sporting hip and groin ist 2
TRANSCRIPT
Sporting Hip and Groin IST
By Darren Finnegan 14/8/12
Objectives• Provide an overview of anatomy
and biomechanics of groin/hip
injuries.
• Introduce a concise and
thorough method of diagnosis
and rehabilitation of groin/ hip
injuries
• Help understand the diverse
injuries that occur in this complex
anatomical region.
Anatomy & Biomechanics• Muscle imbalance
• Movement restriction
• Fascial slings
• Open vs. closed chain
function of adductors
Anatomy Quiz
Partner up!
Subjective Assessment• Acute vs. insidious
• Mechanism
• Red flags
• Aggs/ Eases
• Investigations
• Athletes goals
• Occupation
• Training program
• VAS
• Referral pattern
Subjective Ax• Training volume/intensity
• PMH- previous surgery or injury, medical conditions
• Sport level, technical requirements of sport,
changes in footwear/ environment
• Other joints- LX,SIJ, knee, scrotal pain
Objective Assessment
• AROM/PROM
• Fabers
• Quadrant
• Labral
• Cough Impulse
• Squeeze test
• Thomas +/- neural
component
• Resisted sit up
• Passive abduction
Objective Ax• Functional tests- hopping,
SLS, SKB, COD, alignment
• Palpation- Rectus
abdominus, Pubis
symphysis, Iliopsoas
• Neural- Obturator,
ilioinguinal, genitofemoral
• Invagination of inguinal
ring
• Area A (in orange) genitofemoral
nerve; area B (in green) ilioinguinal
nerve; arrow C (in red with blue outline)
shows the direction and location for
cremasteric reflex.
Abdominal related pathology• Intra abdominal-
appendicitis, UTI, gynae
issues, rheumatological
(AS), gout
• Osteitis pubis
• Pubic bone stress
syndrome
• ‘Hockey groin’
• Rectus abdominus
tendinopathy
• Inguinal hernia
Athletic Pubalgia• Athletic Pubalgia
• 1/deep pain in
groin/abdo area
• 2/pain agg sprinting,
cutting, kicking, eased
by rest
• 3/Palpable tenderness
over pubic ramus, rec
femoris and/or
conjoined tendon
• 4/Pain on resist add 0,45
+/- 90deg hip flexion
• 5/Pain on resisted sit up
Athletic Pubalgia• Local overload - Pubic bone stress – adductors –
iliopsoas -Posterior ingunial wall deficency -
gilmores /hockey players groin/ external oblique
aponeurosis tear
• Definiton- Caudill(2008) phenomena of chronic
activtiy related groin pain unresponsive to
conservative MX and significantly improves with
surgery.
• Surgical- Bissini repair- transversalis sewing together,
+/- mesh +/- nerve dehiscence
Adductor related pathology• Trochanteric bursitis
• Gluteus medius
tendinopathy
• Snapping hip
• Rectus femoris strain
• Obturator neuropathy
• Iliopsoas strain/ bursitis/
tendinitis
• Adductor strain/
tendinopathy
Hip related pathology• Femoro-acetabular
impingement
• (Sahrman,2002)
• Primary cause of labral
tears
• CAM
• PINCER
• Stress #- NOF, pubic
ramus, acetabulum
• Synovitis
• Labral
• Chondral lesion
• LX/SIJ referred
• Avulsion apophysitis-
ASIS, AIIS
• Perthes
• Slipped capital femoral
epiphysis
Labral Tears• Extrinsic vs Intrinsic
factors (+/- FAI)
• Pain in anterior inguinal, thigh and/ or buttocks region
• AROM/ PROM painful EOR
• Audible clicking/catching/ locking
• Snapping Jt line/ ITB
• MRa
• +ve Impingement, Fabers, Mccarthyhttp://www.aafp.org/afp/991015ap/168
7.html
Rehabilitation• 8-12 weeks (continue with rehab for up to1 year)
• Avoid NSAIDs
• Criteria for return to sport/ running-
• a/brisk walking pain free
• b/Thomas test + resist hip flexion pain free
• c/Nil crossover sign
• d/Minimal adductor guarding
• Manual therapy/ Acupuncture/ Soft tissue work
• Home exercise program
• Additional- compression shorts, pelvic belt
• Cycling
• (Brukner and Kahn, 2007)
Rehabilitation
• Progression of adductor exercises- Core setting
add squeeze short then long lever
with sit up
with Russian twist ¼
bridging
plank
plank with add/abd using friction free surface
standing as above
Other factors to consider????
Rehabilitationkneeling pelvic tilts
wall squat with pelvic tilt sumo squat
lunge with reciprocal arm movement
straight line running
Change of direction --> sport specific training
Take home message
• Any questions?
References• Binningsely, D. (2003). Tear of the Acetabular Labrum in an Elite Athlete. British
Journal of Sports Medicine.37 p 84-88.
• http://www.mayoclinic.com/health/hip-labral tear/DS00920/DSECTION=symptoms
• http://www.sportsinjurybulletin.com/archive/acetabular-labrum-tears
• J. C. McCarthy, B. Busconi. Canadian Journal of Surgery. Hip Disease in Young Adults. Ottawa: Feb 1995. Vol. 38, Iss. 1, p. S13-7 (5 pp.)
• http://www.isakos.com/innovations/soccer.aspx
• Holmlich, Urhskou, Ullnits (1999) Effectiveness of active physical training as treatment for long standing adductor realted groin pain in athletes- RCT, The Lancet, 353, pp.439-443.
• Quinn, A (2010) Hip and groin pain_ physiotherapy and rehabilitation issues,
the open sports medicine journal, 4, pp.93-107.
• Bizzinni, M (2012) the groin area_ the bermuda triangle of sprots medicine, british journal of sports medicine, 45.
• Caudill, P, Nyland, J, Smith,C (2008) Sports hernia a systematic literature review, british journal of sports medicine, 42, pp.954-964.
• Internation Olympic committee World conference: prevention of injury in sport, http://www.ioc-preventionconference.org/OnLPMonaco.php, Monaco. Symposium 16 Session B.
References• Brukner and Kahn (2007) clinical sports medicine, 3rd
edition, McGraw hill, pp.405-424.
• Sahrman,S (2002) diagnosis and treatment of
movement impairment syndromes, Mosby, pp.121-
144.
• Gibbons SGT (1999) A review of the anatomy,
physiology and function of psoas major: A new
model of stability. Proceedings of: The Tragic Hip:
Trouble in the Lower Quadrant. 11th Annual
National Orthopaedic, Symposium. Halifax,
Canada. Nov 6-7.
• Moore, J (2011) Pre-habbing and rehabbing the
sporting groin, the gilmore groin and hernia
symposium,RSM,.