Exam 3 PED 315

Femoroacetabular impingement (FAI)

Osseous condition in the hip joint

Symptoms:

• Pain in groin

• pain with hip flexion, adduction, and IR

• May have clicking

• Decreased ROM

Pincer FAI

Cam FAI

Combined FAI

both cam and Pincer found at the same time

Hip Labrum

• Often accompanied with FAI

• Can be the result of trauma, repetitive stress or osseous abnormality

Treatment

• conservative or surgical

Gluteal tendinopathy/bursitis

Pain in lateral hip on greater trochanter

Symptoms:

• pain in lateral hip

• pain exacerbated with resisted hip abduction resistance testing

• weakness with testing of glutes

Treatment

• gradually strengthen glutes

• even if some tearing, still rebuild strength

Hamstring strain

Cause:

• quick hip flexion and knee extension (runnning movement)

Symptoms

• sudden onset of posterior thigh pain

• palpable

• pain and weakness with resisted knee flexion

• may have bruising

Treatment

• peace and love

• gradually rebuild strength and ROM

• Surgery only if not responding or major setbacks

Adductor strain

Causes:

• sudden acceleration

• sudden change in direction

Symptoms

• pain in inner thigh

• pain with resisted hip adduction

treatment

• peace and love

• gradually rebuild adductor strength and ROM

Athletic Pubalgia

Sports hernia

• defined as weakening of ab wall without evidence of true hernia

symptoms

• groin and lower ab pain

• pain with kicking, cutting, and sprinting

• pain with resisted sit up

• pain with coughing

treatment

• rest

• gradual build in strength

• surgery if failed response

Femoral Neck Stress Fracture

Most common in military recruits and endurance athletes

• large increase in activity

• MRI!!

• Positive fulcrum test

• gradual return to activity

Gluteal Tendinopathy EARLY Exercises

Gluteus minimus and medius tendons attached to greater trochanter

• respect to pain

Early Exercises

• isometrics

• DL bridges

• Clam shells

I

Gluteal Tendinopathy INTERMEDIATE Exercises

Side hip abduction

standing hip abduction

side steping

Gluteal Tendinopathy ADVANCED Exercises

pistol squat

SL hip thrust

Step up with resistance

Hamstring strain

NO ICE

NO STATIC STRECHING

• focus on eccentric and quad activation

Hamstring strain: running

start stage 1 when able to walk with minimal pain

• build when tolerated

Adductor muscle strain

Similar to hamstring

isometrics to advanced eccentrics

• copenhagen adduction

lateral ankle ligaments

lateral ankle sprain

Cause: inversion injury

• rolled ankle from cutting, landing, change of direction

Symptoms

• ligament tenderness

• acute hypermobility

• swelling

• bruising

high ankle sprain

damage to the syndesmotic ligaments

cause: extreme external rotaion and dorsiflextion of the talus

symptoms

• anterolateral ankle pain

• squeeze test

• ER + DF test

  

Achilles tendinopathy

can be inflammatory tendinitis or chronic

cause: rapid increase in activity level OR chronic degredation

symptoms

• painful and weak plantarflexion

• limited dorsiflexion

• painful palpation on tendon

• may have bump

plantar fasciitis

plantar fascia becomes irritated or inflamed

causes:

• can be one time injurry

• often chronic overuse

• altered foot posture

• decreased flexibility and strength of foot intrinsic and calf muscles

Symptoms

• decreased flexibility

• pain with first steps in morning

• pain will subside after minutes of walking tho

• painful palpation

Flat foot

prolonged stretching of plantar fascia due to loss of foot arch

high arch

poor shock absorption by reduced contact area

turf toe

toes need to extend to be able to walk and run

What actually happens?

• joint capsule injruy to first MTP joint

Cause

• hyperextended MTP joint with external load

symptoms

• decreaed and painful ROM

• swelling

• bruising

• tenderness

Progressions

• DL to SL

• level ground to unlevel

• add sport specific activity

• add cognitive demand

• add perturbations

Ankle tape

significant improvements in end range joint position sense

• it doesn’t affect performance except to improve stair decent

brace or tape?

• if able, an individual should participate in therapy exercises without any tape or brace to load their own tissues

• if the patient can safely return to sport quicker with the assistance of tape or brace, they are encouraged to do do

Tape

proprioceptive

Brace

mechanical stability

achilles tendinopathy treatment

wait and see is not recommended

• Needs active treatment!

Eccentric

• heel raise off step

• DL to DL concentric, SL eccentric to 100% SL

Standing calf raise

gastrocemius

fast twitch

bent knee calf raise

soleus

slow twitch