Week 5

Question 1

What is an alpha angle

Answer 1

angle at which the femoral head departs from its normal spherical outline

Question 2

What alpha angle is indicative of CAM morphology

Answer 2

> 55 degrees

Question 3

Is it possible to have CAM morphology on X-ray but no hip pain

Answer 3

Yes

Question 4

What do you need to have a FAI diagnosis confirmed

Answer 4

CAM morphology on X-ray AND pain

Question 5

What is a lateral centre edge angle

Answer 5

coverage of femoral head by acetabulum roof

Question 6

Lateral centre edge angle <20 degrees

Answer 6

dysplastic (undercoverage)

Question 7

Lateral centre edge angle 20-25 degrees

Answer 7

borderline dysplastic

Question 8

Lateral centre edge angle 26-40 degrees

Answer 8

normal

Question 9

Lateral centre edge angle >40 degrees

Answer 9

overcovered

Question 10

What is FAI

Answer 10

abnormal contact between femoral head and acetabulum

Question 11

what is the distinction between someone having CAM morphology and FAI

Answer 11

can have CAM morphology but need pain/symptomatic to have FAI

Question 12

What is CAM morphology

Answer 12

Femoral head boney lesion

Question 13

What is pincer morphology

Answer 13

Acetabulum boney lesion

Question 14

2 types of FAI morphology

Answer 14

CAM and Pincer

Question 15

Association of cam lesions and hip OA

Answer 15

association of larger CAM lesions increasing risk of hip OA

Question 16

Management options for FAI

Answer 16

surgery only option if we want to change underlying bone morphology

Question 17

Intrinsic factors of FAI

Answer 17

Factors originating within the patient

- Strength: improve ability to dissipate forces through lower limb

- Biomechanics: impingement occurs in positions of hip flexion, adduction and internal rotation. Reduce amount of time in certain positions to reduce hip joint loading

• Morphology: surgery

Question 18

Extrinsic factors of FAI

Answer 18

Factors outside the person –> environmental
- type of activity
- Reducing load

• Losing weight

Question 19

Which intrinsic factor can’t be targeted by physiotherapy

Answer 19

morphology –> surgery

Question 20

physiotherapy group vs hip arthroscopy group for FAI

Answer 20

using iHOT-33 scale found arthroscopy group had better improvement (hip impacting life less) than physical therapy group

However, neither option brings patients anywhere near back to normal

In this study –> not best exercises selected

Question 21

impairment based rehabilitation following hip arthroscopy study

Answer 21

Hip muscle strength and single leg dynamic balance reduced FAI

targeted impairments to improve patient QoL and reduce pain

Targets:
- better hip flexion range and Adduction strength were associated with better QoL
- greater strength in hip abduction and adduction = better functional performance
- better functional performance = less pain and better QoL

Question 22

In FAI impairment based rehab, better hip flexion range and Adduction strength were associated with

Answer 22

better QoL

Question 23

In FAI impairment based rehab, greater strength in hip abduction and adduction =

Answer 23

better functional performance

Question 24

In FAI impairment based rehab, better functional performance =

Answer 24

less pain and better QoL

Question 25

Which positions are provocative for FAI patients

Answer 25

hip flexion --> deep squats/deadlifts

Question 26

FAI exercise plan

Answer 26

Hip abductor - Bridges - Wall sits - Banded Clam shells (not in hip flexion) - Step up Hip extensor - Laying hip extensions - Banded hip extension - single leg RDL Hip adductors - Ball Holds - Side lying holds - Banded adduction Hip external rotators Trunk muscles - One arm, one leg raise - Pall off press - Ball crunches Functional progressions - Box squat - Bossy Ball squat - Lunges Plyometrics - Step Jump - Step Hop - Bossy Ball Jump Squat

Question 27

What can gluteal tendinopathy affect

Answer 27

QoL, physical function, sleep Walking up hills and activities requiring hip abductor function

Question 28

When do glute tendons become compressed

Answer 28

when hip is moved into positions of adduction and hip flexion sitting cross legged, crossing legs while standing, shifting weight to one hip while standing, abductor stretching

Question 29

How can we avoid compression of gluteal tendons

Answer 29

minimise compression in ADLs and activity to manage GMT

Question 30

How could you differentiate hip OA and GMT

Answer 30

GMT patients will have normal hip ROM whereas hip OA patients will be limited in ROM

Question 31

Common findings in GMT patients

Answer 31

contralateral trunk lean dynamic valgus contralateral pelvic drop due to weak abductors which struggle to stabilise pelvis and lower limb

Question 32

LEAP trial for GMT

Answer 32

3 treatments - education and exercise - corticosteroid injection - wait and see approach used GROC scale and pain intensity scale Best results for education and exercise

Question 33

GMT education and advice

Answer 33

Manage compression: avoid positions where there is compression on the glute med and min tendons particularly in positions where hip is moving into hip adduction (sitting cross legged or hanging off hip) as well as in positions of hip flexion greater than 90 degrees - Exercises prescribed shouldn’t involve moving into these positions of compression (don't want to prescribe clams for these patients) Manage tensile loads: speak about activity modification, reducing amount of provocative exercises they were doing to prevent further aggravation of pain and gradually building up capacity of tendon

Question 34

Exercises for GMT following 4 phase rehabilitation program (isometric, isotonic, energy storage loading and return to sport)

Answer 34

Exercises - Bridging: o double leg --> offset bridge --> SL bridge when patient can adequately control pelvis to perform movement - Functional loading o Single leg squat (not too much hip flexion) o Single leg stance progressing to step up o Encourage maintenance of lower limb alignment (not dropping into hip adduction or contralateral trunk lean) for both - Abductor loading once a week at high intensity use bands, rubber mat or reformer

Question 35

What does hip distraction in supine do

Answer 35

improves general ROM

Question 36

What does an AP glide in 90 degrees hip flexion do

Answer 36

improves hip flexion

Question 37

What does a PA glide in 90 degrees hip flexion do

Answer 37

improves hip extension

Question 38

what does a lateral glide in 90 deg hip flexion do

Answer 38

improves general hip ROM

Question 39

What does TFL/quad STM do

Answer 39

improves knee flexion