♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Hi, folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet. - In our opinion,
of course, Bob.
- What is causing your hip pain?
Femoroacetabular impingement, or FAI.
Are you having a labral tear?
How to tell.
These are a mouthful, Brad, but we'll go over what they are.
- Yeah, it sounds a little intimidating,
but it's really not.
- Yeah, so femoroacetabular impingement.
Let's break it down, Brad.
So this is the femur.
I pulled it off Sam here.
That's the biggest bone in the body if I remember.
Right, Brad?
- I think you're exactly right.
- And it's got a ball on the top of it.
- Right, the femoral head.
- And that ball fits into a socket.
It might be better to show on this one.
Fits into a socket, and that forms a ball and socket.
Then that's the acetabular.
So that's the femoral, and that's the acetabular.
- It's a very stable joint.
It's designed to hold a lot of weight.
Obviously, your whole body weight through most of it
with impact as well.
- And supported by some heavy ligaments going around it.
But what happens in femoroacetabular impingement
is that either you're born...
(both laugh) You can show that side, Brad.
Either this is misshapen.
The ball is not shaped quite like it should be,
you're born that way, or the socket is misshapen.
- Right, so this is the acetabulum.
- [Bob] That's the acetabulum.
- Yeah, that can be...
You can see the blue lines in here.
It should fit in there real nice.
It's a good fitting joint, if you will,
but there can be anomalies or problems
with the shape not being correct.
- And they could both be misshapen.
And what happens then is it obviously grinds
and rubs together, creates pain
but it can also damage the cartilage inside.
And here, Brad and I, with our advanced digital graphics-
- [Brad] (laughs) We are in the age of a wonder.
- We took it, and I just outlined
what the labrum looks like.
Now that's the cartilage of the hip,
and that's kind of the shape of it.
It helps hold, cushion it a little bit.
It helps hold the hip in there.
And that can get all messed up when those are misshapen
as you could see, especially over time.
- You wanna have a lot of surface area,
and that's way it is on a healthy one,
but on these misshapen ones,
you get pressure points,
and that's where it wears away that cartilage readily.
- So yeah, over time.
I've had about three patients like this
in the last couple of years.
And they're all girls that were in their early 20s,
and they were all athletes,
and they were all competing for a while
and they couldn't anymore,
because it was just too much pain.
- So what was the end result?
- Well, they, all three, had surgery.
And surgery is not unusual.
Again, you see it in a lot of athletes,
but you could see it in adolescence and adults also.
And, again, usually present at birth.
Each case, they had the surgery to repair the damage
and the deformity too.
- So the athletic or the activity did not cause it,
it was already there, but the activity
kind of accelerated it. - Enhanced it, right.
So, with FAI,
which can lead to the labral tear,
again, remember the labrum in there,
you may not have any symptoms.
I mean, there's people...
As you get older, I mean,
you may go through your entire life without having symptoms,
especially, I think, if you don't do sports.
- Sure, where you're stressing it.
- But here are, and we'll go over some of the symptoms,
and some of these symptoms, to me,
aren't really helpful, Brad, because you find these
with a lot of hip problems.
- Yeah, they overlap
with other problems. - Nonetheless, here they are.
Stiffness in the hip joint.
Obviously that can be with a lot of things.
The hip joint, this is probably one that's more indicative,
it may lock, or click, or catch.
And that's the labrum getting caught,
or even part of the bone maybe getting caught.
- I know my sister has the symptoms.
She's 50 years old now, but she showed me 15 years ago,
and she's had no problems.
I don't know if this is a problem, or it's something else.
- She may have have a torn labrum,
and a lot of people do, and they are asymptomatic
just like you find tore cartilage in the knee,
and they're asymptomatic.
The patient may limp.
Hip pain, if you're having pain,
it's usually in the inner thigh or groin.
That's where the problem is.
The pain worsens with physical activity.
It may get worse with even prolonged sitting,
because your hips up like that,
especially on a low chair like in a car.
- So you're sitting, you're actually knee is up higher
than the hip putting-
- Yeah, see how it's jamming that.
- More pressure on that joint.
- Right.
And it also, of course, may be worse with climbing
or doing stairs, which all hip problems
tend to be worse with.
- Yeah, it's just more stress on the joint.
- So the test the doctor can do, they can do x-rays,
MRI, CAT scan.
The x-rays can show the bones,
and the MRIs can show the labrum.
- Yeah, the softer tissues.
- So we're gonna show you one test you can try yourself.
Well, you can't really do yourself.
I'm sorry, you do need a friend or a family member
to help you with it,
but it's pretty easy to do.
Brad, will have the leg facing this way
is the one that we're gonna test.
- Okay, facing the camera? - Yeah, facing the camera.
- Okay, so you want me to be the Guinea pig, if you will?
- Why don't you lie down?
So all you're gonna do is you can grab a person's leg,
or have someone grab your leg by the ankle
and by underneath the knee. - So, I should be relaxed.
- You should be relaxed.
- Okay, put this leg down or up?
- Yeah, that down.
I'm just gonna bring it up to a right angle.
See, this is a right angle.
You can see really well with the stripes,
and that's at a writing.
Very easy.
Bring it up to this point.
Now I'm gonna bring it across to the other hip.
All right, now once it's across,
I don't know if you can see this or not,
I'm gonna bring the ankle out like this.
- I've got a healthy hip. - Oh, no pain?
- No, but it's like
not really comfortable. - Not real comfortable, no,
'cause we're really jamming the hip here.
- Putting it to end range, if you will.
- Yep, so I don't need to push down at all.
All I'm doing is bringing the ankle out like this.
- And you're not applying a lot of pressure.
- No, I'm not going.
I'm not, am I?
- Well, no you're not,
but I can- - You can feel it?
- It's like I'm thinking, "Just be nice."
- Yeah, gentle internal rotation.
And I did this actually on a girl
that was not diagnosed with this yet,
and it was so positive.
- So she became clearly painful?
- Yes. - Like apprehensive,
"Stop, stop, stop?"
- No, but just it hurt.
- Then you could compare to the other.
- Yeah, I compared to the other side,
which you always wanna do.
And it was unfortunate with this girl, too,
'cause she was a very good runner
this one that I diagnosed it in.
She ended up having to give up her running career.
I mean, it was tough. - That would be tough.
She was on a state team and, and a state runner.
It can be a drag.
- Yeah, maybe she'll find another activity.
- Okay, remember, this video is a part of a series of videos
on hip pain.
You can go to bobandbrad.com.
Go to the programs section. - Programs, yes.
- And you'll see a list of all of our hip programs.
- This is gonna have a PDF? - A PDF, yep.
It'll have a print-out. (Brad laughs)
Every video we have has a print-out.
Every video we have is free.
We don't ask for an email.
- On the programs section. - On the programs section.
- It's a good deal.
- Yeah, check it out.
You can't lose.
- What does PDF stand for?
- Mike? (laughs)
- Nobody. - Nobody knows.
- Well, you print it out. (laughs)
- You can print it out. - Very good.
Good luck and take care. - Good question.
(upbeat music)