Alan rankin pdf

Hip Dysplasia Pathology and assessment Alan Rankin MSc, BSc (Hons) Physiotherapist

A confused picture!

Hip joint

Muscle Groin pain

Infection Hernia

SIJ Medical Lumbar

2014 Doha Consensus on groin definitions

24 experts – systematic literature review

Groin injuries in Club football

Male footballers 4-19%

Female footballers 2-14%

72 studies33 different diagnostic terms

Consent on classification of groin pain

Defined clinical entities

2014 Doha Consensus on groin definitions

Hip related pain

Other cause of pain in athletes

10% of all groin region problems are hip related.

Reiman (2014)

Catching Locking Clicking Giving-way

HistoryOnset Nature Location

Funnel approach to examination

Faber test

Fadir test

Hip ROM

Palpation

Test reliability?

Radiology to confirm

Literature poor on testing accuracy Doha (2014), Reiman (2014) Subjective exam56-90% accurate Objective exam30% accurate Reiman (2014)

Dysplasia is a radiological diagnosis and not clinical

Radiological findings point to impingement + - OA

What is it?!

Unknown cause congenital defect Loder (2011)

Depth of the socket is the centreedge angle (C-E angle).

Normal C-E angle is 25° or more

Implications for women's football?

Most common cause of hip arthritis in young women.

Hip Dysplasia Institute (2016)

75-80% patients were female.

(Loder 2011)

Secondary OA commonly related to Dysplasia Loder (2011)

Dose-response relationshipFrequency of training in young age- development of future problems.

Tak et al (2014)

Abnormal joint alignment is a risk factor to labrum.

Saw and Villar (2004)

More frequent due to increasing football demands?

What now then?!

Early referral to experienced hip surgeon

Relatively good outcomes of surgery and back to pre injury status (Doha 2014)

Periacetabular osteotomy (POA) Move acetabulum to cover more of the femoral head

Pre

Improve the biomechanics of the hip joint

Post

Reduce the high stresses that start to cause damage

Principles post -op

Movement Strength Core Proprioception Function

Stage 1

Mental wellbeing

Mobile with e/c’sapprox. 6 weeks.

Then full weight as able

Early range of movement and strength exercises ROM > 85% Contralateral

Specific exercises

Stage 2 Aim for hip strength to be 6075% compared to opposite

Full weight bearing and minimal pain

Normal gait pattern

Strength, Proprioception and core exercises No ballistic or forced stretching No treadmill use Avoid hip flexor/joint inflammation

Stage 3

Gradual move from Physio to sports scientist

Take home Good prognosis in football High chance of surgery

Not common in football Suspect the hip!

Sixth Hip Conference.

Warwick Orthopaedics Sports Surgery

St George’s Park, Burton-on-Trent, Staffordshire.

Of Interest 27th-28th June 2016

www2.warwick.ac.uk/fac/med/research/csri/ orthopaedics/about_us/welcome/

Thank you!!

www.footballmedic.co.uk www.damiangriffin.org www.hipdysplasia.org