gms | German Medical Science

Objective: Hip dislocations usually occur with high-energy trauma and are uncommon in sports. American football and rugby are the sports in which hip dislocation has been the most widely reported, followed by snowboarding and alpine skiing. Most contact injuries were caused by tackling or kicking.

In a posterior dislocation, the head of the femur lies posterior to the acetabulum and the injured lower extremity has a clinical presentation of shortening, internal rotation, and adduction.

An intimate knowledge of the sport and the specific duties required of the athlete for playing soccer are importants for a successful functional progression program. This knowledge obliges the sports physician, the physical therapist and the athletic trainer to prescribe a specific rehabilitation program for the unstable hip joint.

Material/Methods: We report a case of a 22-year-old fourth division soccer player who sustained a posterior hip luxation in his left non-dominant leg during a game. He tried to kick the ball away while running, with the left hip in internal rotation, but at the same moment the adversary tackled him from behind and dropped him to the ground. The patient arrived to the emergency room with the left lower extremity in a position of flexion, adduction and internal rotation. Radiologic evaluation confirmed a right posterior hip dislocation.

Results: General anaesthesia allowed the patient and his musculature to relax, and the reduction was performed. Skeletal traction through the tibia was installed for one month, and then the patient was treated with rest and physical therapy, including non-weight-bearing for another two months.

Following several month of physical therapy intervention, in full weight-bearing, the athlete will be able to return to his previous level of activity in soccer.

Conclusion: A frequent mechanism of injury for a posterior hip dislocation is the knee striking the ground with the hip in a flexed and adducted position, thereby forcing the femoral head posteriorly over the rim of the acetabulum. This injury occurs more commonly during contact and collision sports when a running player is tackled from behind and falls onto a flexed knee and hip. As the opposing player falls onto the tackled player's back, his added weight drives the torso and pelvis toward the ground, and the femoral head is thus driven out of the socket in a posterior direction.

The best way to prevent this occurrence is to reduce the injured hip as soon as possible, preferably less than 6 hours after injury. Degenerative osteoarthritic changes are the most common long-term outcome of hip dislocation, and can be exacerbated by the presence of bony fragments and soft tissue in the joint space.

At the point of ball contact the knee extensors and hip flexors are agonists, and therefore need to be trained concentrically. At other points during the kicking movement these same muscles act eccentrically, which means that flexor activity is dominant during extension and extensor activity dominates during flexion. Quadriceps activity was greatest during the loading phase when they are antagonist to the movement and the hamstrings were most active during the forward swing, when they are antagonistic to the movement. Equilibrium and balance between the flexors and extensors is likely to reduce the incidence and frequency of injury, improve the neuromuscular kick pattern, and generally improve kick performance.

Soccer skills such as kicking, passing and trapping the ball, tackling, falling, jumping, running, sprinting, starting, stopping and changing direction, all involve the hip joint.

Athletes recovering from hip dislocations must follow a strict physical therapy regimen to ensure complete recovery of function. Stretching and range of motion exercises are important early in the recovery process, advancing to walking on crutches when the patient's pain fully resolves. Strengthening exercises of the muscles around the hip are important during the rehabilitation to take stress off the injured joint. Muscle strength is a determinant factor in successful performance of the kicking skill and can be developed through appropriate training.