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Sports Medicine/hip impingement and gymnastics

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QUESTION: Hello!

I have been quite active all my life, doing some acrobatics stuff for years.
I recently started studying sports and I also train gymnastics+handbalancing 4 times a week.

I have sometimes felt kind of a click in my groin, when I did cartwheels or round-offs. But it wasnít painful at all, it just snapped a little and after some shaking and twisting it was fine again.
Some weeks ago, 3 hours after training, when I was watching TV and wanted to get up, I noticed some pain in my groin. I donít know where it came from. It got aggravated when I was abducting my leg, knee towards chest as well as inner rotation.
It subsided after some days. It is better now, I just always have this snapping when doing cartwheels and even handstands, but it is not painful at all. Also splits donít hurt.
The only thing that really hurts is when I support myself in a straddle L position (I hope you know what this is).
Here is a picture: https://www.google.at/search?q=straddle+L&espv=210&es_sm=93&tbm=isch&imgil=sNK_wEXw-KWzRM%253A%253Bhttps%253A%252F%252Fencrypted-tbn3.gstatic.com%252Fimages%253Fq%253Dtbn%253AANd9GcTq0WdWeqbo8bBW6Hmk0ZQQVD9d6PYbFNHMapGhxb3oIhqupVBt6w%253B450%253B412%253BZclZKKAjOcOkAM%253Bhttp%25253A%25252F%25252Fwww.drillsandskills.com%25252Farticle%25252F15&source=iu&usg=__27vITZ7FfftfzXR_KAoSLkXPt5I%3D&sa=X&ei=5K0UU8GlLILjswbqv4GYBg&ved=0CC0Q9QEwAA&biw=1280&bih=901#facrc=_&imgrc=sNK_wEXw-KWzRM%253A%3BZclZKKAjOcOkAM%3Bhttp%253A%252F%252Fwww.drillsandskills.com%252Fimages%252Farticles%252Fstradls.jpg%3Bhttp%253A%252F%252Fwww.drillsandskills.com%252Farticle%252F15%3B450%3B412

When I do a normal L-Sit, I donít feel it, just sometimes a little bit. The same is with leg raises, they almost aggravate no pain, just a little bit. But as soon as I straddle my legs during the exercises I feel a sharp shooting pain in my groin. The strange thing is Ė sometimes itís fine, if this snapping thing is in the right place it doesnít hurt.

I know that my right hip joint is not ideally round, so I have hip impingement CAM type, which can cause laberal damage. I have been to two specialists. The first one was really mean, he said I am just not made for sports, although he didnít even do any tests or something . I should quit immediately or the symptoms will just worsen and I will need a new hip (I am 20 btw).  The other one did some test, which didnít aggravate any pain, just some clicking, but no stiffness or limited range of motion.
He said itís fine, I should just take it a little easier on running, sprints or obstacle runs. Maybe I will get some arthritis in my 60s Ė but well, I donít really care now!
I really want to continue doing sports. It has been part of my life since ever, or it basically is my life, as even my job as a sports teacher!

I donít need train a lot that puts stress on my hips. I am planning to do running exercises (either a jog or some sprints) once a week for less than an hour. The remaining cardio work I will do on the elliptical or go swimming. I need to stretch a lot due to gymnastics, but I wonít do middle splits, just front splits, as they are easier on the hip.
I am doing a lot of handbalancing, so I donít do any split jumps or jumping exercises in general.
I guess tucks and handprings are fine.

But what about Round-Offs? I wonít overtrain them, but I will need to do them at least twice a week for some time.
And press handstands? I guess if you do the handstand presses in a pike position is fine, but straddle is really bad for me.
I am super scared that I wonít be able to continue. I think I do not need surgery right now, but what about my sport? Will it really worsen that much? Is there no option for prevention?
Next week, I am going to see a third specialist and will ask about physiotherapy. I just wanted to get another opinion, as this is really frustrating me!
Would surgery prevent any further damage? What is your opinion?

I hope you can help me!

PS: I think this website and service is great!
PPS: Please excuse any grammar or spelling mistakes Ė I am from Austria!

ANSWER: Dear Katharina!

