As finely tuned a baseball machine as Alex Rodriguez might appear to be, a critical part of his body's machinery has long been working its way toward malfunction. The cyst on his hip that was drained last week is not the problem, but simply a result of a deeper structural problem with the joint itself; one that has developed over years and resulted in a condition that is increasingly being recognized in both athletes -- and the general population -- as a common cause of chronic groin and back pain.
According to a rough estimate by Rodriguez's surgeon, Dr.Marc Philippon, who has operated on dozens of pro athletes, perhaps 20 percent of people have a structural abnormality that can impair internal rotation of the hip joint. (Internal rotation is what happens when you flare your foot to the outside of your body.) The problem is that the head of the femur -- the bone that runs from knee to hip -- rubs against the socket excessively either because there is too much bone covering the head, or because the head itself is not, as it should be, round like a baseball. The condition is called femoracetabular impingement, or FAI -- orthopedic lingo for the square-peg-in-the-round-hole.
Picture Rodriguez, staring down a pitcher, waiting for a fastball. When the pitch comes, he generates his power by pivoting on his back foot and swinging his hips open. The head of the bat follows, like the end of a whip trailing the handle. The more force with which he can throw open his hips, the harder and faster his bat will come around. That motion causes a powerful internal rotation of Rodriguez's right hip -- the one being repaired on Monday. Rodriguez has probably taken hundreds of thousands of swings in his life, not to mention the hip rotation that comes with throwing to first or second base from shortstop or third base.
Rodriguez is one of those people who has a misshapen head of his femur. According to Philippon and other doctors, there is very likely a genetic component to this, but they also believe that stressing the hip joint -- doing deep squats with heavy weights is one sure way to stress the joint -- can cause the femoral head to deform further. So now picture Rodriguez's hip: instead of a round ball rotating smoothly in a cup, his formidable muscles jam his misshapen ball into the socket, where it scrapes along the surface of the cup, meticulously rubbing away the protective cartilage until it tears the labrum -- the band of tissue that rings the hip joint, securing the head of the femur.
The sooner someone with FAI gets surgery, the better. If left untreated, Rodriguez would likely end up with bone scraping bone inside his joint, and would be at risk for early arthritis or in need of a hip replacement. Philippon has seen athletes as young as 25 who have needed total hip replacement, surgery that would seem more to befit their grandparents.
The most insidious part of FAI is that it often manifests as something other than hip pain. Hockey goalies who have impingement use the butterfly technique, in which they go down on their knees and splay their feet out, will sometimes develop chronic groin pulls. The pain may actually be a result of muscles around the hip working hard to make the head of the femur fit into the socket. The trouble gets worse if the athlete is made to stretch the groin more, as most who complain of groin pain are. "If you're stretching and the ball doesn't fit in the socket," Philippon says, "you're going to accentuate the contact stress, you're going to accentuate the conflict."
Chronic back pain can be a sign of impingement, as well. Philippon once operated on a woman with back pain so excruciating that she was wheelchair bound. The woman had an MRI which showed no damage, and visited several surgeons who told her that her pain was from an old back injury. Finally, one doctor suggested she get an MRI arthrogram, a particular type of MRI in which dye is injected into the hip to highlight damaged areas. That test revealed multiple tears in her labrum. After Philippon operated on her, the woman was eventually walking pain-free. Vesa Toskala, the Maple Leafs goalie who had hip surgery, had a similar experience in which an initial MRI was negative, but an arthrogram showed a torn labrum. "I want to say to everybody who thinks they have hip problems," Toskala says, "when they go to take an MRI ... you have to put the dye on it so you're able to see it."
As he has helped to spread the word about FAI, Philippon has treated not only hockey and baseball players, but, among others, football players, skiers, golfers (Greg Norman broadcast his surgery live on his Web site), and figure skaters. Remember Michelle Kwan's tearful departure from the 2006 Olympics with groin trouble? Turns out the problem was actually her hip, and she was under Philippon's knife soon after the Games.
The good news is that the operation seems to be a permanent fix. Philippon will repair the tears in Rodriguez's labrum, and shave the head of his femur into a sphere. In an interview before Rodriguez's impingement was reported, Philippon said that the goal of surgery to fix impingement is "to improve the movement, but by improving the movement, by shaving the bone, you're basically resolving the conflict between the ball and the socket. You're making it fit better." For some athletes, there seems to be a performance benefit to the newly crafted joint with its increased range of motion. Jean-Sebastien Giguere, the Anaheim Ducks goalie, had the surgery in 2005, and says that it was like having a ball bearing in his right hip oiled for the first time. "It feels pretty good," Giguere says. "It actually feels better than the other hip."
A better rotating A-Rod? Could be a scary thought for pitchers when he returns to the field in a few months.