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.

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

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

CEU Review: Modern Pain Sciences by NXT Gen Institute of Physical Therapy

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Course Title: Modern Pain Sciences: Manual Therapy’s Keys to Motivation, Input and Plan

Date: December 7th, 2014

Location: Pittsburgh, PA

Faculty: Joseph Brence, PT, DPT, COMT, FAAOMPT, DAC & Francois Prizinski, PT, DPT, OCS, COMT, FAAOMPT, DAC

Throughout my didactic and clinical education as a student at the University of Pittsburgh, I was exposed to very little in terms of modern pain science or therapeutic neuroscience education and I believe this is very common across all graduate programs. Considering most every patient being seen in a outpatient physical therapy clinic is being seen due to pain or functional limitations secondary to a painful condition, it was apparent that I needed to improve this area of practice. In the months since graduation, I have taken online courses by Adriaan Louw at MedBridge and have read the recent literature being put out by Moseley, Butler, Puentedura, and others. When I realized that Joseph Brence and Francois Prizinski of NXT Gen Institute of Physical Therapy were hosting a course at Revolution Physical Therapy just outside of Pittsburgh, I knew I had to attend.

Opposed to most continuing education courses, this course was firmly imbedded in clinical reasoning and decision making, which was made evident very early in their presentation. The emphasis on medical screening and attaining a proper initial prognosis/need for referral was good to hear as it is an area often neglected by clinicians and is VERY important as we transition to the primary point of contact for many patients with neuromusculosketal complaints. As someone is currently going through the Maitland Certified Orthopedic Manual Therapist (COMT) process, I was very pleased to see several of these concepts being included within their proposed framework. This approach is entrenched in patient response and attaining a firm understanding of the complaints of the patient and the exact movement(s) that bring on the patient’s chief complaint (comparable sign). This is in place of more biomechanical measures taught and used by therapists utilizing other orthopedic manual therapy examination/treatment philosophies.

In addition to this framework, there was an obvious emphasis on pain science principles and treatment options. This was the area I was most looking forward to and it did not disappoint. Topics ranged from the epidemiology to the current theoretical approaches for the onset of pain. Learning about the pitfalls of the Gate Control Theory was refreshing and very much coincides with my biases and why many patients do not respond to a purely biomedical approach. The introduction and explanation of the Neuromatrix was thorough and, in my opinion, is more telling with regards to patients presenting with a painful condition. This theory takes into consideration a Biopsychosocial approach, which means each individual’s painful experience is created based on contributions from the involved tissues/nervous system (biological), kinesiophobia/catastrophizing (psychological), and our interactions with our environment and support systems (social).

In addition to the lecture portion of the course, there was also ample lab time to learn to examination and treatment interventions. In all, there was about 3.5 hours of lab instruction, which was very well organized and informative with frequent one-on-one instruction from the presenters. Once again, many Maitland techniques and examination philosophies were evident, however many concepts were taken further and were organized in a efficient progressive manner to more easily determine the patient’s comparable sign. A large portion of the lab included Neurodynamic testing and treatment, which is an area that I have had little exposure. Following the lab, I felt as though I had enough confidence in the examination and treatment of patients presenting with positive neural tension of the upper quarter, which was a huge takeaway for me.

All in all, this was a fantastic course and allowed me to expand my knowledge of therapeutic neuroscience education and its place in clinical practice in addition to broadening my hands-on examination/treatment of Neurodynamics. I would definitely recommend this course to anyone who needs a more efficient examination system, a better understanding of TNE, or exposure to neurodynamics.

Below are several videos taken by the presenters of our course, which was an added bonus as I can frequently refer back to these videos if any of the techniques become fuzzy over time…

Modern Pain Sciences Course in Pittsburgh, PA

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I just wanted to take the time to let everyone know about a great course being taught in the Pittsburgh, Pennsylvania area by NXT Gen Institute of physical Therapy. I have already registered and am looking forward to learning more about pain science and how I can integrate this approach into my clinical practice. Additionally, by using the promo code Snyder10, you can save 10% on the registration fee!