You have been so patient with me, but I have to tell you what happened to my letter to you:  After exhaustive research in your groin pain, and clicking sounds, I wrote a lengthy letter  explaining what I thought was happening, and why.  As I finished the letter, and was previewing it on the last sentence, the whole thing just vanished from my screen! I reversed the process, forwarded it, and anything else I could think of, but it was GONE.  I had told you I was unfamiliar with all the sequences in your gymnastics technique, and I was following up with how the anatomy was affected in that area with the soft tissues, and the skeleton.  Nevertheless, I could not bring it back from cyberspace.

I called the Tech Dept at About.com, and they replied it was one of the servers....either on my side, or theirs, that must have dropped the information. So, I will briefly tell you what to do, and what NOT to do:

1)     The pain is caused by some minute rotation in the pelvis, which then activates a strain in the soft tissue, which is trying to protect the boney structure by keeping the pelvis from moving further out of its' juxtaposition (normal);

2)     In this instance, you should not have to worry about surgery at all!  What you need to do is find a good Manual Therapist, or a very good Sports Chiropractic Physician.  These professionals are found by referrals from friends, professionals, family physicians, etc.  No advertisements in the paper or phone book, please.  Sometimes, if you are able to contact the Austrian Gymnastics Organization, or even the Austrian Olympic Team Physician for Gymnastics, they would be able to tell you who is good at manipulation, and also understanding the mechanics behind the injury.

3)     Fortunately, this is not a difficult  thing to fix, and don't let anybody convince you that surgery or steroid shots are the answer! Additionally, don't let anybody touch you that does not have the training to treat you with manipulation.

4)     The idea of running and/or sprinting does not sound like a good idea at this point.  Let's get the boney structure seated where it should be normally, and the soft tissue will settle down without having to strain itself in protecting you.  By my own experience with treating high-profile Olympic gymnasts, I feel if you can find someone of the caliber of what I mentioned above, it will be a simple, fast recovery.  If you need some help, either look in the Internet, or write me again to see if I can find someone for you.

Incidentally, I was an Exchange Student in Wien (a long time ago), and lived on the Donau Canal in Maria Theresias' summer home.  I loved it there, and if I ever had a chance to visit Austria again, I would be very happy!

Again, I want to apologize for not getting the original letter to you, but maybe this note will give you some idea of what I am speaking about.  If you have any questions or concerns, would you please feel free to drop me a line?  By the way, your English is excellent, and I applaud you for doing so well in your explanation.

Take care, Katharina, and I hope this works out well for you, and thank you for writing me.  Please let me know what you have found, and how you are doing.

Best Wishes,

Dr. Patricia Arthur

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Arthur,

I just received your message and this is far beyond everything I could ever think of. When I first visited AllExperts.com I doubted that this is going to work.
You need to know, I have kind of a quirk that if I explain something, I need to do it as detailed as possible, because I am scared to miss something that might be THE crucial point to indicate the problem, so I didnít really dare to believe that anybody will bother to read my ďstoryĒ.
I cannot express how overwhelmed I am by your message! THANK YOU!!!

During the last few years I have been to so many doctors because of several minor overuse injuries, and, no matter if I went there as a private client or not, most of the time had the feeling they just donít really took me seriously.
This shouldnít be an allegation at all. No one is perfect, and of course, nobody, or the fewest, can find out a problem whilst the first examination and I also do not expect that. Also, overuse injuries are far less common than fractures or shin splints and maybe not everybody knows about special conditions or injuries. The bad thing is that they donít like to admit when they donít know the problem immediately, they just donít really care about working on a solution and just declare a quick diagnosis, no matter if they are right or not. Sometimes a simple conversation and answers to my - maybe to doctors clearly seeming - questions is what helps a lot.

So do I get it right that my pelvis kind of ďmovesĒ in a wrong way? I had a torn hamstring some years ago, which left scar tissue and high hamstring tendinopathy for more than 5 years and I noticed that my pelvis always automatically got into an aslant relieving when I stretched. Also my right hip is 0.2 inches higher than my left one, if that might contribute to my problem.

What should the treatment be like? Do I need to learn the right posture and how to rotate the hip correctly?

Again, thank you for your advice! I will try to find a good Manual Therapist as soon as possible and hopefully my problem will be fixed soon.
However this is going to turn out, your message gave me a lot of hope and some positive thoughts again!

Thank you very much, there should definitely be more people like you!

Katharina

Answer
Hello Katharina!

