A Systematic Approach to the Athlete with Hip Pain: Introduction (02:18)
Dr. Pete Seidenberg and Dr. Jimmy Bowen began collaborating while in the military. Hips are often considered the "black box" of sports medicine. The panelists encourage the audience of physicians to ask questions.
Patient History (03:55)
Hips are often considered the "black box" of sports medicine because patients give vague complaints about the pain. Ask about paresthesias, radiation, pain with a cough or sneeze, medications, diet, and other symptoms. Have the patient point to the pain using one finger, reproduce the pain, and discuss training regiments.
Physical Examination (04:46)
Take vitals; check standing posture; look for muscle wasting, gait, and low back activity; palpate the lumbosacral; perform a Trendelenburg test; and have the patient sit down and stand up. Dr. Bowen describes how he conducts the physical examination.
Abdominal Examination (02:04)
Referred pain occurs in the abdominal area. Complete a male genital exam and pelvic examination to check for hernias. Dr. Bowen checks the flexion, extension, abduction, abduction, and the rotation of the hip joint.
Testing the Hip Joint (05:04)
Include strength, log roll, Stinchfield, straight leg raise, Thomas, Patrick's, Ober's, lateral pelvic compression, and Ely's tests in a physical examination. Dr. Bowen explains how the tests and hip pain relate to different vertebrae in the spine.
Special Tests (04:49)
Aaron Daws agrees to act as the patient. Hip flex to 90 is an internal rotation. Dr. Seidenberg demonstrates the log roll, Stinchfield, popliteal angle, piriformis, external rotation, scour, and FAIR tests.
Other Hip Tests (03:03)
Dr. Seidenberg demonstrates the Patrick's, Ober's, lateral pelvic compression, Ely's and femoral nerve tests. If a patient begins to rock, measure from that spot.
Thomas Test (04:27)
Dr. Seidenberg prefers a modified Thomas test which examines the hip flexors and knee extensors. When he sees a tight iliotibial band, he checks the ipsilateral gluteus medius. If he believes the pain generates from the patient's back, he performs a straight leg raise and slump test.
Testing for Hip Issues (04:43)
If a runner has extension-based back pain, check for hyperlordosis and patient compensation. Dr. Seidenberg demonstrates other tests to perform on patients with hip pain.
Treating More than Pain (01:49)
Physicians must correct asymmetry or the patient will reinjure his or her hip. Audience members comment and react to the panelist's demonstration.
Q/A: Hip Pain with Leg Length Discrepancy (03:59)
Heel lifts do not help leg length discrepancy.Dr. Seidenberg tends to not use high-velocity low-amplitude manipulation to re-establish symmetry; he prefers muscle energy.
Q/A: Testing the Sacroiliac Joint (03:55)
The Patrick's test is the most specific test for the sacroiliac joint. Bowen sees many patients with osteogenesis imperfecta. Patients with vastus medialis oblique inhibition also have quad and hamstring weakness. Physicians need to examine above and below the afflicted joint.
Q/A: Functional Screening (05:14)
Dr. Bowen's strength and conditioning specialists perform functional movement tests. Dr. Bowen makes patients who injured their hip abductors perform front and side planks, and bird activities before allowing them to return to sport. A doctor in the audience performs a plyometric evaluation on athletes before allowing them to play sports.
Credits: A Systematic Approach to the Athlete with Hip Pain (2013 ACSM) (00:26)
Credits: A Systematic Approach to the Athlete with Hip Pain (2013 ACSM)
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