CLICK HERE TO REGISTER

Course Title: Modern Pain Sciences: Manual Therapy’s Keys to Motivation, Input and Plan

Date: December 7th, 2014

Location: Pittsburgh, PA

Faculty: Joseph Brence, PT, DPT, COMT, FAAOMPT, DAC & Francois Prizinski, PT, DPT, OCS, COMT, FAAOMPT, DAC

Seminar Description: This course is designed to provide a biopsychosocial insight into the emerging neuro-scientific revolution of pain science, particularly as it relates to plasticity of the brain and the dynamics of the nervous system. Modern concepts of pain neurophysiology will be taught which are vital in the care of every one of our patients’ “painful” conditions. This course will assist the modern manual therapist on how to examine, evaluate and treat the physical health of the nervous system. It is geared toward practicing clinicians who want to learn how to effectively discern when pain is likely due to nociception, peripheral neuropathy or central sensitivity and how to approach with treatment. Additional intervention emphasis is placed on neurodynamics, engaging social forces to communicate with patients and imagery to reduce their painful experience. This is an intermediate level course.

Duration: 8 contact hours

Cost: $300.00, use promo code Snyder10 to save 10%!

CLICK HERE TO REGISTER

For a sneak peek of the concepts and philosophy behind this approach, watch the following clip from the 2013 AAOMPT Annual Conference…

CEU Review: MedBridge Education's Patient Care HEP

Patient education and the instruction of a home exercise program (HEP) is of utmost importance to clinicians in order to obtain positive patient outcomes and to improve compliance. Recently, MedBridge Education rolled out their Patient Care Portal, which includes a HEP and Patient Education materials. I have had the opportunity to use this software for the past month or so and have broken my review into the following areas…

Content

With 1,500 exercises (and growing) this HEP is almost all you will ever need with regards to prescribing a patient’s home program. These are not just simple stick figures or awkwardly drawn models either. Each exercise includes simple, modifiable instruction of technique, exercise parameters, and an in-depth video demonstration. Each exercise program can also have a detailed description and 3D video demonstration of the injury and/or disorder that your patient is being treated for. Additionally, if you cannot find the exercise or disorder that you need, both can be easily uploaded to the system. After you finished creating your patient’s program it can then be printed out, e-mailed, or the patient can visit their ‘Patient Portal’ to view their HEP and associated videos.

Ease of Use

MedBridge’s Patient Portal is one of the most user friendly HEPs that I have come across. Finding the correct exercise is simple with the ability to search based on body region, exercise type, or by searching for the specific exercise’s name. We all know that there can be countless names for the same exercise and this can cause significant issues when attempting to find your exercise in most HEPs. MedBridge’s program actually gives you the ability to modify the exercise’s name so that you can keep things straight in your head and so searching for the exercise in the future can be more efficient. Finally, to create a more efficient process, you can create templates for the more common disorders/injuries that you see on a day to day basis.

Patient Feedback

In my limited use of this program, I have heard nothing but positive feedback. Most patients are used to receiving crude drawing with poorly described exercise techniques and once they get home, all memory of how to perform their exercises is gone. I have noticed improved patient compliance and recall of exercise technique since implementing MedBridge’s HEP. The only negative comment I have received from a few patients/clients is that the pictures on the printouts are rather small and when printing in black & white, they can be difficult to see. Obviously, they could go to the website to watch the associated videos, but many patients don’t want to take that extra step.

Overall 

Honestly, I have very few negative things to say about this software. It is intuitive, detailed, and a game-changer with regards to home exercise and patient education. The only negative I see is having to log into the online program in order to make a program, but this is a very minimal hassle for such a beneficial component to my patient’s care. After using basic and (mostly) frustrating HEPs in the past, my switch to MedBridge’s Patient Portal has been seamless with a very minimal learning curve. After 15-20 minutes of playing around with the program, I felt comfortable creating, editing, and sending programs to my clients. What’s the best part of this program? The cost. Currently, the Patient Portal is included with MedBridge’s online continuing education product, so for all those therapists already using this great resource, it is absolutely FREE.

For those of you who have not yet subscribed, you can purchase a one-year subscription to the continuing education, patient portal, and reference tools (Orthopedic Exam Videos, Manual Therapy Technique Videos, and 3D Models) for only $200, which is a savings of $225! For the Discounted rate, CLICK HERE or feel free to check out the MedBridge website and use promo code orthomanualPT when you’re ready to buy. This sale is good until 11:59 PM EST on Sunday, August 10th, so don’t wait too long!