For some reason there is a person  who had decided to spoil my long letters to you, and a few other letters!  Unfortunately, my last letter to you was more a clinical lecture, of which it showed the reasons why the rotation in the pelvis would cause pain and neuropathy in one side of the hip joint more than the other.  I suggested to you that no amount of physical therapy (explanation provided), nor X-rays, MRI's, etc., will add any definitive answers.

What I need you to do is find a GOOD Chiropractic Physician, or a GOOD Manual Therapist. They check your hips relative to their position with each other and the bones attached herein.  It seems easy to work with this, but one has to be keenly educated for many years to know how to deal with this issue.  This is why I didn't suggest your Family Physician, your Orthopedic Physician, nor your Physical Therapist.  Not that these folks are not medically well trained, that is not the case.  As Chiropractic Physicians who study not only all the medical dynamics of a medical doctor, but then continue with intense study of the Biomechanics of the body.  It's like being a Body Engineer and a medical doctor all in one.

When you find someone with good credentials, sit down with them prior to any treatment, and ask them how much experience they have had with pelvic instability. If they have been in practice a long time, they will explain what they do.  You should have no pain during the treatment, and it should start to feel much better very soon.  In fact, you should not have to have lifelong appointments, but after the second or third appointment, they will probably ask for you to come back for a check-up in 2 to 4 weeks!  This is what has been a common procedure for my patients, and there is no reason to believe your injury is any different than many athletes that are highly trained, and did some type of maneuver which caused those joints to be out of their normal juxtaposition.  To replace that joint correctly takes an equally highly trained Manual Therapist or Chiropractic Physician.

After you make a decision, and go to the person you have chosen, please let me know how you are doing, OK?  I will look forward to your story!

Best wishes,

Dr. Patricia Arthur  

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Dr. Patricia B. Arthur, DC, MRC, CST

Expertise

As a 30-year practicing Chiropractic Physician, my specialty was Sports Medicine. For 8 years I had the distinct pleasure of working with the USOC, and traveled the world to care for the athletes in the Pre-Olympic venues for the Summer Games. When I wasn't traveling, I had a private practice, and a hospital practice, in Kamuela, Hawai'i. Questions I couldn't answer usually dealt with pharmeceuticals. This was not my expertise, but the simple questions pertaining to familiar drugs I was able to digress, or refer to someone that was knowledgable in that field. Most Sports Medicine field injuries were familiar to me, but I always aired on the side of caution. In my office practice, I would tend to see more patients with the weekend injuries who would try to self-treat, only making the injury worse than it should have been! Nevertheless, I never took anything for granted, and so it was my conservative approach to the "cause-and-effect" mechanisms that were vitally important to the healing process.

Experience

Following my competitive nature, I knew Sports Medicine would always be a part of my life. After graduation from Palmer University in Iowa, the old adage taught at the school dealt only with the spinal column......anything connected to the spine was outside our scope of practice. To me, this was too simplistic, because the complex body also had arms and legs! From this point, I developed specific technigues which would encorporate the body as a whole rather than haphazard segments. There is nothing traumatic that happens to a single ligament, tendon or joint that doesn't effect a secondary, or possibly a tertiary element in that area. In order for that space to heal, all the factors must be addressed. Volunteering my time teaching referrees, coaches, and interested parents about the realities of probable sports injuries was worth a thousand words!j

Organizations
American Chiropractic Association; Local Emergency Response Committee; Hazardous Materials Response Team; Urban Search and Rescue Team - Operations and Planning; Federal Corps of Engineers Committee; Earthquake Advisory Board; Big Island Wildfire Committee

Publications
Papers published focusing on the importance of proper care of sports injuries; Authored medical columns for the syndicated magazine "The People's Doctor "; Published papers in professional journals on Head Injuries in Sports; Published papers on Drug Abuse in Sports.

Education/Credentials
Robert Packer Hospital - Certified Surgical Technician - CST; Palmer University - Doctor of Chiropractic - D.C.; Wright State University - Masters in Counseling/Psychology; Wright State University - Masters In Couseling of the Severely Disabled.

Awards and Honors
Selected US Olympic Physician -1988; Graduated Wright State University with a 3.75 GPA; Graduated Palmer University with a 3.5 GPA; Faculty Appointment - Palmer University Post Graduate Education; Faculty Appointment- Hawai'i/Kapiolani Community College - Skills Team Tester;

Past/Present Clients
Cincinnati Bengals Football Team pre-season training; Summer Olympic Athletes worldwide; Kona Ironman Triathletes - Finish - line physician

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