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HIP PAIN IS DIFFERENT IN FEMALE DANCERS: NEW INSIGHTS FROM DYNAMIC ULTRASOUND

Posted on March 3, 2023 by Joanne Barker | Clinical, Research
Tags: hip preservation, orthopedics, performing artist athletes, sports injury,
sports medicine
A recent study of female dancers sheds light on hip microinstability, a
little-understood but clinically relevant condition.

Dancers put unique demands on their hips, achieving extreme ranges of motion
that can strain the joints and damage supporting tissues around them. Not
surprisingly, hip injuries account for up to 17 percent of injuries in dancers
and 27 percent among professional dancers.


MICROINSTABILITY — NO SMALL PROBLEM FOR DANCERS

Conditions such as hip dysplasia and impingement are well studied. In recent
years, however, hip and sports medicine specialists at Boston Children’s
Hospital have expanded their focus to include microinstability, excess movement
of the ball (femoral head) inside the hip socket (acetabulum).

“We believe micro motions inside the hip joint overload the cartilage, muscles,
and tendons around the joint,” says Andrea Stracciolini, MD, director of Medical
Sports Medicine at Boston Children’s Hospital. The condition, also known as
femoroacetabular translation, can lead to pain, impaired function, and early
osteoarthritis.

In a study published in the British Medical Journal Open Sport and Exercise
Medicine, Stracciolini and her colleagues in the Sports Medicine Division
analyzed hip microinstability in dancers and other athletes.

The team’s research sheds light on this little-understood but clinically
relevant condition. It also points to the potential of dynamic hip
ultrasonography to support more accurate diagnoses, non-operative therapies, and
more informed surgical planning for patients who need surgery.


IN DANCERS, PAINFUL HIPS ARE OFTEN UNSTABLE HIPS

Using dynamic hip ultrasound, the team compared the incidence and severity of
microinstability in:

 * female dancers with hip pain
 * female dancers without hip pain
 * non-dance female athletes

Of 171 subjects (average age 22), 62 were dancers with hip pain. Non-dance
participants’ primary sports included gymnastics, cheering, figure skating,
soccer, and basketball.

In a further sub-analysis, researchers compared a small cohort of 34 symptomatic
dancers to 53 asymptomatic dancers of comparable age, height, and body mass
index.

Results
Dancers with hip pain tended to have greater microinstability than:
– non-dance athletes with hip pain
– dancers with no hip pain
Nearly two thirds of dancers with hip pain also met the criteria for
hypermobility.

The results support a relationship between hip microinstability and hip injury
in dancers. The fact that microinstability was less common in non-dance athletes
with hip pain suggests that their sports predispose them to different types of
hip injuries.

Further, the greater incidence of hypermobility in dancers with hip pain than
non-symptomatic dancers could indicate that extreme ranges of hip motion that
can serve as an advantage in dance may also increase dancers’ risk.


DYNAMIC HIP ULTRASONOGRAPHY: SEEING HIPS IN MOTION

Boston Children’s is a pioneer in the use of dynamic hip ultrasound to diagnose
hip injuries.

In 2019, Stracciolini and her colleagues published a study showing that dynamic
hip ultrasound can reliably assess microinstability. Since then, the clinicians
have continued to explore ways that ultrasonography can be used to inform
management of complex hip pain in dancers and other athletes.

> Ultrasound gives us another piece of the puzzle to understand
> microinstability.”
> 
> Andrea Stracciolini, MD

Unlike static images produced by MRI and radiologic imaging, dynamic hip
ultrasound allows clinicians to see inside a patient’s joint as they move
through a variety of positions. Patients can provide real-time feedback to help
pinpoint which positions cause them pain. Ultrasound is also more efficient,
safe, and cost-effective that traditional imaging. 

“Ultrasound gives us another piece of the puzzle to understand
microinstability,” says Stracciolini. “The next step will be to establish normal
values in different athletes: dancers, soccer players, and swimmers for
instance, so that clinicians can use ultrasound to differentiate between a
healthy hip and a damaged hip.”

Learn more about the Sports Medicine Division, Child and Young Adult Hip
Preservation Program, and Sports Ultrasound Clinic.


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Tagged: hip preservation, orthopedics, performing artist athletes, sports
injury, sports medicine

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