets of this exercise for each leg, three times a day. Work your way up to performing this exercise while standing up, using a chair or table for balance if needed.
  • Hip Abductions: While standing, support your weight with both hands on a chair and your feet shoulder width apart. Slowly extend one leg to the side, away from the chair, as far as you can comfortably reach. Hold this position for up to ten seconds, then slowly return to the original position. Perform three sets for each leg, three times a day, working your way up to using a resistance band wrapped between your legs in the future.
  • Leg Swings: If necessary, this exercise can be performed in a pool to ease the weight bearing on your hip. Starting from a similar position as the hip abduction, slowly raise your leg to the side, same as that exercise. Then, swing your leg forward slowly, rotating the hip until your leg is extended in front of your body. Hold this position for five to ten seconds, then swing the leg backward so it is extended behind your body. Repeat this exercise three times for each leg, three times a day.

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Yoga

Another avenue for therapeutic stretching, Yoga is a series of more advanced full-body stretches with a rich history of promoting physical and mental health. A few yoga poses and stretches can be effective in restoring flexibility and relieving pain in the hips after a dislocation. A yoga mat is recommended when performing these exercises. These are advanced stretches that can be painful or damaging if done improperly. Be sure to consult a physical therapist before trying any of these stretches.

  • Cat Pose/Cow Pose: Support your weight on your knees and arms, in an “all fours” position. Round your back by lifting your tailbone and head while inhaling. Hold for a few seconds, then slowly bend your back the opposite way, compressing your stomach and curling in the neck. Repeat this movement six to eight times.
  • Bound Angle Pose: Sit upright with your feet in front of you and your knees bent at a 90-degree angle. Spread your knees apart from each other, as close to the ground as you comfortably can. Then, grasp your big toes with your arms and pull your torso as close to your feet as you comfortably can. Hold for ten seconds, then release. Do this three times a day.
  • Child’s Pose: Kneel on the mat with your knees spread apart and your heels touching the floor. With your torso straight and your arms raised, slowly lower your upper body as close to the floor as you comfortably can. Hold for ten seconds, then release. Do this three times a day.

Strength Exercises

In addition to a range of stretches, some basic strengthening exercises should be performed on your legs and hips in order to recover from hip dislocation and surgery.  While stretches are effective in restoring a full range of motion to your hips, strengthening exercises are important for retraining your lower body to bear the weight of your upper body. Some of these exercises may require additional materials, such as a bar or step.

  • Prone Leg Lifts: While lying completely prone, face down on a mat or towel, slowly lift one leg in the air and hold at a 45-degree angle. Hold for two to three seconds, then slowly lower it back to the starting position. Repeat ten times for each leg.
  • Bridges: Lie face up on a mat or towel, with your arms, back, and both feet flat on the ground, your knees bent and pointing upward. Slowly lift your pelvis off the ground with your glutes, forming a straight line with your thighs, hips and torso. Hold position for two to three seconds, and repeat ten times.
  • Hip Abductor Squeezes: Lie on a towel or mat in the same starting position as in the Bridges exercise, with a rolled towel or soft ball between your knees. Squeeze the ball or towel between your knees, applying as much pressure as possible without pain. Hold for three to five seconds, and repeat ten times.
  • Hip Raises: Stand straight with one foot on a step or stair, and the other dangling. Slowly lower the dangling foot using your hip, keeping your knees straight. Once the lowest comfortable point is reached, raise the foot to a higher position. Repeat this exercise ten times for each leg.
  • Wide Squats: Stand upright with your legs spread further than shoulder length apart, as far as you can comfortably reach. Keeping your back straight, slowly lower your upper half as far as you can, stopping when your knees are at a 90 degree angle. Raise your upper half slowly to the starting position, then repeat ten times. This is an advanced exercise, and should be performed carefully to prevent injury.

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Heat and Ice

Applying either higher or colder temperatures to your body will achieve different effects, depending on when and how you use them. In general, both heat and ice are effective at recovering from injuries and aiding you in performing the aforementioned stretches and strengthening exercises in physical therapy. As an effective general rule, applying heat before exercise and ice afterward is conducive to better workouts.

