Developmental hip dysplasia  

Developmental hip dysplasia is a condition that must be caught early.

At the Chiropractic Coalface one comes regularly into contact with patients who have had less than satisfactory femoral head and acetabular replacement surgery. In addition, I personally have several patients every single day who are experiencing side of the upper thigh and groin pain after the operation.

Hence began a long journey of self-discovery about the hip joint. 

Prevention of hip arthritis is vital and DDH was not, in my day, something we learned about in Chiropractic School; nor was Femoro Acetabular Impingement Syndrome, dysplasia's first cousin. Both if poorly managed have a high predilection for degenerative arthritis.

In the normal healthy hip the upper part of the femur ends in a round, smooth ball.

"If left untreated, and the condition does not resolve on its own, the long-term consequences are very serious, including a shorter leg and a pronounces limp, with premature onset of arthritis and hip pain."

Orthopaedic Topics

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The normal hip joint

The normal hip joint has smooth outlines, a definite joint space, is well roofed and has no pincer or CAM deformities.

A normal spot x-ray of the hip.
Schematic view of the normal hip.

which fits neatly and snugly right in a cup (called the acetabulum) in the large ilium bone...

Schematic view of the hip socket showing the three parts.

Both the ball and the cup are lined with super slippery, hard hyaline cartilage so that one doesn't have bone on bone contact. The hip joints after all bear the full weight of the body.

The joint is filled with a nutrient rich fluid that sloshes about supplying the cartilage with oxygen and all its needs for metabolism; it's living tissue, just as muscle, bone and nerves are. It has no blood supply of its own.

This hyaline fluid also removes the waste products of cartilage metabolism. HYALINE CARTILAGE ...

In utero

Notice the position of the thighs in this normal vertex presentation... the "taylor's position" with flexed and ABducted hips. The ball is kept firmly in the socket.

Normal hips develop inutero.

The space in the belly may be, due to various factors very limited (tight) and some babies show a range of abnormalities from a moulded head to abnormal feet, a congenital torticollis or stiff neck. Likewise Developmental Hip Dysplasia may occur if the knees are forced together, with a tendency to subluxate the hips.

Thus it's vital the pregnant woman does not in the last trimester spend long hours sitting in a cramped position. Stretching out whilst lying, walking or swimming is essential, simply to make space for the developing infant. Whilst DDH almost certainly has an underlying genetic predisposition, scientists reason that the position of your babe in utero is profoundly important. Read further at our developmental hip dysplasia page; what happens in utero?

Thus the chiropractor who treats Infantile Colic and finds a baby with a strong disinclination to turn the head one way or another, a common finding in huilbabies, the crying infant, as we call them in Holland, would be on the look out for other abnormalities such as DDH. More about Colic Chiropractic and the Pavlik harness used for babies with this condition.

Google appears to frown on too many links, so phrases in bold, like that below, need to be put into the Site Search function in the navigation bar on your left if you want more information.

How DISABLING is your Hip Pain?

This hip pain questionaire has been designed to give your Chiropractor (and you) a more objective measure of how bad your hip pain is... HIP PAIN QUESTIONAIRE ...

So, what is DDH?

Normal spot x-ray of the hip.

Notice, in the X-ray above, the deep socket and especially the very definite lower margin of the acetabulum.

The normal spot hip x-ray showing the full circle of the head of the femur.

In the X-ray below of DDH, there is a shallow socket, with a sloping upper margin instead of a proper roof. In addition the lower margin of the acetabulum is barely seen.

Developmental hip dysplasia

Developmental hip dysplasia often leads unerringly to severe arthritis if not well managed.

Spot x-ray showing the indistinct margin in developmental hip dysplasia.

Ancillary findings ...

Notice, in comparison with the normal hip above, how a much larger portion of the ball protrudes beyond the socket; it is un-roofed, and cannot contribute to bearing the weight of the body. The nett result is that the weight of the body is concentrated on a much smaller area of cartilage between the ball and socket, with far greater stress on the hyaline cartilage and underlying bone.

Notice too, instead of a nice round ball, the flattened, 'mushroom-shaped' medial margin of the ball; this is a finding common to several hip abnormalities.

Spot x-ray showing the unroofed phenomenon in developmental hip dysplasia.

Notice again in the X-ray below the various features of Developmental Hip dysplasia. The sloping socket, the large unroofed part of the ball, the flattened femoral head, the wide margin in the lower part of the hip, and now, in this slightly older patient, the beginning of 'sclerosis' on both the roof of the socket and the ball. This is hip arthritis in the making.

This patient already has pain in the groin radiating down the inner thigh muscles, pain on the side of the hip, and sacro-iliac joint pain. She also has short leg causing a tilted pelvis and a curvature of the spine. Undiagnosed Development Hip Dysplasia causes a leg length inequality.

Take no positive action and there's a hip replacement waiting in the wings. It won't be long before hiking will become painfully impossible.

X-ray showing the sclerosis in the hip caused by developmental hip dysplasia.
  • Leg length inequality ... use the site search function to find the link to this page.

Examination of the infant

If you take your colicky baby to a Chiropractor s/he will during the routine examination gently flex the hips, moving this way and that, listening for a deep-sounding 'thunk' as the hip subluxates. In fact whilst caring for your child, you too should listen out for odd sounds coming from the hip joints.

Whilst only 1 / 1 000 babies (about 80% girls) have Developmental Hip Dysplasia, it's probably a much higher percentage of unhappy, colicky babies.

