Why Having “Squash Butt” May be More Bane Than Boon:
A look at osteoarthritis of the hip
Ball and Socket of the Hip
Well-known US players like Kenton Jernigan, Richard Millman and Azam Khan have at least one thing in common with World Champions Geoff Hunt, Rodney Martin and Chris Robertson. After years of playing and training, they have been done in by their hips. These players have been forced to consider alternatives ranging from activity modification to arthroplasty (hip replacement). The game of squash can take its toll on everyone from a local D player to a World Champion when it comes to osteoarthritis of the hip. There are, however, some preventative actions we can all take to mitigate the pounding that we take on the court. Cross training, adequate stretching, weight control and special consideration of our feet can go a long way towards forestalling the discomfort that accompanies osteoarthritis of the hip.
While arthritis of the knee is more predominant in contact sport athletes, arthritis of the hip tends to be seen in runners and those who play racquet sports. Structurally, the hip is a ball and socket joint with the head of the thighbone (femur) fitting into the socket (acetabulum) of the pelvis. The joint is held together by three capsular ligaments and supported by the dynamic muscles that cross the joint. The muscles surrounding the joint enable its complex movements, including flexion, extension, adduction, abduction, internal and external rotation. The muscles responsible for abduction (movement of the leg away from the midline) and extension are the superficial gluteal group which includes the gluteus medius, gluteus minimus, the tensor fasciae latae (which becomes the iliotibial band), and the gluteus maximus. This group of muscles hypertrophy (grow larger) in highly active squash players as a result of the lateral movement and change of direction that are required to play the game. Hence, “squash butt.”
The cat-like ready position that squash players assume while preparing to move explosively toward the next shot forces the head of the femur (again your thighbone) into the socket, as the hip is flexed, slightly everted, and abducted. Increased contact of the head of the femur with the socket leads to more wear and tear on the joint. Eventually, the joint space narrows, the articular (joint) cartilage wears down, inflammation increases, and bone spurs develop. These changes define osteoarthritis of the hip.
Symptoms of hip arthritis can be varied. Athletes may notice groin pain, back pain, generalized stiff movement of the hip, or a painful first step. As the disease progresses, it may become painful to tie shoelaces or clip toenails; or a limp may result. If the disease progression becomes this advanced, suitable relief might only be achieved through hip replacement, which may be an unacceptable alternative for many active people. Therefore, there are four areas in which squash enthusiasts can take action in order to prevent hip arthritis or at least slow its progression.
1. Cross train. Swimming and bicycling are the two best exercises because they reduce inflammation in the joint space, maintain range of motion, promote weight loss, and avoid weight-loading the hip.
2. Lose weight. Weight loss is important for those carrying extra pounds, as each additional pound overweight adds three pounds of stress to the hip joint.
3. Combine your workouts with adequate stretching, range of motion, and strengthening exercises. Ask the trainer at your club to give you special exercises to stretch and strengthen your hamstrings, quadriceps, and gluteus muscles because these are the main groups of muscles supporting your hip.
4. Pay attention to your feet. The forces that damage our hips are transmitted through our legs from the floor on up. Double sock when you play and make sure to change your well-padded squash shoes every few months. Also, if possible, play on sprung courts as opposed to those with concrete or extremely hard floors.
If you are already experiencing moderate to advanced discomfort, there are pharmaceutical products that may help. Those include ibuprofen (e.g., Advil®), and Viox® and Celebrex® (anti-inflammatory drugs that do not affect your stomach). If you are already experiencing severe discomfort that is hampering your ability to play, glucosamine and chondroitin sulfate are over-the-counter drugs that are substrates for the joint cartilage that is broken down in osteoarthritis. Talk to your doctor about each of these options.
Osteoarthritis of the hip may be to a certain extent unavoidable in high level, active racquet sport enthusiasts. Chances are, however, that if you take the recommended preventative actions, you may be able to play the sport that you love longer. What squash enthusiast wouldn't want that result?