Mentoring Minutes: Non-arthritic hip pain

Mentoring Minutes covers a helpful sequence in treating non-arthritic hip pain

*** NOTES & REFERENCES ***

DDx: 
—FAI Labral, chondral lesions
—good research on what it is and assess it (guidelines A and B) but evidence limited with how to best manage/ treat it (F); 
Assessment
—Trendelburg test (hold 3 sec without hip drop) 
—FABER: pain, range side to side
—FADIR (90 deg hip knee flexion, then IR/add- postive ROS – if negative repeate in full flexion; 
—PROM flexion- painful., repeate with inf glide
—Hip PROM IR/ER Seated at 90, prone at 0; - greater than 30 deg
—2012 those who display excessive hip internal rotation range of motion compared to external rotation range of motion have weakness in the hip exter- nal rotator muscles. 
—MMT: Hip abd/ post glut med)- hold for 3 sec- add HHD 5 mm ablve malleolous
—MMT Hip ext: muscle activation: and MMT
MMT: hip ER 90 deg sitting nad 0 deg;

Rx:
—emphasis on abd and ER to improve rotational stability; 
clams, with TB holds- progressed to in side plank; quadruped —hip ext/ER
—Standing (breugers wrap- squat hold weight shift,, heel taps, sliders, to lateral walks- progressed to single limb deadlifts, and rotational airplanes
—Education: avoid EOR motion, ER, IR, ext

Cliborne AV, Wainner RS, Rhon DI, et al. Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mo- bilization. J Orthop Sports Phys Ther. 2004;34:676-685. http://dx.doi.org/10.2519/jospt.2004.34.11.676

Cliborne AV, Wainner RS, Rhon DI, et al. Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mo- bilization. J Orthop Sports Phys Ther. 2004;34:676-685. http://dx.doi.org/10.2519/jospt.2004.34.11.676

Wyss TF, Clark JM, Weishaupt D, Nötzli HP. Correlation between in- ternal rotation and bony anatomy in the hip. Clin Orthop Relat Res. 2007;460:152-158. http://dx.doi.org/10.1097/BLO.0b013e3180399430

Krause DA, Schlagel SJ, Stember BM, Zoetewey JE, Hollman JH. Influ- ence of lever arm and stabilization on measures of hip abduction and adduction torque obtained by hand-held dynamometry. Arch Phys Med Rehabil. 2007;88:37-42. http://dx.doi.org/10.1016/j.apmr.2006.09.011

Cibulka MT, Strube MJ, Meier D, et al. Symmetrical and asymmetrical hip rotation and its relationship to hip rotator muscle strength. Clin Biomech (Bristol, Avon). 2010;25:56-62. http://dx.doi.org/10.1016/j. clinbiomech.2009.09.006

Mentoring Minutes: ACL Rehab and Single Leg Hopping

REFERENCE LINKS AND NOTES

2013 Jan;41(1):216-24. doi: 10.1177/0363546512459638. Epub 2012 Oct 5.
Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction.

Hewett TE1, Di Stasi SL, Myer GD.

ACL Tears/Re-tears:

• Related most to:

  • Hip rotation control (IR), frontal plane knee motion during landing (adduction), sagittal plane knee moment asymmetries at initial contact (hamstring/quad contractions), postural stability deficits on surgical leg (trunk side bend, poor control);

• Treatments:

  • Quadriceps strength- need to make sure > 90% compared to opposite side; emphasis on proper activation if needed (NMES)

  • Gait mechanics- need to make sure get back proper shock absorption at loading (moving from extension into flexion)

  • Loading: look at Drop jumps and SL jumping (tend to still land more on non surgical leg at 2 years out)

    • Need to train single leg

  • Large % of patients do not go back to same level of sports due to fear (kinesiophobia): use sport specifics when able

Orthop J Sports Med. 2017 Nov 14;5(11):. eCollection 2017 Nov.

SingleLeg Hop Test Performance and Isokinetic Knee Strength  After Anterior Cruciate Ligament Reconstruction in Athletes.

Sueyoshi T1, Nakahata A2, Emoto G2, Yuasa T2.

• Looked at single-leg hop and isokinetic knee strength testing in athletes who underwent anterior cruciate ligament reconstruction (ACLR) upon returning to sport participation

• The strongest correlation between the hop tests and knee strength was found between the total distance of the hop tests and flexion total work/body weight and between the timed 6-m hop test and flexion peak torque/body weight.

J Athl Train. 2016 Sep;51(9):669-681. Epub 2016 Oct 10.

Changing Sagittal-Plane Landing Styles to Modulate Impact and Tibiofemoral Force Magnitude and Directions Relative to the Tibia.

Shimokochi Y1, Ambegaonkar JP2, Meyer EG3.

• Looked at ground reaction force and tibiofemoral force vectors with changing single leg jump landing, using 3D kinetics and kinematics

• Patients performed single leg landing using 1) self selected, 2) leaning forward on toes, and 3) body upright foot flat.

• The upright foot flat landing: less time to peak tibial axis forces, smaller knee flexion angles, greater magnitude and anteriorly directed ground reaction force vector= greater peak tibial axial and anterior shear forces

• The leaning forward and landing on toes: resulted in longer time to peak tibial axial forces, greater knee flexion angles, and reduced magnitude and a more posterior incline ground reaction force vector to the tibia = lowest peak tibial axial and largest posterior shear forces.

J Athl Train. 2017 Nov 20. doi: 10.4085/1062-6050-52.11.25. [Epub ahead of print]

Landing Kinematics and Kinetics at the Knee During Different Landing Tasks.

