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Soft tissue injuries of the hip and pelvis are common among athletes and can result in significant time loss from sports participation. Rehabilitation of athletes with injuries such as adductor strain, iliopsoas syndrome, and gluteal tendinopathy starts with identification of known risk factors for injury and comprehensive evaluation o...
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Context 1
... eccentric training can be achieved with a theraloop around both feet stepping out to the uninvolved side, loading the involved limb, then slowly returning to the starting position (Figure 3). And eccentric treadmill resistance, performed by resisting the belt of the treadmill as the leg comes from an abducted to an adducted position (Figure 4). ...
Citations
... Another study supports this idea by stating that one of the best ways to rehabilitate the knee from common issues like "runner's knee" and osteoarthritis is to strength train the hip [16]. For injuries directly affecting the hip joint, higher-intensity training is needed to strengthen muscles that have been weakened from the injury and inactive in early recovery [20]. With the number of individuals affected by hip and knee joint injuries, there appears to be a use for devices that require more work at the knee and hip joints, specifically the quadriceps. ...
Background: Millions of people are affected yearly by “runner’s knee” and osteoarthritis, which is thought to be related to impact force. Millions are also affected by chronic falling, who are usually both difficult to identify and train. While at first glance, these topics seem to be entirely disconnected, there appears to be a need for a device that would address both issues. This paper proposes and investigates the use of the Variable Stiffness Treadmill (VST) as a targeted training device for the different populations described above. Materials and Methods: The VST is the authors’ unique robotic split-belt treadmill that can reduce the vertical ground stiffness of the left belt, while the right belt remains rigid. In this work, heart rate and energy expenditure are measured for healthy subjects in the challenging asymmetric environment created by the VST and compared to a traditional treadmill setting. Results: This study shows that this asymmetric environment results in an increase in heart rate and energy expenditure, an increase in activity in the muscles about the hip and knee, and a decrease in impact force at heel strike. Conclusions: Compliant environments, like those created on the VST, may be a beneficial tool as they can reduce high-impact forces during running and walking, engage the muscles surrounding the hip and knee significantly more than normal walking allowing for targeted training and rehabilitation, and be a useful way to identify and train high fall-risk individuals.
... The children in the study group received the pelvic control exercises with a physical therapy program, including the following [25][26]; pelvic bridge, dynamic stability bridge, circuit exercise, advanced lateral hip and gluteal strengthening exercises, and all 4's Clockwise and Counterclockwise circles with hip in extension. The exercises start from passive to active to achieve the oriented task. ...
Lack of pelvic control is a common functional impairment in children with spastic cerebral palsy (CP), so pelvic stability may be critical to improve controlled movements and activities in these children. The aim of this randomized controlled trial was to evaluate the effect of physical therapy programs combined with pelvic control exercises on controlled hip, knee, and ankle movements and gross motor functions in children with spastic CP. Thirty-two children diagnosed with spastic cerebral palsy at levels II and III on the gross motor functional classification system participated in this study. They were randomly and equally divided by a computerized program into control and study groups. The control group (eight boys and eight girls) received the designed therapy program for one hour. The study group (four boys and twelve girls) received lumbar-pelvic control exercises for 20 minutes in addition to 40 minutes of a physical therapy program. The program for both groups was applied three times per week for twelve weeks. After twelve weeks of treatment, the controlled movement, functional ability plus a joint range of motion of the hip, knee, and ankle were assessed by selective motor control scale, Peabody scales, and Kinovia software program, respectively. All statistical measures were performed through the Statistical Package for Social Studies (SPSS) version 20 for windows (SPSS, Inc., Chicago, IL). The results of our study showed a statistically significant improvement in median selective motor control, the Z score of Peabody scale, and the mean angle of hip, knee, and ankle range of motion after the treatment program in the study group compared with the control group (p < 0.05). Lumbar-pelvic control exercises are useful in improving the controlled movement and functional abilities in children with spastic diplegia CP when combined with a physical therapy program.
... Amongst others, the incidence of injuries to the lumbopelvic region ranges from 5-11% of all injuries sustained by runners [2,3]. These injuries can be debilitating and often result in significant time loss from participation in sports [4]. ...
Aims
Injuries to the lumbopelvic region are often debilitating and result in significant time loss from sports participation. Different factors which have been correlated with the occurrence of injuries are, for example, the magnitude of the anterior pelvic tilt angle and the repetitive impacts the body has with the ground. When running downhill, step length is longer, which translates into a greater joint range of motion, and the vertical velocity at foot contact is greater. As a result, risks of overuse injury could be greater as compared to level running. To help prevent such injuries, we hypothesise that increasing step frequency may be a valid way to reduce the impact with the ground and the maximal anterior pelvic tilt without affecting oxygen consumption, both in level and downhill running.
Methods
We analysed 10 inexperienced runners at preferred and +10% of step frequency during level and downhill running. We recorded the oxygen uptake together with running kinematics and kinetics.
Results
When the step frequency was increased by 10%, both in downhill and level running, neither the oxygen uptake nor the running kinetics were modified. In contrast, the maximal anterior pelvic tilt was significantly reduced with increased step frequency.
Conclusion
For inexperienced runners, these findings show that increasing step frequency may partly reduce the anterior pelvic tilt without significantly influencing the running economy.
... In other word, therapeutic exercise was very benefited on healing chronic hip, knee, and ankle injuries. Sprain and strain can be relieved by soft tissue massage but we need to complete the recovering with strength exercise [19]. At the end the posttest of strength and have been done and the outcomes showed that there was an improving of them comparing to the pre-test data. ...
