JN

Question 1

Give ASIS and AIIS attachments -

Answer 1

ASIS - Sartorius and TLF
AIIS-Rectus Femoris

Question 2

NPRS and its comparison to VAS

Answer 2

Numerical pain rating score

Chronic pain patients prefer the NPRS over other measures of pain intensity, including the VAS, due to comprehensibility and ease of completion ( Williams et al, 2000)

Doesn’t capture the complex and individual nature of pain.

Question 3

Common Pathologies of the Anterior Hip

Answer 3

• Hip Flexor tendinopathy / strain
• Illio-psoas bursitis
• OA- Link to age of patient

Question 4

Other pathologies to consider- Relating to the lumbar spine

Answer 4

• Illiolumbar ligament syndrome/ illiac crest pain syndrome- which can be due to a lifting injury
• SIJ dysfunction - in relation to lower back pain - can results in symptoms such as feel of instability/giving way.

Question 5

Pathophysiology of tendinopathy

Answer 5

• Mechanically weaker tendon
• Excessive load + Individual factors
• Reactive tendinopathy
  -Tendon disrepair
• degenerative tendinopathy
• Rounded fibroblasts distributed unevenly throughout the tendon
• increased ground-substance
• Capillary growth
  -Disorganised type 1 and type 3 collagen.

Question 6

Stages of muscle repair

Answer 6

Bleeding
Inflammation
proliferation
Remodelling

Question 7

Timescale for Hip flexor strain -

Answer 7

It typically requires one to three weeks of rest and treatment to recover from mild conditions fully. On the other hand, more severe cases can take around four to six weeks or longer

Question 8

Pathology behind SIJ syndrome

Answer 8

SIJ syndrome is a term used to describe pain at the SIJ.

Question 9

Biomechanics of a deadlift

Answer 9

Anterior overload may occur with techniques that encourage pushing into extension.

Hip impingement may occur in deep hip flexion - especially for those with CAM morphology

Question 10

Reasons for shooting pain and giving way

Answer 10

Lumbar ridiculopathy - Compression of spinal nerve roots at levels L1-L4

Question 11

Sertraline - 50mg

Answer 11

• Antidepressant
• Nausea being the most common side effect

Question 12

Evidence for goniometry and modified Thomas Test-

Answer 12

A high Interclass correlation coefficient (ICC) was also reported for goniometry use in conjunction with the modified Thomas test. (Clapis, Davis and Davis, 2008)

ICC - How strongly data resembles each-other among different groups in terms of reliability.

Question 13

Postural management and office based work

Answer 13

It is having been shown that anterior pelvic tilt can be applied as an auxiliary treatment method for preventing pelvic deformation in seated workers (Lee and Yoo, 2011).

Question 14

Novice at the Gym

Answer 14

Especially in the deadlift and squat, driving their backs backward and/or tucking the pelvis under, causing tremendous shearing forces in the hip join and also the lumbar spine.

Question 15

AROM AND PROM

Answer 15

• Pain AROM flexion, external and internal rot due to flexion
• Pain in R on L abduction and adduction
• Limited global R on the right
• Limited pain in L due to pain in right

Question 16

ROM treatment and evidence

Answer 16

Initial assessment , Global range of movement was greatly limited , with pain bought on due to flexion hypothesized as the likely source of dysfunction.
- Warm up advice was given
Lunges- Holding for 10 seconds x 3 reps on each leg - Due to initial SIN factor the hold of the stretch was reduced to ten seconds with primary focus on control in and out of the lunge its-self .
Glute bridges 3x8 daily

Active management phase
- in this stage the stretching should be done carefully and always to the point of discomfort but not pain. Advice given around active warm up , this being either walking or marching on the spot, as this facilitates activation of neural pathways and reduces muscle viscosity ( Kary,2010)

Dynamic stretching-
In line with the problems identified , therapeutic stretching may return ROM after immobilisation form injury as well as in dynamic activities to promote ease of motion/concentric control ( sands et al , 2013).

Secondary benefit for referred lower back pain.
- Studies show that both core stability training and dynamic stretching have positive effects in improving thoracolumbar range of motion, pain level and functional ability to perform daily tasks ( Chan et al , 2019)

Question 17

Running evidence

Answer 17

Full hip extension of the hip is required during as the feels lift from the ground

• Stretching
• Running drills for confidence - heel strike

Question 18

What happened in follow up appointment

Answer 18

Awaiting XRAY results – Pain in the hip has remained constant throughout the 4 weeks , possibility of another pathology such as Hip impingement.
Review results
Continue to progress running drills to match patients’ goals
Continue establishing goals weekly

Continuation of pain
- SIJ , pelvic instability
- results Pelvic compression belt -SLR
-Hip hinging exercise given
- Hip distractions
Glute bridges - 8x3 once a day
-Hip hinging- 15 x2 daily - Shown in session for technique , no pain but can feel activation in quads and glutes on the return up.
- Pendulums- When needed, throughout the working day - techniques observed and advice given about control
- Pelvic tilts - when possible throughout the working day. Technique observed - hands on aid given to assist this.

Hip Distraction- 3x30 - retesting flexion.
Advice given around Compression belt- passive treatment

Question 19

Rectus Femoris in relation to the knee

Answer 19

A markedly shortened rectus femoris is suggested by knee flexion of less than 80°

• Knee extension
• Hip flexion

Question 20

Origin and insertion of Rectus Femoris-

Answer 20

AIIS to Join at the quadricep tendon which then inserts into the patella and tibial tuberosity .

