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The basic details of Alex Rodriguez’s left hip

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On a conference call with Yankees beat writers, Dr. Bryan Kelly spoke for more than a half an hour this afternoon, trying to explain the details of what’s already happened to Alex Rodriguez’s left hip and what’s about to happen to it. Here’s an attempt to give you the basics of those details.  

What exactly caused this problem?
Basically, the top of Rodriguez’s femur is misshapen, and it’s been misshapen for 20-plus years. The top of his hip isn’t perfectly round, which means it doesn’t fit perfectly into the hip socket.

“This is a condition that occurs during the developmental phase of the formation of the hip joint between the ages of birth to anywhere between 14 and 15 years,” Dr. Kelly said. “The reasons why you develop impingement has got to do with two things: the genetics of their hip and the mechanical forces that the hip is subjected to during the first 15 years of development, where growth occurs in something called the growth plate. A remodeling process can occur that leads to a non-spherical femoral head and the hip itself is designed to (resemble) a ball-bearing joint, a ball-and-socket joint. If you have a non-spherical head, which is very common in athletes both male and female, the anatomy of the hip limits the amount of functional motion that can occur in the hip joint.”

What damage has this caused?
Rodriguez could not have known about his hip abnormality. Basically, he’s lost range of motion over the years, and his body has found ways to make up for it. But in making up for it, he’s allowed his body to do damage, and it finally reached a breaking point.

“What happens is there’s premature contact between the ball and socket,” Dr. Kelly said. “That’s what the impingement is. For a lead leg in a hitter, a right-hander’s left leg, if you can’t rotate through the ball-socket joint before there’s premature contact, something is happening to alter the mechanics. The first is, that non-spherical portion crushes the labrum, and that’s what causes a labral tear. The second is — over time, this is an insidious process that takes years — the cartilage on the inside of the joint starts to break down.”

Why did Rodriguez think his problem was in his previously repaired right hip?
Apparently this is common. In the process of compensating for the range of motion issue, the body will create problems elsewhere, and athletes often don’t notice the hip problem and instead focus on those parts of the body that are compensating.

“When somebody ruptures their ACL, you can see it happen on TV, I think we saw it this weekend,” Dr. Kelly said. “When somebody breaks their femur and the bone’s sticking through the skin, it’s not unclear what’s wrong with them. But when somebody has mechanical dysfunction across the hip, what the body tends to do — some patients come in and they don’t have an X marking the spot of where the problem is… The body tends to compensate. It alters the mechanics such that other parts of the body are (affected).”

Is this really enough to explain Rodriguez being a non-factor late in the year?
The short answer is, yes.

“That’s where it becomes clear that there is a direct correlation between inability to use your hips and (lack of) performance,” Dr. Kelly said. “It’s no different from when your Little League coach told you your power was generated through your hips. If you can’t generate torque through your hips because of progressive loss of motion, and you can’t generate power, you alter your mechanics.”

Does that mean fixing this problem will bring Rodriguez back to his old self?
Depends on a lot of factors, including Rodriguez’s ability to rehab, regain strength and teach his muscles to work with this new range of motion (which should be better than it’s ever been). It also depends on Rodriguez’s cartilage. It will have been damaged by the repeated abuse, and Dr. Kelly won’t have a perfect sense of that damage until he actually cuts into Rodriguez’s hip on the day of surgery. Early exams, though, were promising.

“The imaging study shows that he has some cartilage wear that makes me think we will be able to get him back to his pre-injury level of play, that it’s not so extensive that it will ultimately impact his ability to play,” Dr. Kelly said. “Unfortunately, our imaging doesn’t give us all the information, and that’s something we’re going to know at the time of surgery.”

Are you certain this isn’t because of performance enhancing drugs?
The short answer is, once again, yes.

“This is a developmental, genetic predisposition to a certain shape of the hip joint that occurs during the first 15 years of development,” Dr. Kelly said. “This is not related to steroid use. Steroids don’t change the shape of your hip joint. This is a very well known developmental phenomenon.”

Associated Press photo