Hip P! with Muscle Function Impairments

Question 1

What may you hear in the Subjective Exam with those patients with Hip P! with Muscle Function Impairments?

Answer 1

• Chief complaints of hip pain and weakness
• Descriptor: Often sharp, possibly pinching

Question 2

What is the MOI with those patients with Hip P! with Muscle Function Impairments?

Answer 2

Acute or Chronic; often repetitive stress or eccentric loads

Question 3

What is the Primary Agg and Ease Factors with those patients with Hip P! with Muscle Function Impairments?

Answer 3

Agg
loading of specific contractile tissue

Ease
Rest and support

Question 4

What may you find Objectively with those patients with Hip P! with Muscle Function Impairments?

Answer 4

• PROM > AROM
• Tender To Palpate (TTP) of involved musculature
• Pain with loading of involved musculature through PROM/MLTs and AROM/MMTs
• Associated mobility deficits and muscle performance impairments may be present of surrounding structure

This can be due to joint dysfunction and the muscles over compensate (Bray Clinical Pearl)

Question 5

What is the Prognosis for these patients?

Answer 5

• Likely to be favorable
• Dependent upon structures involved and severity of condition
• Minimum of 12 weeks until full return to function
• Further improvement may take up to 24 weeks
• Referral is recommended for patients whose symptoms remain unacceptable

Question 6

What is the PT focus with patients in the Acute Stage of condition?

Answer 6

Often a symptom modulation and reduction of tissue loading
approach; may present with somatic referred pain

Question 7

What is the PT focus with patients in the Subacute Stage of condition?

Answer 7

Addressing muscle performance impairments; may present
similar to a movement and coordination impairments condition

Question 8

What is the PT focus with patients in the Chronic Stage of condition?

Answer 8

Muscle performance impairments need to be continued to be addressed ultimately focusing on functional optimization

Question 9

What interventions are done to those patients with Hip P! with Muscle Function Impairment?

Answer 9

• Reduction of tissue loading
• Graduated rehabilitation
• Manual therapy for symptom modulation and associated mobility deficits
• Regional interdependence
• Education

Question 10

What is Greater Trochanteric Pain Syndrome (GTPS)?

Answer 10

This isn’t just bursitis, also found to include Gluteal Medius/Minimus Tendinopathy/Tears, and external coxa saltans (snapping hip syndrome) or ITB friction syndrome at the hip
- Predominantly occurs in females between 40 and 65 years-old

Question 11

What is a common subjective report with patients with Greater Trochanteric Pain Syndrome (GTPS)?

Answer 11

Typically presents with lateral thigh, groin and gluteal pain, especially when lying on the side at night, sitting and during prolonged standing , walking and climbing up and down stairs
- It may also radiate distally to theknee and the lower leg

Question 12

What interventions can be done for those patients with Greater Trochanteric Pain Syndrome?

Answer 12

• Should utilize conservative case since greater than 90% of cases respond; impairment-based approach
• Eccentric exercises are should be considered due to tendinopathic component
• Corticosteroid injections could be considered to provide short-term pain relief
• Orthotics may be prescribed if there is a biomechanical fault in the kinetic chain
• Surgical options (bursectomy, gluteal tendon repair, ITB lengthening, trochanteric reduction osteotomy) for persistent conditions exist but have low methodological quality research to support their use

Question 13

With Hip Region Muscular Strains, what are common muscular strains?

Answer 13

Gluteus medius, Adductors, iliopsoas, Rectus Femoris, Rectus Abdominis and hamstrings are most common
- Muscle induced groin region pain typically due to adductor strain (Adductor longus, Adductor Magnus)

Question 14

With Hip Region Muscular Strains, what are common objective findings?

Answer 14

• PROM > AROM
• TTP of involved structures
• Pain with loading of involved musculature through PROM/MLTs and AROM/MMTs

Question 15

Which hamstring is the most commonly strained?

Answer 15

Bicep Femoris

Question 16

What are the Characteristics of Hamstring Strains?

Answer 16

• Most common strained muscles of the Hip
• Typically a grade 2 strain
• Usually due to a sudden eccentric load (sudden change in direction, acceleration or deleceration)
• High recurrence rate
• Prolonged recovery
• Should use a holistic approach to consider contributing factors

Question 17

Hamstring injuries and/or tears typically occur during what movements?

Answer 17

They occur in the end-range hip flexion with knee extension stretching movements

Question 18

How can a hamstring injury to the Semimembranosus and it proximal free tendon occur?

Answer 18

During slower speed activities such as a dance and yoga

Question 19

What Hamstings strains, what are common examination findings?

This is digital lecture

Answer 19

Posterior thigh pain during activity with reproduction of Sx with muscle lengthening, activiation, and palpation along with a loss of function

Question 20

What are Clinical findings associated with Hamstring Injuries?

(Book)

Answer 20

• The patient reports distinctive MOI with immediate p! during sprinting or decelerating quickly. In acute cases, they may report a “pop”or tearing sensation
• Tenderness elicited with passive stretching of the hamstrings (hip flexion and knee extension)
• Altered gait mechanics
• Posterior Thigh pain, often near butt, worsens with resisted knee flexion and/or hip extension
• Tenderness to palpate, generally located at ischial tuberosity but may also be at belly and distal attachment
• Positive special test specific for hamstring injuries

Question 21

With Hamstring Strains, what is Grade 1?

Answer 21

Gait appears normal, but there is pain with the extreme ranges of a straight-leg raise

Question 22

With Hamstring Strains, what is Grade 2?

Answer 22

Antalgic gait or gait with a flexed knee. Resisted knee flexion and hip extension are both painful and weak

Question 23

With Hamstring strains, what is Grade 3?

Answer 23

Usually requires the use of crutches for ambulation. In severe cases, ecchymosis, hemorrhage, and a muscle defect may be visable several days post-injury

Question 24

What should be assessed with Hamstring Strains?

Answer 24

• Assess Knee Flexor strength with Dynamometer
• Assess hamstring length with hip flexed at 90° using an inclinometer

Question 25

What Interventions can be done with Hamstring Strains?

Answer 25

• Eccentric training added to stretching, strengthening, stabilization and progressive running programs
• Trunk stabilization and progressive agility training
• Neural tissue mobilization
• Therapeutic modialities to control pain and swelling in acute stage of healing