In the clicking hip of the small infant, the diagnosis of DDH is confirmed with a ultrasound scanner which allows the radiologist to view the hip whilst it's in motion. S/he'll actually will see the hip subluxate as it clicks.

In serious cases the hip actually dislocates. That's a disaster. In mild cases it simply subluxates and clicks and becomes arthritic in later life.

Your chiropractor, if s/he is experienced in the examination of the infant will be doing these tests, Hip Dysplasia Ortolani Galeazzi Barlow, noted orthopaedists to whom the world is indebted for their enormous contribution to the understanding of Developmental Hip Dysplasia.

HIP DYSPLASIA Ortolani Galeazzi Barlow ... again, use the site search function.

The Cause?

There is a strong genetic predeliction for Developmental Hip Dysplasia. If Granny or Gramps had an arthritic hip, then every one of their children and grandchildren should be routinely examined for abnormalities like Developmental Hip Dysplasia (DDH) and Femoro Acetabular Impingement Syndrome (FAIS).

Breech births increase the likelihood of DDH too, by a very large margin of ten. Now it's 1/ 100 babies.

Add to that the effect of a constrained, tight intrauterine last-trimester, and a poor diet, and smoking, and we may be looking at 1/20 - 1/50 births.


The treatment of the infant with DDH cannot be successfully achieved only with chiropractic. Your chiropractor would reduce the subluxation, but modern care involves an orthopaedic device called the Pavlik harness which keeps the head of the femur firmly in the socket.

Why? Because in the newborn, the socket hasn't yet properly formed. It's the presence of the ball in the socket that builds a proper socket and to date that can only be done by successfully keeping the femoral head firmly in the acetabulum - that's what moulds the socket to the correct shape.

However, in the child, young adult and adult, I believe that chiropractic has a major role to play. Currently I have one adult woman of 45, two young women in their early twenties and one girl of nine under care. All four have far less pain, and are more than satisfied with chiropractic care. All four had been less than satisfactorily managed medically. Developmental Hip dysplasia CaseFile.

Hip and buttock exercises

You cannot alter the shape of the socket, but what you can do is to strengthen the muscles with hip and buttock exercises. Hip exercises ...

I've been developing these exercises for several years, and am now ready to share them with you. They are tricky, be warned. Do them every morning before arising from your bed, and again before going to sleep. Obviously again during the day would be helpful. They take about two minutes only.

So, I've split the exercises into three parts. Do part I for perhaps a week until you can do it confidently, and only then proceed to part 2.

You've practised part 1 and can do it confidently? Right, you're ready for part 2.

And now on to Developmental hip dysplasia exercises, part 3. Make this exercise routine part of your life and by reducing the tendency for your hip to subluxate, pop out, click, it will add years to the hip joint and save you a lot of pain; and perhaps a total hip replacement.

The hip socket cannot be deepened, nor the ligaments easily shortened; all you can do is to strengthen the muscles that support the hip, and make sure the sacroiliac joint remains mobile and unfixated.

Hip arthritis

It's widely acknowledged medically that Developmental Hip Dysplasia leads unerringly to hip arthritis and surgery. "Total hip surgeries may be inevitable later in adulthood."

There is no research currently to prove my assertion, but my experience of this condition is that correct management from an early age, and a sensible expercise regime will be able to prevent many total hip replacements. But there is I regret no chiropractic research following the child with DDH for fifty years! Not yet. HIP ARTHRITIS ...

Femoro acetabular impingement syndrome

Femoro acetabular impingement syndrome is an allied condition in which there is TOO MUCH coverage of the ball. Conversely it makes for an inordinately stiff hip in the young person, mimicking an arthritic capsular pattern, but with no degenerative change. Like developmental hip dysplasia, undetected it too leads to hip arthritis. Chiropractic manages this condition exceptionally well too. Femoro acetabular impingement syndrome CASE FILE ...

HEALTHY LIVING TIPS for the pregnant woman

The rapidly growing infant places great demands for nutrients and oxygen on the mother. A diet rich in the healthy fats, protein, carbohydrate, vitamins and minerals, HEALTHY LIVING TIPS ... and of course ample oxygen. I know of no direct link like a lack of Folate and choline, or the smoking mother to Developmental Hip Dysplasia but that's probably simply because researchers haven't yet discovered the link. What is known, even worse, is that a deficiency causes birth defects; your greens and eggs is the short answer.

Of course, because of the prevalence of backache in pregnancy, WALKING BENEFITS ... are even more important.

OMEGA-3 fat is essential for healthy blood vessels, and for the growing brain. Sixty percent of the brain is built of omega-3 fatty acids. Think fish oil and/or flax seed nutrition information ...

  • Benefits of folate ... again, use site search.
  • Choline food sources
Breast fed babies are more intelligent.

Mixed hip dysplasia AND impingement syndrome

Occasionally, both hip dysplasia and either a CAM or Pincer deformity can coexist in the same hip, confusing the clinician. Hypermobile hip dysplasia CAM FAIS ...


› Developmental hip dysplasia


Are you enjoying this chiropractic site? Have you found this page on developmental hip dysplasia useful? Then you'll love Stones in my Clog by chiropractor Dr Bernard Preston.

Chiropractic stories from the Holland, light, interesting and fun; you'll find a tale there about developmental hip dysplasia and perhaps femoro acetabular impingement syndrome too. 

True tales from the Chiropractic clinic. Only $2.99 on your Kindle, tablet or smartphone. Find it at Amazon.

Stones in my Clog.

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.