Hip-Dislocation-Injury-Running-heat-therapyHeat can be applied with heat packs or a trip to a sauna. In general, applying heat to the body will increase the flow of blood, soothe pain, and can even increase resistance to injury from exercise. For these reasons, heat is usually applied before engaging in a workout; hence the term ‘warming up’ when preparing for a physically intensive activity.

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Ice and cold treatment, on the other hand, is effective post workout, as it reduces inflammation and can numb pain. Ice can be applied to a specific area of the body with ice packs, or can be utilized in cold showers and ice baths. Full-body exposure to cold water in particular is highly effective at treating injuries, raising resistance to injury and illness, and promoting your body’s production of healthy fats.

Diet

In addition to physical therapy, your doctor may recommend a change in diet to help accelerate the healing process. There are some vitamin-rich foods you can incorporate into your meals that will help strengthen your bones and recover muscle that may have been lost from extended inactivity.

Vitamins and Nutrients that Aid in Bone Recovery:

  • Vitamin C is used to create collagen in the body, which is an essential protein found in bones. Vitamin C can be found in citrus fruits, tomatos, and leafy green vegetables.
  • Vitamin D is used to regulate the production of calcium in the body, which is a vital mineral in strengthening bones and recovering from fractures. It is found in fish such as mackerel and tuna.
  • Vitamin K2 is commonly used to treat osteoporosis, since it increases the body’s production of osteocalcin, a key protein used to bind calcium to bones. It is found in olive oil and broccoli.
  • Iron promotes collagen production similar to the effects of vitamin C, but it also increases hemoglobin in the blood, which supplies the bones with oxygen. It is found in dark meat and whole grains, but it is most commonly added to the diet through supplements.

The best way to supply your body with all the nutrients it needs to quickly recover from hip dislocation is to eat fresh fruit and vegetables, and to steam them instead of boiling so as to prevent losing vitamins in the heating process.

Preventing Hip Dislocation

Even after recovering from hip dislocation, it is still possible for your hip to become dislocated again. After going through physical therapy and resuming regular running exercises, be sure to keep these tips in mind to prevent any repeat occurrences.

Orthotics

Whether it’s walking or running, certain orthotics can be used to provide extra reinforcement to your hip. These range in size and thickness; smaller ones made mainly of foam are ideal for light jogging, while more complex braces will contain additional cushioning and metal and are better suited for walking. These larger orthotic hip braces are a good starting point after recovering, as they can restrict your range of movement when first easing back into a running routine. As you adjust more to your hip and are able to bear more weight and increase your range of motion, using less supportive braces is a good idea for running.

Safeguarding Your Home

After a major hip injury or hip surgery, some changes may need to be made in your home. These simple changes will ease the stress of regular household activities on your hip, preventing any potential repeat injuries. This is most commonly done for the elderly, but runners of all ages can benefit from some of these minor changes in their home lifestyle.

  • Bedroom: If you find yourself tossing and turning frequently while sleeping, you may want to add some extra pillows to your bed. These pillows can be placed on the sides of your body and between your legs, in order to prevent excessive leg movement that can exacerbate hip injury.
  • Bathroom: In order to prevent excessive bending when performing bathroom activities, there are some simple changes that can be made. An adjustable shower head will allow you to target key areas of the body without overextending, an elevated toilet seat will put less stress on the legs and hips, and rails can be attached to the walls allowing for an easier time getting up from the toilet.
  • Kitchen: When organizing items in your various kitchen cabinets and shelves, try and place items you use most frequently at waist or shoulder height. For items placed outside of this range, consider using a grabber of some kind or having someone else get the item for you.
  • Living Room: In general, it’s a bad idea to bend more than 90 degrees on a bad hip, whether you’re seated or standing. Make sure to elevate your chairs and couches, and use a recliner to keep your body in a back-leaning position when sitting.

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Advanced Physical Therapy

Even when your hips feel perfectly normal and pain-free while running, some additional physical therapy may be required in order to maintain your hip health. After all, the likelihood of future hip dislocation after surgery increases quite a bit, so you should be at your guard for potential repeat injuries. These physical therapy techniques are done with the help of a professional, and are more severe than common home exercises. Consider using these techniques alongside your standard recovery process, and semi-regularly as a way of checking up on your body.

