The Athlete’s Hip: Simplifying Evaluation, Treatment, and Return to Sport

The Athlete’s Hip can be a complicated issue for sports medicine professionals and athletes alike… Do you want to learn how to accurately and efficiently evaluate and treat this population?

Currently scheduling for 2018/19, see below for information regarding the course and learn if you want to host a course!

Description:

Hip pathology is an often under-appreciated and misunderstood problem for clinicians and athletes alike. As intra-articular and extra-articular hip pain has become more prominent, surgical procedures have increased exponentially, but examination and conservative management have unfortunately lagged behind.

This two-day course will delve into evidence-based evaluation, conservative management, and return to sport of athletes presenting with hip pain. Through lecture and lab sessions, you will learn how to evaluate and treat athletes presenting with intra-articular (femoroacetabular impingement syndrome, acetabular labral pathology, and ligamentum teres pathology) and extra-articular pathology (sacroiliac joint, extra-articular impingement, athletic pubalgia, piriformis syndrome, proximal hamstring pathology, and greater trochanteric pain syndrome).

By simplifying the evaluation and management of these conditions, at the conclusion of this course, clinician will be more confident in determining underlying pathology, appropriate management, need for surgical consult, and safe return to sport.

Presenter:

John Snyder, PT, DPT, OCS, CSCS

Objectives:

Upon completion of this course, participants will be able to:

  • Understand the complexity of pain and its impact on hip pathology
  • Understand the impact of femoroacetabular biomechanics on hip and concomitant LE pathology and injury risk
  • Be able to accurately assess for red flags (avascular necrosis, femoral stress fracture, and inguinal hernia) and referral from proximal regions
  • Be able to accurately and efficiently evaluate extra-articular and intra-articular hip pathology
  • Be able to screen for and determine the need for surgical intervention
  • Understand pathology dependent and region dependent manual therapy and exercise progression for hip pathology
  • Progression of LE exercise and end-stage rehabilitation principles
  • Be able to determine psychosocial, functional testing, and pathology specific factors to determine safe and efficient return to sport

Schedule

Day 1

09:00 – 09:30 Introduction & Pain Science
09:30 – 10:15 Impact of hip pathology and biomechanics on movement
10:15 – 11:00 Screening of Pelvic/Hip Region (Lab/Lecture)
11:00 – 11:15 Break
11:15 – 12:15 Examination of Intra-articular Pathology (Lecture)
12:30 – 13:30 Lunch
13:30 – 14:30 Examination of Intra-articular Pathology (Lab)
14:30 – 15:15 Examination of Extra-articular Pathology (Lecture)
15:15 – 15:30 Break
15:30 – 16:00 Examination of Extra-articular Pathology (Lab)
16:00 – 17:00 Where does surgery fit in?

Day 2

09:00 – 10:00 Epidemiology of Conservative and Surgical Interventions
10:00 – 10:45 Treatment of Intra-articular hip pathology (Lab/Lecture)
10:45 – 11:00 Break
11:00 – 12:00 Treatment of Extra-articular hip pathology (Lab/Lecture)
12:00 – 13:00 Lunch
13:00 – 14:00 End-stage Rehabilitation Considerations
14:00 – 15:30 Return to Sport Determination (Lecture/Lab)
15:30 – 15:45 Final Comments/Conclusion

Scheduled Dates

I am currently scheduling for 2018-2019. Please contact me if you are interested in hosting The Athlete’s Hip or Management of the Ice Hockey Athlete at your facility.

Review: MedBridgeGO Patient HEP app

Patient compliance is an integral piece of the rehabilitation puzzle. Patients being consistent with their prescribed home exercise program depends on several factors, however there are two aspects that stand out beyond the rest.

  1. Forming a Therapeutic Alliance with the patient and getting buy-in that their program will help them achieve THEIR goals
  2. Providing a thorough, efficient, and easy to use resource so that they can feel confident in the performance of their program.

