Welcome back to the blog!!
Today we're we're moving up the chain from the knee to the hip. We're discussing femoroacetabular impingement a.k.a. "hip impingement." Anyone familiar with that "pinching" in the front of their hip with a squat, lunge, or while running has likely dealt with a "functional hip impingement" episode. If you have experienced this over a longer period of time, you should be evaluated for hip impingement syndrome.
Hip impingement has gained notice in the sports medicine community specifically over the last 15 years as advancements in diagnostics and surgical procedures has led to increased people going under the knife. This is a syndrome that can be defined in really 2 ways; intra-articular and extra-articular impingement. Extra-articular refers to soft tissue impingement outside the joint, which could be muscular or nervous system in nature. Most commonly though, we are refereing to intra-articular issues which are further classified in to 3 sub-diagnoses; a Pincer Lesion, Cam Lesion or Mixed Lesion. In a Pincer lesion the, there is bony overgrowth of the acetabular rim (the socket) that leads to decreased available motion for femoral head (ball) and increased "pinching" at the top of the joint with flexion. In a Cam Lesion, the overgrowth is on the neck of the femur and leads to an early contact between the acetabulum and head of the femur at end range. Both of these can lead to increased shearing at the joint. They are often diagnosed both clinically with certain special tests as well as with both x-ray and MRI. However, recent studies have show that clinical tests are not as specific as we would like them to be for diagnosis, and imaging does not seem to have a direct correlation between evidence of a Cam or Pincer lesion and the presence of pain.
The amount of information on the internet regarding this condition is endless. Also endless, is the amount of information on how to correct this condition. There are many options from many different medical practitioners including; massage, anti-inflammatory injection, surgery, stretching and strengthening, dry needling, myofascial release, adjusting squat position and form, etc... I'm here to tell you that you really should weigh your options and seek advice from a trusted health care professional to make a decision on your treatment. In many cases, non-operative treatment should be your absolute first choice.
A recent study (https://www.ncbi.nlm.nih.gov/pubmed/30398893) looking at FAI non-operative management in 76 youth athletes showed that 82% of athletes were successfully managed conservatively with rest, physical therapy, and progressive activity introduction.
This is obviously a study with youth, but much of the research also supports non-operative management in the older adult. Cam Impingement does seem to have a increased incidence of steroidal and surgical intervention.
Now, I'm not going to go over the specific exercises that will help you with hip impingement as you should be evaluated by a Physical Therapist to tailor a program directly to your needs or refer you for additional testing if needed, but I will say that structural findings on an imaging technique do not always correlate with pain. Many people function every day with structural hip Pincer and Cam lesions but are asymptomatic and able to squat heavy loads at the gym as well as run long distance races. Healthcare providers need to be very careful diagnosing people on imaging alone, and focus more on individual structural demands and goals for the patient.
Therefore, when looking for a solution to your "squat stopper" hip impingement problem, first seek medical advice from a trusted musculoskeletal expert. You should receive a detailed subjective and clinic evaluation that treats you as an individual with specific needs. Relay your goals to the clinician and then weigh your options based on multiple opinions on what your treatment should be. Remember, conservative treatment should be your first choice when addressing your pain and limitations. Most of the time, a skilled rehab specialist will be able to get you back to doing the things you love, with minimal to no pain all the while avoiding invasive techniques such as surgery if possible.
Well I hope this was educational for everyone. Make sure you check back in next week.
Welcome back everyone!
I'm finally discussing some current research on the diagnosis and treatment of a specific injury. In this week's blog, I'm discussing the current Clinical Practice Guidelines for diagnosing and treating Patellofemoral Pain Syndrome (PFP). So if you have ever had knee pain related to squatting, running, descending stairs etc.. then this should be an informative read for you, providing you some direction in your ability to address your symptoms.
PFP is commonly referred to as "Jumper's or Runner's knee." This condition involves, typically, insidious onset of pain behind or around the knee cap. This is a very common syndrome with an estimated prevalence of 25% up to 50% in the general population over their lifespan and does account for anywhere between 2-7.5% of people presenting for medical care. This syndrome most commonly affects youth athletes between the ages of 12-19 but some studies indicate a higher prevalence in the 50-59 year old age group.
Symptoms usually present with no specific injury and can come on slowly overtime. Typically there is worsening of pain with lower-limb loading (eg, squatting, prolonged sitting, ascending/descending stairs, jumping, or running, especially with hills). There is poor correlation between internal derangement of tissue or cartilage damage and symptoms, and therefore a clinical diagnosis based on a cluster of symptoms associated with pain reports during squatting, descending stairs, and knee flexion positions like prolonged sitting should be used. Your medical provider and rehab specialist should be looking at these things as the best supported way to diagnosis this condition.
