Hip Posterolateral pathology

Question 1

what is the subjective patient presentation with piriformis syndrome?

Answer 1

• pain in posterior hip +/- pain/symptoms in sciatic nerve distrubtion
• increases with sitting

Question 2

what is the objective patient presentation with piriformis syndrome?

Answer 2

• provocative testing: FAIR
• tender to palpation over muscle
• +/- neurodynamic testing (SLR, slump)

related:

• movement coordination: excessive femoral IR
• gluteal strength impairments

Question 3

what is the rehab for piriformis syndrome?

Answer 3

goal: address muscle imbalances
- manual therapy: tone reduction, care with stretching
- exercise: glutes, lumbopelvis, NM coordination, movement correctino

Question 4

why does piriformis syndrome occur?

Answer 4

sciatic nerve compressed by the piriformis muscle due to:

• piriformis hypertrophy/spasm
• muscular firbrosis following trauma (fall)
• anatomical variation

Question 5

What population does proximal hamstring tendiopathy usually occur in?

Answer 5

• runners
• hurdlers
• yoga
• dancers
• perimenopause

Question 6

Why does proximal hamstring tendiopathy usually occur ?

Answer 6

loading errors:

• training changes (overload)
• stretch/shorten cycle (plyo)
• lengthen or contract in HF (eccentric)
• excessive static stretching

movement coord impairments:
-hip flexion + adduction= compression

histological changes:

• collagen, neovascular growth,
• signs of degeneration>inflammation

related sciatic nerve entrapment

Question 7

what is the subjective patient presentation in prox hamstring tendinopathy?

Answer 7

• deep, localized pain lower gluteal/ischial region
• aggravated by sitting, fast walking/running, lunging/squatting, removing shoes
• may improve post warmup and then increase after

Question 8

what is the objective patient presentation in prox hamstring tendinopathy?

Answer 8

• pain w passive stretch
• pain w progressive loading (more with hip ext)
• tender to palpate
• assess neurodynamics (SLR, slump)

related impairments:

• flexibility
• glute muscle perfroamcne
• SLS: excessive anterior pelvic tilt, femoral IR, adduction

Question 9

what is the rehab for prox ham tendiopathy?

Answer 9

goal: load management; progressive loading within pain framework
pain provocation ok if 3/10 <24 hrs

• limit compressive, energy storage until irriatiblity stabilizes (hill running, quick starts, hurdles)
• postural modifications
• cushioned seating
• avoid repeated stretching
• use more squat instead of hinge

manual therapy: soft tissue mob, dry needling
pain education: little bit of pain= remodeling tendon

Question 10

What is the intra-articular pathology of a C-sign?

Answer 10

OA
labrum
FAI

Question 11

who is likely to have greater troch bursitis?

Answer 11

• females
• middle age
• runners
• overweight/obese

Question 12

why does greater troch bursitis occur?

Answer 12

inflammation of bursa between greater troch and ITB

• direct trauma
• overload/overuse
• thickened ITB or glute max tendon snapping over greatrer troch

risk factors:
spine or hip disorders
gait/movement alterations

Question 13

what is the subjective presenation of greater troc bursiits?

Answer 13

• sharp pain (acute), dull (chronic)
• L5 dermatome
• agg with laying on side, walking, stairs

Question 14

what is the objective presenation of greater troc bursiits?

Answer 14

• palpation over greater troch
• pain w resistive abduction
• pain w passive elongation of hip abductors (obers)

related impariments:

• gait alterations, glute weakness
• femoral adduction + IR

Question 15

what is the rehab for greater troch bursitis?

Answer 15

manage pain and inflammation:

• tone reduction/modalities/assisitve device
• movement correction/posture
• lumbopelvic muscle performance
• modified activity

reinforce strenght defificts:

• restore normal ROM
• NM control/ movement coordination

Question 16

who will have glute med tendinopathy?

Answer 16

2-5/annual incidence
F:M 4:1
>40
overweight/obese

Question 17

why does glute med tendinopathy occur?

Answer 17

degen tendon changes

• thickening, thinning or tears of glute med/min tendon
• changes in bursal structure

mechanisms:
tensile or compressive overload

35% have LBP
2/3 have OA

Question 18

what is the subjective patient presentation of glute med tendinopathy?

Answer 18

pain over GT +/- extension down lateral thigh

-agg: standing, walking, stairs, sitting

Question 19

what is the objective presenation of greater troc bursiits?

Answer 19

-provocation testing:
ober, FABER
resistance to hip rotation and abduction

-related impairments:
SL stance (pain, pelvic tilt, trunk lean)
weak glutes
poor movement patterns
hip adduction +IR
lat pelvic tilt
increased use of TFL vs glutes

Question 20

what is the rehab for glute med tendiopathy?

Answer 20

• load modifiction
• tone reduction (avoid stretching)
• isometrics
• heavy-slow resistance training hip abductors
• LE strength
• movement re-training
• foot orthosis