While the first aspect of the puzzle relies on the clinician and their ability to educate and coach their patient, the second aspect can be accomplished with the correct technology. Recently, Medbridge came out with their MedBridgeGO app to compliment their growing Home Exercise Program. I have been using both the HEP and app for the past month and below are my thoughts…

How it Works:

1. You use MedBridge’s VERY easy to use home exercise program

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2. The patient downloads and accesses MedbridgeGO, then inputs their access code (provided by their PT)

3. Their session begins…

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Additional Features:

1. Patient education resources that are modifiable are also available to be accessed via the MedbridgeGO application. This allows the patient easy access to information regarding their condition.

2. The ability to set a reminder in order to improve patient compliance.

This feature gives your patients the ability to set an alarm that will automatically sync with their phone’s alarm system. This allows for the patient to have continual reminders that they need to do their homework. In theory, this eliminates the, “I forgot” excuse.

1. Ease of Use

The program is very easy to use and I have been able to utilize it with patients in their teens (much more successfully) and my geriatric population (with a bit more coaching). There will always be patients that prefer a paper home exercise program whether because they prefer that medium or they do not feel comfortable with the technology. All menus and screens spell out what needs to be done and it is presented in a very clear, simple manner.

2. Accuracy of Program

With over 4,000 exercises and 150 patient education resources, there is ample to choose from when making your patient’s home exercise program. That being said, if something has not found its way into their database yet, you do have the ability to add your own exercises/patient education or modify existing content. All exercises chosen in the HEP transferred seamlessly to the MedbrdgeGO app throughout my use to this point.

3. Patient Compliance

The added benefit in this system is being able to see when patients actually performed their HEP… Some patients can be a but ‘misleading’ in their responses. Outside of this additional checks and balances, I have found that giving my patients an easy to perform and easy to access home exercise program has led to increased compliance and accuracy of exercise performance throughout my time using the program.

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4. Overall

This program gives the therapist all of the tools needed to provide a simple, effective home exercise program. The program itself is not for everyone because it does require a requisite comfort level with technology, however this has been a much smaller population than I had expected.

As great as the program is, there are a few areas that do need addressed moving forward. The exercise program is based on a timer that is calculated based on the sets and reps chosen by the therapist. However, as we know, patients perform movements with varying levels of ease and speed. This can make some patients feel as though they are lagging behind throughout the program. Additionally, this issue especially comes through when giving patients a hold time during their exercise (i.e. hold a bridge for 5 seconds or long duration isometrics for 30 seconds) since the current time calculation does not account for this. By having the patient ‘pause’ their program, this issue can be worked around.

The MedbridgeGO app gives the clinician and patient the ability to ensure that they are 100% on the same page with regards to exercise performance and frequency of performance. It has a few small areas that need addressed (and I am sure they will be), but overall adding this program has been incredibly beneficial to my patient care and I will continue to utilize it moving forward.

Updated Clinical Prediction Rule Resource (Again)

Clinical Prediction Rules (CPRs) are an interesting, complicated, and often misunderstood area of rehabilitation research.

To say all CPRs are not created equal would be a significant understatement.

In this most recent rehaul of the CPR Resource, I focused on not just adding to the quantity of rules included, but I spent the vast majority of time adding adequate information in order to allow the reader to discern the value of each specific rule.

From rules that have been invalidated under further investigation (Stabilization for low back pain) to those that have contradictory findings (Spinal manipulation for low back pain), enough information is available to allow the reader to make the most logical decision based on the evidence available.

In addition to the added thoroughness of the information provided, I have also added several rules that were left off the original list. See below for the additional rules provided…

Diagnostic:

Ankylosing Spondylitis (Berlin Criteria)
Ankylosing Spondylitis (IBP Criteria)

Interventional:

Exercise for Ankylosing Spondylitis
Manual Therapy and Exercise for Acute Lateral Ankle Sprain
Mobilization with Movement for Lateral Epicondyalgia

Finally, make the best clinical judgment of each rule based on your patient population, the stage of CPR development (derivation –> validation –> impact analysis –> implementation), and the literature supporting or refuting its value.

Welcome to the New Site!

This site was created to act as a resource to rehabilitation professionals, students, and patients alike…

Having spent nearly 5 years blogging, I have amassed a large amount of content and I have been able to see how my thought processes and beliefs have evolved over this timeframe. In doing so, I have recognized areas that needed to be updated in order to keep up with the current literature.