  • Manual Therapeutic Techniques (MTT): These are techniques used by physical therapists to provide intensive, hands on care. It involves deep massage and targeted exercises to strengthen mobility and prevent inflammation.
  • Neuromuscular Reeducation: In order to strengthen the connection between the nerve endings and muscles in your body, specific stimulation is used alongside repetitive exercises. This will help improve your responsiveness when using your legs and hips, including strengthening your reflexes.
  • Ultrasound Therapy: Commonly used in infants and children, this is a safe and non-invasive procedure that can soothe pain and promote recovery from hip dysplasia. It involves bombarding the affected area with ultrasound rays, which have been scientifically proven to achieve positive health benefits in a variety of conditions.

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Conclusion

As previously stated, hip dislocation as a result of running is rare, especially in younger runners. However, in the case that it does occur, it can be devastating, and the recovery process is long and arduous. It certainly wouldn’t hurt to utilize some safeguards when running normally in order to prevent hip injury, since the onset of dislocation or the process of surgery will lead to guaranteed drastic lifestyle changes. However, a hip injury is not a death sentence, and with enough hard work and proper physical therapy, you will be able to resume running after recovering.

References used in researching

These are external links to resources cited in this article. All of these links are from informed sources, such as professionally published scientific journals or posts written by doctors and physical therapists. Always consult your doctor before making any changes to your exercise routine.

Sources

  1. University of Virginia, Posterior Hip Dislocation,
  2. Clifford R. Wheeless, III, MD., Anterior Dislocations of Hip,
  3. Thompson Epstein , Posterior dislocation of the hip - Thompson-Epstein classification,
  4. Bauer GJ. | Sarkar MR., Injury classification and surgical approach in hip dislocations and fractures,
  5. Hassan Rahimi Shorin | Mohammad Mohajer,| Ali Parsa | Amin Azhari | Maryam Assadian, Femoral Nerve Palsy Following Delayed Reduction of a Dislocated Hip in a 44- Year-old Man,
  6. Carlos A. Guanche, M.D., | Robby S. Sikka, B.A, Acetabular Labral Tears With Underlying Chondromalacia: A Possible Association With High-Level Running,
  7. Ricardo Munir Nahas | Eliseu Netto | Takechi Chikude | Roberto Ikemoto, Traumatic hip fracture-dislocation in soccer: a case report,
  8. ESPN, Cody Ross dislocates right hip,
  9. Matsumoto K | Sumi H |, Sumi Y | Shimizu K, An analysis of hip dislocations among snowboarders and skiers: a 10-year prospective study from 1992 to 2002.,
  10. Christopher Peters, University of Utah, Discovering the Gene(s) Causing Developmental Dysplasia of the Hip (DDH),
  11. International Institute of Hip Dysplasia, Hip Dysplasia Physical Therapy,
  12. Sports Injury Clinic, Hip & Groin Exercises,
  13. Dr. Mercola, When to Use Ice, When to Use Heat,
  14. Halvorson GA., Therapeutic Heat and Cold for Athletic Injuries.,
  15. R. Meeusen | P. Lievens, The Use of Cryotherapy in Sports Injuries,
  16. A Mooventhan | L Nivethitha, Scientific Evidence-Based Effects of Hydrotherapy on Various Systems of the Body,
  17. Humpal Physical Therapy, Artificial Hip Dislocation Precautions,
  18. Jens Dargel, PD. | Johannes Oppermann | Gert-Peter Brüggemann | Dr. phil. | Peer Eysel, Dislocation Following Total Hip Replacement,
  19. APTA, Manual Therapy Techniques,
  20. iHealthSpot, Neuromuscular Re-education,
  21. Falliner A1 | Hahne HJ | Hassenpflug J., Follow-up and ultrasound-controlled early treatment of hip dysplasia,
  22. Baker KG1 | Robertson VJ, Duck FA., A review of therapeutic ultrasound: biophysical effects.,