Once there is a clear idea that you are dealing with PFP, a tailored strengthening program and symptom management program should be developed based on these well supported treatment approaches. This really should be a staple in all treatment approaches.
Have you ever been told you have flat feet?? Well, it turns out that, flat feet in combination with an increased knee valgus (inward tilt) angle may contribute to symptoms early on.
Therefore, within the first 6 weeks, a pronation controlling foot orthotic may provide relief from symptoms temporarily. Studies also show that over-the-counter orthotics provide just as much support for this condition as do custom orthotics. Talk to your therapist about one that might work for you.
In addition within the first 6 weeks, patellar taping can provide relief for symptoms and can be a very cost effective way to address symptoms early on.
With that that being said, the major focus for individuals with PFP should be gluteal and quadriceps specific strengthening exercises. These should be in both the open chain (resisted knee extension, hip raises, banded stepping etc..) as well as in the closed chain (weighted cross over step ups, progressive resisted squats and lunges etc..). This program should be set over a 6-8 week time frame allowing for true strength gains.
So, If you are someone that is battling anterior knee pain associated with tasks such as running, squatting, descending stairs, or sitting for prolonged periods and are looking for a resolution to your problem, talk to a physical therapist or musculoskeletal healthcare expert today to follow these research supported guidelines to aid in your recovery.
Hope you enjoyed and thanks for reading!
Citation: Willy, Richard Et. al. Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 2019 Volume:49 Issue:9 Pages:CPG1–CPG95 DOI: 10.2519/jospt.2019.0302
Welcome back to the Blog! Hopefully you have found useful information here in the past, or if this is your first time reading my material, well then, I hope you enjoy!
Today I am discussing 3 ways to optimize your ability to lift and load weight overhead. In addition to helping you lift more in the gym, this also has major implications for maximizing your function as you age. My goal with you reading today is for you to gain a better understanding of how you move with and without weight. So let's get started with the first Key!!
1. How well do you move without weight or load??
One of the most important points. Simply put, Can you move freely and smoothly without restriction when you are not holding weight?. If you can't move smoothly, then you can't load correctly. It's equivalent to attempting squat 150lbs when you can't move from sitting to standing. It's possible to do it once with compensation, but over time it will lead to a disaster. So you first need to understand your movement without load and what you need to do to improve it. A strength and conditioning coach, movement coach, or physical therapist is a great resource here.
2. Identify any limitations and address them with targeted exercises.
I mean how long can you drive a car on a bad tire or without new oil before it breaks down? How far can you ride your bike on plastic parts? So you need to identify and understand your limitations with shoulder Mobility, thoracic Mobility, movement flaws, and/or strictly strength limitations. There are many ways that you can go about doing this. In fact, head to my YouTube channel for more information or see a movement specialist to help you. They'll identify your limitations and restrictions as well as give you some tips on how to correct these. Now, if you've been loading for a long time, and you're like, I'm fine.. I've been doing great. Well that's fine too, but I bet you're wondering; Man, I haven't really ever had anyone look at this. I wonder how much better I could be performing and how many PR's I could break if I was moving optimally? That is another reason why it is important to know your limitations and know what to do to address them.
3. Have a plan with progression of load
How many times have we gone into the gym and just started working out, or just followed the workout for the day that we saw online?? I mean, I'm as guilty of this as anyone, but I do understand the long term importance of progressive load. I think we really need to identify a true strength and conditioning program for us to progress overhead strength. This may look like a standard 8 to 12 week hypertrophy and strength progression. It could be a CrossFit program from your local box or online that you stick to, that you don't deviate from. I think having a plan is ultimately one of the most important things that we need to do with fitness, with nutrition, with our jobs. So having a plan is going to let you optimally load your shoulder and build strength to crush your overhead goals.
So those are the three keys to overhead success and keys to optimizing your overhead shoulder performance which has long term implications with your ability to maintain strength as you age as well as achieve your weightlifting and functional goals!
Hope you enjoyed the blog and check back in soon for our next topic!
Dr. Luke Greenwell is a Performance Based Physical Therapist with an extensive background in treating the injured athlete. He is passionate about returning people to the sports & activities they love. He has post-doctorate certifications in Manual Spine Therapy and Functional Dry Needling. He is also a NSCA Certified Strength and Conditioning Specialist. He has extensive experience in Dartfish video gait/running analysis, concussion rehab, & functional movement screening & correction. He is the owner of CrossFit based RecoverRx Physical Therapy