Question 21

Action of rectus femoris in relation to the hip and gait

Answer 21

Rect fem acts with Illiopsoas to produce Hip flexion and acts with illiopsoas in the ‘toe off’ phase of the gait cycle

Question 22

Efficiency of Rectus femoris - and the pattern of pain JN experiences

Answer 22

Rectus femoris is more efficient in movement combining hip hyper-extension and knee flexion

Question 23

Most common quadricep for strain-

Answer 23

Rectus femoris

Question 24

What features predisposed Rectus femoris to injury?

Answer 24

Several factors predispose this muscle and others to more frequent strain injury. These include muscles crossing two joints making it more prone to stretch induce strain, those with a high percentage of Type II fibers, and muscles with complex musculotendinous architecture.

Question 25

Iliopsoas- Origin and insertion

Answer 25

Psoas major muscle, a long, tapering (fusiform) muscle that originates at either side of the spine and inserts at the lesser trochanter of the femur.

Iliacus muscle. The iliacus muscle is a triangular sheet that connects the ilium bone to the lesser trochanter.

Question 26

Hip flexors

Answer 26

Iliopsoas, pectineus, rectus femoris and sartorius

Question 27

Iliopsoas bursitis

Answer 27

The iliopsoas has an associated bursa that is the largest bursa in the body and lies between the iliopsoas and the hip capsule/pubis Iliopsoas bursitis is an inflammation of the bursa located beneath the iliopsoas muscle.

Question 28

Sitting jobs and sedentary lifestyle

Answer 28

Sitting too long or all day shortens and tightens these the hip muscles. This condition is a common problem with with people who sit for many hours daily eg anyone sits at a desk for hours each day; bus drivers. Shortened muscles are unable to generate as much power as lengthened muscles, which can lead to functional problems.eg causes anterior pelvic tilt and a lumber hyperlordosis[2].

Question 29

Common symptoms of Iliopsoas strain-

Answer 29

• groin and/or proximal medial thigh pain, which are exacerbated by actively flexing the hip against resistance
• pain with passive extension of the hip by stretching the iliopsoas tendon

-tenderness over the femoral triangle

swelling may also be palpated.

Question 30

Other actions of Iliopsoas

Answer 30

Stabiliser of lumbar spine and pelvis

Question 31

Etiology of Iliopsoas tendinopathy

Answer 31

Although the exact etiology is yet to be fully established, the two most commonly described causes of irritation to the iliopsoas tendon include either acute injury or overuse injury from repetitive microtrauma

Question 32

JN- Not managed his condition or sort advice 7 months -

Answer 32

• Continued as usual and tried to work through the pain
• Office job - avoidance
• Limited walking and general activity - weight gain since the injury

Question 33

Hip Impingement

Answer 33

Hip impingement, or femoroacetabular impingement (FAI), occurs when the femoral head (ball of the hip) pinches up against the acetabulum (cup of the hip). When this happens, damage to the labrum (cartilage that surrounds the acetabulum) can occur, causing hip stiffness and pain, and can lead to arthritis.

Cam impingement
Cam impingement is the most common type of hip impingement. It happens when the femoral head is misshapen, usually because of a “bump” of bone that forms where the head meets the top part of the femur (an area called the femoral neck) - “square peg in a round hole”. Cam impingement is the most common cause of labral tears. Cam impingement is the most common cause of hip arthritis.

Pincer impingement
Pincer impingement happens when the edge of the socket bone extends too far over the ball part of the joint. When you move your hip, the extended bone “pinches” the ball and prevents it from moving freely. Pincer impingement is often associated with tears of the labrum.

Combined impingement
This impingement happens when both the ball and socket portions are misshapen.

Question 34

Anterior femoral glide!!!!!

Answer 34

Anterior femoral glide syndrome, or FAGS, is a term created by the renowned physiotherapist Shirley Sahrmann. It involves forward shearing forces in the hip that occur when the femoral head is forced forward in the joint socket.

A very common cause of anterior glide, is faulty technique in training. Especially in the deadlift and squat, driving their backs backward and/or tucking the pelvis under, causing tremendous shearing forces in the hip join and also the lumbar spine.

Question 35

METs evidence

Answer 35

• Has been suggested that MET produced neurological relfex on muscle relaxation following isometric muscle contraction ( Nicholls,2011).

Studies investigating isometric contraction duration founf that 5 seconds produced larger effect size compared to 20 seconds within a round of three repetitions ( Fryer et al,2004)

Question 36

Postural management evidence

Answer 36

It is having been shown that anterior pelvic tilt can be applied as an auxiliary treatment method for preventing pelvic deformation in seated workers (Lee and Yoo, 2011).

Question 37

Postural management evidence

Answer 37

It is having been shown that anterior pelvic tilt can be applied as an auxiliary treatment method for preventing pelvic deformation in seated workers (Lee and Yoo, 2011).

Question 38

Evidence behind pelvic stabilisation

Answer 38

Pelvic stabilisation has been shown to-
- Movement control of trunk and lower extremities
- Hip muscles strength
- Gait speed
- Lateral pelvic tilt
( Dubey et al,2018)

Question 39

Providing a holistic patient approach -

Answer 39

This review found that in an outpatient musculoskeletal context, physiotherapists needed to treat each patient as a unique person, requiring core traits and strong communication skills as well as promoting empowerment ( Naylor et al, 2022)