Movement Impairment Syndromes of Hip

What 3 components cause movement impairments?

• Repeated movements

• Sustained alignments

• Personal characteristics

What factors may create preferred ways of movement?

• Tissue adaptation over time

• Choosing path of least resistance

• Repeated microtrauma

• Tissue overload, breakdown, or pathology

What are movement system impairment syndromes?

• Deviation from optimal arthrokinematics

• Contributes to hypermobility & path of least resistance

• Localized painful conditions can arise

According to Shirly Sahrmann, what are the diagnoses named by?

The movements or postures that cause the patient pain

What is AGMR?

• Femoral anterior glide, medial rotation

• Hip IR/adduction during LE stance

• Excessive anterior glide of femoral head & medial rotation of femur

• Failure of hip ER counteracting hip IR

What does AGMR lead to?

• Decreased accessory mobility of hip in posterior direction

• Creates path of least resistance in anterior hip jt

• Femoral IR & hip add during OKC OR CKC movements

What is the clinical presentation of AGMR?

• Hip/groin pain during active hip flexion or LE loading

• Groin pain → aching pain of whole hip

• Affects low back & knee

• Seen in runners, dancers, martial arts, soccer players

• Caused by repetitive motions of LE

What are some symptoms/conditions associated with AGMR?

• LBP

• ITB problems

• GT bursitis

• Knee pain

• Ankle pain

• Foot pain

• Impaired neural dynamics

Which muscles are weak in AGMR?

• Psoas

• PGM

• Glute max

• Hip ER

Which muscles are stronger and more dominant in AGMR?

• TFL

• Medial hamstring

How does AGMR present in OKC movements?

Hip flexion imbalance b/w TFL & iliopsoas during swing phase

How does AGMR present in CKC movements?

Hip ER, PGM, glute max, lateral hamstrings usually weak during stance phase

How should a typical MSI clinical exam look like?

• ID painful movement through subjective interview

• Observe painful movement & do key movement screen

• Find modification that has biggest reduction of symptoms

• Promote exercises/activities w/ that modification

What are the key tests & measures for AGMR?

• Squat

• SLS, single leg squat, single leg hop

• Patient described activity or position that causes pain

What are you looking for when a patient does a squat?

Increased femoral IR & adduction of involved side

What are you looking for when a patient does a single leg stance/squat/hop?

• Increased femoral medial rotation

• Increased hip adduction (Trendelenburg)

• Combo of both (dynamic Q angle)

• Lumbar rotation

What are some key modifications for AGMR?

• Avoid hip IR

• Avoid hip adduction

• Avoid combo

• Avoid excessive lumbar rotation

How can you make modifications during your session?

External stabilization or cuing

What are the main parts of PT intervention of AGMR?

• Symptom modification

• Accessory mobility (posterior glide)

• Strength

• Patient education on movement & modifications

• Manual therapy

• Therapeutic exercises