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Hip Injuries, Risk Factors, and Return to Sport

. . ?The empiric observation that children and adolescents in our modern society are confronted with fewer physical stresses than their parents or grandparents is contrasted with the increasing specificity of stresses that are placed on them during current sports and athletic training activities."

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Hip Injuries, Risk Factors, and Return to Sport

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    1. Hip Injuries, Risk Factors, and Return to Sport John Frey, PT, DPT 2012 Coaches Clinic

    2. “The empiric observation that children and adolescents in our modern society are confronted with fewer physical stresses than their parents or grandparents is contrasted with the increasing specificity of stresses that are placed on them during current sports and athletic training activities.” Micheli (1992)

    3. Posture Flexibility Strength Risk of injury

    4. GROIN PAIN

    5. THE HIP Importance of awareness 3.1 years and 4.2 healthcare providers prior to receiving the correct diagnosis. 13% had unsuccessful surgery at another site. Clohisy (2009) 30% of groin pain remains undiagnosed. Morelli (2001) Youth injuries increase the risk of arthritis later in life. Gelber (2000)

    6. THE HIP A complex joint The other ½ of “THE CORE” Withstands 8x body weight during jogging Frank (2010)

    7. Anatomy of the Hip The hip is a complex region with anatomic involvement throughout the trunk and lower extremity Ball and socket joint between the femur and pelvis, acetabular labrum, capsule, intra/extra-articular ligaments Dutton (2004), Kapandji (1985)

    8. Anatomy of the Hip >20 muscle cross the hip joint The other ½ of “THE CORE” Bursae, superficial bony prominences Neurologic, vascular, and lymphatic systems Dutton (2004), Kapandji (1985)

    9. Hip Injuries Groin strain, muscle strain, tendonitis, IT band syndrome Bursitis Femoroacetabular impingement and labral tears Atheltica pubalgia, “sports hernia” Inguinal hernia Osteitis pubis Stress fractures, avulsion fractures Snapping hip Slipped capital femoral epiphysis Posterior hip pain, sciatica, piriformis syndrome, lumbar referral , peripheral nerve compression Morelli (2001), Frank (2010), Martinez (2011), O’Kane (1999), Groh (2009)

    10. Primary Types of Injuries: Traumatic

    11. Primary Types of Injuries Traumatic: tissue is forced beyond its ability to accommodate Soft tissue/cartilage damage Fractures Dislocations Vascular/neurologic involvement

    12. Traumatic

    13. Primary Types of Injuries Most common injury is a strain of the adductors (adductor longus, gracilis). Morelli, (2001) Forced abduction, eccentric forces Muscle length/strength imbalances Tyler (2010)

    14. Primary Types of Injuries Overuse/insidious onset: Repetitive micro-trauma > tissue repair 65% of hip injuries are insidious and 83% have groin pain Extreme ROM Clohisy (2009), Micheli (1992). Manfred (1993), UWSM (2012)

    15. Primary Types of Injuries Overuse/insidious onset

    16. Overuse/Insidious Injuries Primary cause are training errors Most occur during pre-season with a rapid acceleration of training Tyler (2010)

    17. Risk Factors for Injury #1 Previous injury Training errors, overtraining Level of conditioning Muscle length/strength imbalance Capsular laxity Cook (2012). Lehmann (1993). Murphy (2003). Chomiak (2000), Groh (2009)

    18. Risk Factors for Injury Foul play (31%) Environmental changes Inadequate rehabilitation Chomiak (2000), Della Villa (2012), Murphy (2003)

    19. Physical Therapy and Rehabilitation Observation: willingness to move, symmetry, alignment, assess the “chain” RICE: rest/ice/compression/elevation Control pain and inflammation for treatment and to allow further evaluation Range of motion, symmetry, alignment

    20. Physical Therapy and Rehabilitation Strengthening Isometric, concentric, eccentric, functional patterns and combined movements Balance and proprioception Neuro-muscular re-education for sport specific activities

    21. Physical Therapy and Rehabilitation Re-assess training techniques and aggravating factors Functional/sports screening and testing Taper down from therapy and return to sport progression

    22. Return to Sport Full pain free range of motion At least 80% normal strength Eccentric strength is key Pain free and proper form with running, cutting, agility, sport specific drills Caution to assess if pain free by guarding or limiting normal motion Askling (2010), Della Villa (2012), Engebretsen (2008), Kiesel (2007), Providence (2010), Sportsmetrics (2012)

    23. Return to Sport Some hip rehabilitation programs require pain free completion of an ACL prevention program Mental preparation and readiness Sports tests, functional screening, injury questionnaires Askling (2010), Della Villa (2012), Engebretsen (2008), Kiesel (2007), Providence (2010), Sportsmetrics (2012)

    24. Functional Movement Screening A research based, standardized screening tool to assess risk for injury in athletes, patients, and individuals interested in increasing exercise/activity levels.

    25. FMS Deep Squat

    26. FMS Deep Squat

    27. FMS Hurdle Step

    28. FMS Hurdle Step

    29. FMS Hurdle Step

    30. FMS Inline Lunge

    31. FMS Inline Lunge

    32. FMS Shoulder Mobility

    33. FMS Shoulder Mobility

    34. Rotary Stability

    35. Rotary Stability

    36. FMS Active straight leg raise Clearing exam for lumbar extension Clearing exam for lumbar flexion Clearing exam for shoulder impingement

    37. Adductor Strain Injury Prevention Program Warm up Bike, adductor stretching, sumo squats, side lunges, kneeling pelvic tilts Strengthening Hip adduction (sitting, standing, cables), unilateral and bilateral sagittal plane slide board, lunges with reciprocal UE movements Tyler (2010)

    38. Adductor Strain Injury Prevention Program Sports-specific training On ice kneeling adductor pull togethers Standing resisted skating simulation Cable crossover pulls Clinical goal Adductor strength at least 80% abductor strength Tyler (2010)

    39. Research Based Sports Screening and Injury Prevention Cincinnati Sports Medicine Sportsmetrics Santa Monica ACL Program (PEP) F-MARC, The 11+ (FIFA) Functional Movement Screen Noyes (2012), Kiesel (2007), FIFA (2012) Howard Head Hip Injury Sports Test

    40. In Summary Safety and peak performance require communication and collaboration between the athlete, parents, teachers, coaches, trainers, physical therapists, and physicians.

    41. In Summary Evidence based screening, prevention, and intervention may reduce injuries in sports and is a progressive area of research in sports medicine and rehabilitation.

    42. Resources available upon request. Please feel free to call or email me if you have any questions about the presentation, FMS Screening opportunities, or additional resources for physical therapy and injury prevention. John Frey, PT, DPT Providence Sports Medicine and Rehabilitation Therapy 907-212-6558 john.frey@providence.org

    43. THANK YOU!

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