Heebner NR1, Rafferty DM2, Wohleber MF3, Simonson AJ3, Lovalekar M3, Reinert A4, Sell TC5.

• Kinematic and kinetic analysis Comparing lower extremity biomechanics across 5 commonly used landing tasks: (double- and single-legged drop landing, double- and single-legged stop jump, and forward jump to single-legged landing)

• Single-legged landings generated higher vertical GRF and lower peak knee-flexion values except for forward jump to single-legged landing, which had the lowest peak knee-flexion value and the second highest peak vertical GRF. The single-legged drop landing generated the highest vertical and posterior GRFs. Peak knee-valgus moment was higher during the double-legged drop landing

Extra Tests:

-       Star excursion balance test (Y test)

o   Risk for injury: Ant direction < 4cm, and total composite score < 94%

-       Landing Error Scoring System (LESS) (side and front views jumping off step)

o   Excellent 0-3, Score > 7 is poor

-       Noyes Hop tests

o   Single, Triple, cross over, 6 meter timed –need to stick landing for 2 seconds; > 90% compared to opposite side

Mentoring Minutes: Hip Adductor Strain

Hip Adductor Strain Part 1

Hip Adductor Strain Part 2

Also, check out our Patient Education on SO YOU STRAINED YOUR GROIN - NOW WHAT?

***REFERENCES AND VIDEO NOTES***

—Incidence: (Orchard et al, AJSM 2014) . 
o Soccer: 6 per 1000 player games
o Ice Hockey: 3.2 per 1000 player games
o Football: >23,000 over 10 years
o Average 12 days lost
—The Epidemiology of professional ice hockey injuries: a prospective report of six NHL seasons. (McKay, J Sports Med 2014
o 617 groin injuries, >90% non-contact;
o Training camp > regular season > playoffs
-62% adductor longus
-Conflicting data on playing surface (turf vs grass) and shoe type

—Risk Factors (Engebretsen, AJSM 10)
o Previous injury- strongest predictor
o Offseason training > 18 sessions: 3x decreased risk

—Mechanism of injury: 
o Eccentric contraction; Sudden ER and adduction, sudden stop/change of direction

—Screening:
o Flexibility: conflicting evidence about hip ROM (Tak, BJSM, 2017)
o Strength: Eccentric weakness (Thorborg, ortho J Sports med, 14)
o Muscle Imbalance: hip add to abd strength ratio: Adductors < abductors (17x increased risk) Tyler TF et al. The association of hip strength and flexibility with the incidence of adductor strains in professional ice hockey players, AJSM 29(2), 2001

Mentoring Minutes: Snapping Hip

Part 1 of Snapping Hip

Part 2 of Snapping Hip

Also, check out our Patient Education on WHAT YOU CAN DO FOR A SNAPPING HIP

***REFERENCES AND NOTES***

Topic: Snapping hip (Coxa Saltans)
- External (ITB): (more common) lateral hip; IT band moveing over greater trochanter, during flexion, extension, IR and ER. normally done active, and can be often seen visually, not passive (muscle under tension); where as ilio (can be active or passive felt
- Obers test in side lying; side-lying flex/ext
- Internal (iliopsoas tendon): Anterior Hip; iliopsoas tendons over underlying bony (iliopectinal emincence); could be related to paralabral cysts; 50% of cases associated with additional intrarticular hip pathology
- Supine hip into flexion/ER, then extended hip to neutral
- 5-10% population, majority painless; women > men; most common in ballet dancers (up to 80%), also in soccer players, weight lifters, and runners
- mostly related to overuse phenomenon (gradually progression over months); but can occur post surgical (THR); 
- Related impairments: IT band tightness, muscle/tendon tightness, inadequate relaxation, 
- Most often with hip ER and abduction at or above 90 deg of flexion (fan kick)
- Treatment: 
- rest, stretching, steroid injections, NSAIDS, activity modification
- Let it go”- need eccentric control
Semin Musculoskelet Radiol. 2013 Jul;17(3):286-94. Snapping hip: imaging and treatment. Lee et al.
Understanding and Treating the Snapping Hip. Yi-Meng Yen et al. Sports Med Arthrosc. 2015 Dec; 23(4): 194–199.
Trentacosta et al. Hip and Groin Injuries in Dancers: A Systematic Review, Sept 2017, Sports Health

Mentoring Minutes: Neck Pain and Shoulder Position

Welcome to PhysioU’s Mentoring Minutes! Each episode of Mentoring Minutes directly applies a clinical approach with relevant research for effective results.

Did you know that 4 out of 5 patients improved their neck pain drastically by passively elevating their scapulas and unloading the shoulders? Great for the acute, irritable patient. In today’s episode of Mentoring Minutes, Dr. Marshall Lemoine will be discussing how you can apply this unloading technique in the clinic!

Thank you for watching!  

The newest Mentoring Minutes get posted on Facebook every Monday.  If you are not on Facebook, you can find most of our videos on YouTube.  See you next week!

Van Dillen LR, McDonnell MK, Susco TM, Sahrmann SA. The immediate effect of passive scapular elevation on symptoms with active neck rotation in patients with neck pain. Clin J Pain. 2007 Oct;23(8):641-7. doi: 10.1097/AJP.0b013e318125c5b6. PubMed PMID: 17885341.

• With the scapulae passively elevated, patients reported a significant and immediate decrease in symptoms with right and left neck rotation.