Hip Pain and Movement Dysfunction Associated With Nonarthritic Hip Joint Pain: A Revision.

The Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). This is an update to the 2014 Clinical Practice Guideline (CPG) for Hip Pain and Movement Dysfunction Associated with Nonarthritic Hip Joint Pain. The goals of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. This current CPG covers pathoanatomical features, clinical course, prognosis, diagnosis, examination, and physical therapy interventions in the management of nonarthritic hip joint pain. J Orthop Sports Phys Ther 2023;53(7):CPG1-CPG70. doi:10.2519/jospt.2023.0302.

Clinical tests to determine femoral version category in people with chronic hip joint pain and asymptomatic controls.

STUDY DESIGN: Controlled laboratory cross-sectional. OBJECTIVES: To investigate the relationship between femoral version (FV), measured by MRI (FVMRI), Craig's test and hip rotation range of motion (ROM). To determine rotation ROM values associated with FVMRI categories: excessive anteversion, normal version and retroversion. BACKGROUND: Abnormal FV values are associated with hip disorders, such as osteoarthritis, structural instability, acetabular labral tears and femoroacetabular impingement. Clinical assessment of FV may allow clinician to identify the effect of bony abnormalities on hip rotation ROM to guide clinical decisions. METHODS: Thirty-eight participants with chronic hip joint pain (CHJP) and 38 matched controls participated. MRI was used to determine FVMRI. A digital inclinometer was used to assess Craig's test, hip internal rotation (IR) and external rotation (ER) with hip flexed to 90° (90°), and hip IR/ER with hip in neutral flexion/extension (0°). ROM differences (ROMdif) were determined by subtracting ER from IR. Pearson correlation coefficients were used to assess the relationship between FVMRI and clinical variables. One-way analysis of variance (ANOVA) was used to compare rotation ROM among FVMRI categories. RESULTS: There were no differences between CHJP and control groups in demographics, FVMRI, Craig's test or ROM. ROMdif0° showed the highest correlation (r = 0.63) with FVMRI, then IR90° (r = 0.61) and Craig's test (r = 0.61). Differences were noted among FVMRI categories for rotation ROM except hip ER90°. CONCLUSION: Hip rotation ROM and Craig's test may be used for screening when imaging is not indicated. A 20° difference between hip IR and ER ROM would be suggestive of abnormal FV.

Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2017.

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to hip pain and mobility deficits. J Orthop Sports Phys Ther. 2017;47(6):A1-A37. doi:10.2519/jospt.2017.0301.

Gender-Dependent Differences in Hip Range of Motion and Impingement Testing in Asymptomatic College Freshman Athletes.

BACKGROUND: Athletic activity is a proposed factor in the development and progression of intra-articular hip pathology. Early diagnosis and preventive treatments in "at-risk" athletes are needed. OBJECTIVES: Our primary objective was to report hip range of motion (ROM) and prevalence of positive impingement testing in asymptomatic college freshman athletes. Our secondary objective was to determine whether an association exists between hip ROM and a positive flexion-adduction-internal rotation (FADIR) test. DESIGN: Cross-sectional study. SETTING: Collegiate athletic campus. PARTICIPANTS: Four hundred thirty (299 male, 131 female) freshman athletes reporting no current or previous hip pain. METHODS: During the athletes' preseason medical screening, trained examiners performed a hip-specific exam to obtain data for hip ROM and impingement testing. MAIN OUTCOME MEASUREMENTS: Bilateral passive ROM measures included hip flexion, and hip internal and external rotation with the hip flexed 0° and 90°. RESULTS: Mean age of male participants was 18.5 ± 0.8 and female participants was 18.3 ± 0.6 years (P = .003). Male participants demonstrated less hip ROM than female participants in flexion (115.8 ± 11.2° versus 122.0 ± 10.5°, P < .001), internal rotation in 90° flexion (26.9 ± 9.8° versus 34.7 ± 10.7°, P < .001) and 0° flexion (29.0 ± 9.8° versus 38.9 ± 10.1°, P < .001), and external rotation in 90° flexion (44.7 ± 10.9° versus 49.7 ± 10.4°, P < .001) but not for external rotation in 0° flexion (39.8 ± 11.1° versus 37.6 ± 11.5°, P = .06). Pain with FADIR test on the right and left hip were reported in 11.9% and 14.5% of athletes, respectively. Gender and a positive FADIR were not related (male 12.2%, female 15.3%, P = .36). CONCLUSIONS: In asymptomatic college freshman athletes, male athletes generally demonstrated less hip ROM than female athletes. In addition, a positive FADIR was more prevalent than previously reported in healthy young adults. Preseason screenings that use these baseline data in conjunction with other examination findings may allow identification of athletes at future risk for hip pain and/or injury. LEVEL OF EVIDENCE: IV.

Examination and treatment of a professional ballet dancer with a suspected acetabular labral tear: A case report.