I have recently updated my Clinical Prediction Rule and Functional Testing resources to include updated information and to more accurately present the strength of each rule/test. This allows for the information to be more easily and accurately used in clinical practice.

I will be posting several articles detailing the improvement to my website and how each area has been updated.

Additionally, I am happy to announce that I am offering two Live courses and am in the process of scheduling for 2018-2019. If you are interested in hosting The Athlete’s Hip: Simplifying Examination, Treatment, and Return to Sport or Evaluation & Management of the Ice Hockey Athlete, feel free to Contact Me.

Thanks again for reading and for all the support you have given me and my content over the last 5+ years!

– John Snyder, PT, DPT, OCS, CSCS

Learn from John: Upcoming Courses

I will be teaching two one-day continuing education courses in Indiana later this month through Medical Minds in Motion. These courses will teach clinicians (PT, PTA, or OT) evidence-based assessment, treatment, and return to sport/recreation of hip pathology.

For more information, see the below links for specific details of each course or feel free to message me directly.

February 27th – Indianapolis, Indiana – Evidence-Based Assessment and Treatment of the Hip Joint

February 28th – Evansville, Indiana – Evidence-Based Assessment and Treatment of the Hip Joint

Thanks!

John Snyder, PT, DPT, CSCS

CEU Review: Orthopedic Excellence: The Spine

Course Title: Orthopedic Excellence: The Spine

Faculty: Chad Cook, PT, PhD, MBA, FAAOMPT and Eric Hegedus,PT, DPT, MHSc, OCS, CSCS

Overview:

Orthopedic Excellence: The Spine is a course series offered through the online continuing education company MedBridge Education. The series is broken into three regions (cervical, thoracic, and lumbar) and two categories (evaluation and treatment). All courses, excluding the short introductory course, are taught by Chad Cook.

Pros:

  1. Evidence-based information regarding evaluation and treatment of spinal disorders
  2. Thoroughly planned evaluation and treatment scheme
  3. Accurate and robust reporting of the statistical properties of common special tests and evaluative procedures
  4. Use of a treatment-based classification system
  5. Well-organized and instructed lectures, which lay out not only specific manual therapy techniques, but also the epidemiology, risk factors, and literature supporting the interventions or evaluation techniques discussed
  6. Excellent and clearly recorded videos of specific manual therapy techniques and exercises
  7. Integration of physical performance testing into the evaluation of spinal conditions
  8. 30+ hours of online videos
  9. Ability to complete course series at home without the need to travel
  10. No cost with subscription to MedBridge Education’s online database of courses (~$200)

Cons:

  1. Difficult to learn manual therapy techniques via online course due to the inability to practice with the direction of an instructor
  2. Some redundancy throughout course series due to the fact that the courses are also offered as stand alone entities. This requires overview of the general philosophy, statistics, and pathologies being discussed within each course
  3. No live patient cases included demonstrating the evaluation scheme or treatment philosophy

Overall:

For the busy clinician who cannot make the time/travel commitment of attending a live course, the Orthopedic Excellence: The Spine course series offers a fantastic alternative. Every aspect of the course is centered around evidence-based concepts with no blind claims made without the support of appropriate literature. While a live course will always be the superior choice due to the interaction with instructors and supervised practice, MedBridge offers the best online option for learning evaluation and treatment of spinal conditions.

For more information regarding what MedBridge Education has to offer, check out my review of their excellent Home Exercise Program or browse their Website

Clinical Prediction Rule Update

I have taken the time to update the Clinical Predition Rule (CPR) Resource

Newly added CPRs include:

1. Anterior Shoulder Instability
2. Closed Cervical Fracture
3. Hip Osteoarthritis
4. Lumbar Spinal Stenosis
5. MCL Pathology
6. Vertebral Compression Fracture

Additionally, the Litaker et al. study was added to the diagnostic CPR for Rotator Cuff Pathology and the Tseng et al. study was added to the CPR for Cervical Manipulation.

This is an ongoing project and new CPRs will be added and current CPRs will be updated as new research becomes available. Also be sure to check out the Functional Testing / Return to Sport Resource as well!