Task 7

Question 1

The student is able to explain what a femoroacetabular impingement means.

Answer 1

Subdivision into a Pincer and Cam impingement. Hip impingement usually affects young people, adolescents in sports or middle-aged persons.

• Cam: Deviation on the femoral side at the level of the head-neck transition. There is
then usually an osseous thickening (ossification) on the anterolateral side of the head-neck junction. The hip head is then no longer nicely round. The femoral head then collides with the edge of the acetabulum.

• Pincer: An abnormality of the acetabular margin. The acetabulum becomes relatively deeper. This can lead to impingement of the anterosuperior structures.

Question 2

The student explains the difference between tendinitis and tendinopathy

Answer 2

Histological features of affected tendon tissue in chronic tendinosis.
▫ No inflammatory cells in chronically painful Achilles tendons. There is no question of
inflammation.
 It is therefore better to speak of tendinosis than of tendinitis.
▫ Increased degree of ingrowth of blood vessels. The clinical significance is significant:  only painful (Achilles) tendons show this ingrowth
▫ Increased innervation in the Achilles tendon
▫ Increased concentration of the neurotransmitter glutamate
 stimulates the impulse conduction of nerves and is therefore of significance in the sensation of pain

Question 3

The student names the different stages of tendinopathy.

Answer 3

Stage 1: Light pain after sports, that disappears after a few hours.
Stage 2: Moderate pain beginning sports and after. Stay longer.
Stage 3: Pain beginning sports that becomes less during. After pain stays for days.
Stage 4: Pain during sports that limits performance
Stage 5: Continuous pain
Stage 6: Rupture

Question 4

The student explains the risk factors for developing LAGP.

Answer 4

• Increase in age
• Sex
• Individual genetic makeup
• Abnormal Kinematics
• Decreased muscle stretch
• Overweight
• Decreased eccentric muscle strength
• Sports, training and surface

Question 5

The student is able to describe the the therapeutic process for LAGP.

Answer 5

• Conservative physiotherapy treatment usually consists of stabilizing and muscle strengthening exercise therapy.
▫ There is strong evidence that a period of 8-12 weeks of intensive guided exercise therapy, aimed at improving strength of hip and lower back muscles (both extensors and flexors), is a more effective treatment method for LAGP compared to passive treatment
• The thesis shows: interventions consist of mobilizing techniques aimed at the hip, pelvis and low back, supplemented with muscle strengthening and stabilizing exercises for the hip and pelvis.
• Duration of treatment is approximately 8.5 weeks during which 13 treatments were given.
• 77% of the respondents indicated that they would return to the old level of their sport after 20 weeks.
• 26% of athletes who returned to their sport had a relapse!

Question 6

The student is able to describe the the diagnostic process for LAGP.

Answer 6

• Most tests are inconclusive about the affected structure(s)
• Abnormalities on Rx, bone scan and MRI do not show unequivocal abnormalities in relation to healthy athletes
• Clear norms and standards are missing.
• There are concrete indications that a previous groin injury increases the risk of a new groin injury increased.
• In addition, a reduced hip adduction to abduction force ratio appears to be an important predictor, as well as decreased hip rotational mobility.