Dancers are at risk for developing groin pain that is due to acetabular labral tears. Although surgical management of labral tears has been reported extensively, conservative management has been poorly described. This case report describes the examination, diagnosis, and treatment of groin pain in a professional ballet dancer with a suspected acetabular labral tear. Treatment focused on decreasing anterior hip joint stresses and improving the precision of hip motion through correction of alignment and movement impairments noted during functional activities and dance. Successful outcomes included a reduction in pain and return to professional ballet dancing.

Persons with chronic hip joint pain exhibit reduced hip muscle strength.

STUDY DESIGN: Controlled laboratory cross-sectional study. Objectives To assess strength differences of the hip rotator and abductor muscle groups in young adults with chronic hip joint pain (CHJP) and asymptomatic controls. A secondary objective was to determine if strength in the uninvolved hip of those with unilateral CHJP differs from that in asymptomatic controls. BACKGROUND: Little is known about the relationship between hip muscle strength and CHJP in young adults. METHODS: Thirty-five participants with CHJP and 35 matched controls (18 to 40 years of age) participated. Using handheld dynamometry, strength of the hip external rotators and internal rotators was assessed with the hip flexed to 90° and 0°. To assess external rotator and internal rotator strength, the hip was placed at the end range of external rotation and internal rotation, respectively. Strength of the hip abductors was assessed in sidelying, with the hip in 15° of abduction. Break tests were performed to determine maximum muscle force, and the average torque was calculated using the corresponding moment arm. Independent-sample t tests were used to compare strength values between (1) the involved limb in participants with CHJP and the corresponding limb in the matched controls, and (2) the uninvolved limb in participants with unilateral CHJP and the corresponding limb in the matched controls. RESULTS: Compared to controls, participants with CHJP demonstrated weakness of 16% to 28% (P<.01) in all muscle groups tested in the involved hip. The uninvolved hip of 22 subjects with unilateral CHJP demonstrated weakness of 18% and 16% (P<.05) in the external rotators (0°) and abductors, respectively, when compared to the corresponding limb of the matched controls. CONCLUSION: The results of the present study demonstrate that persons with CHJP have weakness in the hip rotator and hip abductor muscles. Weakness also was found in the uninvolved hip of persons with CHJP.

Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports.

OBJECTIVE: To examine whether passive hip rotation motion was different between people with and without low back pain (LBP) who regularly participate in sports that require repeated rotation of the trunk and hips. We hypothesized that people with LBP would have less total hip rotation motion and more asymmetry of motion between sides than people without LBP. DESIGN: Two group, case-control. SETTING: University-based musculoskeletal analysis laboratory. PARTICIPANTS: Forty-eight subjects (35 males, 13 females; mean age: 26.56+/-7.44 years) who reported regular participation in a rotation-related sport participated. Two groups were compared; people with LBP (N=24) and people without LBP (N=24; NoLBP). MAIN OUTCOME MEASURES: Data were collected on participant-related, LBP-related, sport-related and activity-related variables. Measures of passive hip rotation range of motion were obtained. The differences between the LBP and NoLBP groups were examined. RESULTS: People with and without a history of LBP were the same with regard to all participant-related, sport-related and activity-related variables. The LBP group had significantly less total rotation (P=.035) and more asymmetry of total rotation, right hip versus left hip, (P=.022) than the NoLBP group. Left total hip rotation was more limited than right total hip rotation in the LBP group (P=.004). There were no significant differences in left and right total hip rotation for the NoLBP group (P=.323). CONCLUSIONS: Among people who participate in rotation-related sports, those with LBP had less overall passive hip rotation motion and more asymmetry of rotation between sides than people without LBP. These findings suggest that the specific directional demands imposed on the hip and trunk during regularly performed activities may be an important consideration in deciding which impairments may be most relevant to test and to consider in prevention and intervention strategies.

Movement system impairment-based categories for low back pain: stage 1 validation.

STUDY DESIGN: Cross-sectional study of patients with mechanical low back pain (MLBP). OBJECTIVE: To test the construct validity of 3 categories of a movement system impairment-based classification proposed for use with patients with MLBP. BACKGROUND: A pathoanatomic basis for directing treatment has not proven useful in a wide variety of patients with MLBP. In addition, there is a paucity of data describing the movement system impairments that characterize many of the pathoanatomically based MLBP diagnoses. Because of the mechanical nature of MLBP, a system based on groups of signs and symptoms relevant to conservative management needs to be developed. METHODS AND MEASURES: A movement system impairment-based classification was proposed that defined 5 categories of MLBP based on the findings from a standardized examination. Using the examination, 5 physical therapists examined a total of 188 patients with MLBP. A principal components analysis with an oblique rotation was conducted. Eigenvalues were plotted and a scree test was used to determine the number of factors to retain. A split-sample cross-validation procedure was conducted to verify the factor structure. RESULTS: Three factors were identified in both samples: 2 factors related to symptoms with lumbar rotation and lumbar extension alignments or movements, and 1 factor related to signs of lumbar rotation with different alignments and movements. CONCLUSION: Our results provide support for 3 factors related to 3 of the 5 proposed categories: lumbar rotation with extension, lumbar rotation, and lumbar extension. The existence of these 3 factors provides preliminary evidence for specific clusters of tests of alignment and movement impairments that could be used in classifying patients with MLBP into movement-system-related categories.