Managing the Hip in Supraphysiologic Motion Athletes

The supraphysiologic hip in artistic athletes poses a unique challenge to the discerning sports medicine practitioner. Through stretching and repetitive microtraumatic motions, a cascade of soft tissue laxity, increased strain on surrounding soft tissue structures, and microinstability can develop, resulting in both soft tissue and bony injury. In addition, extra-articular pathology can predominantly affect the artistic athlete. Thus, a thorough understanding of the anatomy and pathophysiology as the hip is ranged to the extremes is paramount to establishing an adequate diagnosis and developing a treatment plan. Through a careful history along with a targeted and thorough physical exam in addition to diagnostic imaging, one can accurately identify the sources of pain and dysfunction. Treatment can range from conservative and interventional nonoperative modalities to open and/or arthroscopic hip surgery. Surgical techniques should not only address the identified pathology but also take care to not limit the extremes of hip motion required by the artistic athlete's sport. Despite the high demands of hip motion and function (supraphysiologic motion and function) the artistic athlete can return to high levels of performance if one pays attention to these factors.