Background: Chronic hip, knee, and ankle injuries are very common issues in the whole world. Musculoskeletal disorder hampers the development in several sectors including training and athletes' performance. Social, industrial, economic, and education declines are often caused by poor muscular-articular problems. This research aims to reveal the effectiveness of combine massage and physiotherapeutic exercises in: (1) the treatment of chronic hips, knee and ankle injuries; (2) improving and increasing the low limb strength and flexibility; (3) reducing the chronic pain of degenerative diseases; (4) improving the physical and mental wellbeing of human body; (5) increasing motor or sensory function; (6) increasing athlete's performance. This research is quasi-experimental with: quantitative approach. The sample of this study was 15 patients with chronic hips, knee and ankle injuries, taken by purposive sampling technique. The data were collected using measurement and treatment with combine massage and physiotherapeutic exercise. Data were analyzed using the descriptive statistics, independent sample t-test, paired sample t-test, and correlation among items using SPSS Amos.23. The result showed that there is a significant difference between pre-test-posttest strength measurement with P value (0.003<0.05). A significant difference between pre and posttest of all kinds of movement flexibilities is with the P value < 0.05. There is a strong correlation between combine massage and physiotherapeutic to the chronic knee, knee, and ankle with r >0.5. In conclusion, massage and physiotherapeutic exercise were found to be a vital part to improve human body health and it can be used by everybody.
... Iliopsoas syndrome is a series of pathologies causing groin pain, and it is composed by iliopsoas tendinopathy, internal snapping hip and iliopectineal bursitis (Tyler et al., 2014). Iliopsoas tendinopathy is an inflammation of the tendon of this muscle, often related to a bursitis, due to their close proximity (Nanni, 2017). ...
... It is more commonly found in young people with prevalence in females (Dydyk & Sapra, 2020). Iliopsoas tendinopathy occurs most frequently as a result of overuse in sports requiring repetitive hip flexion and external rotation movements (Tyler et al., 2014), such as football, artistic gymnastics, canoeing, uphill walking (Milic et al., 2020) and dancing (Tyler et al., 2014) (Laible et al., 2013) (Brunot et al., 2013). This condition in sedentary subjects could be secondary to hip arthroplasty and arthritis (Tyler et al., 2014). ...
... It is more commonly found in young people with prevalence in females (Dydyk & Sapra, 2020). Iliopsoas tendinopathy occurs most frequently as a result of overuse in sports requiring repetitive hip flexion and external rotation movements (Tyler et al., 2014), such as football, artistic gymnastics, canoeing, uphill walking (Milic et al., 2020) and dancing (Tyler et al., 2014) (Laible et al., 2013) (Brunot et al., 2013). This condition in sedentary subjects could be secondary to hip arthroplasty and arthritis (Tyler et al., 2014). ...
Tendon disorders represent some of the most frequent musculoskeletal complaints worldwide. In the athletic population, tendinopathy could affect different anatomical districts. Tendons surrounding hip and pelvis are frequently involved due to overuse and high functional demands in the athletes. These disorders negatively impact on sport performance, since they are a long-lasting clinical condition requiring a multimodal management. Great trochanter pain syndrome, proximal hamstring tendinopathy, insertional adductor tendinopathy and ileopsoas tendinopathy are the most common clinical conditions involving tendon structures of the hip and pelvis. Due to the anatomical complexity of the region, the relationship with pelvic organs, the demographic and anthropometric characteristics of the athletes, the differential diagnosis between these musculoskeletal disorders and other diseases is often difficult to conduct and some therapeutic options are challenging. Modification of risk factors, changes in training protocols, some specific therapeutic exercise programs and rehabilitation procedures have been proposed as an efficient conservative management strategy, guarantying a complete recovery of athletic function. Surgical approaches are required in a specific subset of patients. This narrative literature review aims to summarize current understanding and areas of ongoing research about the clinical features, diagnostic keys and therapeutic options of the main clinical tendinopathies surrounding hip and pelvis.
... Therefore, comprehensive risk factors should be defined, all kinetic chains should be assessed, and the exercise program should be planned accordingly. [37] In a study conducted with transvaginal physiotherapy in patients with CPP, a significant decrease was observed in pain complaints of 63% of patients. [38] In another multi-center study, patients with bladder pain syndrome/interstitial cystitis underwent physical therapy including manual therapy and exercise for the pelvic floor and hip circumference muscles, and a significant improvement was observed compared to those treated with global therapeutic massage. ...
Chronic pelvic pain is defined as persistent painful condition which lasts for at least six months under umbilicus. Numerous factors are blamed for etiopathogenesis, and quality of life of individuals is adversely affected. Chronic pain as well as functional disorders are accompanied to chronic pelvic pain. The treatment and rehabilitation program should be tailored for specific causes, targeting general pain treatment. Consequently, chronic pelvic pain management can be used to propose personalized treatment options and include patient education, behavioral therapy, and a biopsychosocial approach. Interdisciplinary teamwork and collaboration are essential for facilitating patient-centered rehabilitation. © Copyright 2018 by Turkish Society of Physical Medicine and Rehabilitation.
... Iliopsoas-related groin pain like muscle and tendon strain/tear and iliopsoas bursitis is commonly elicited on resisted hip flexion and/ or stretching of the hip flexors [35][36][37]. In the present case, iliopsoasrelated tendinopathy could be excluded, based on the location of his subjective and palpatory pain, which was located far medially. ...
... Non-aggravating activities initiated in this phase included low-level lumbopelvic exercises recommended in surgical and non-surgical progressions described in previous literature. 43,44,48,49 The goal of to approximately two to three times per week, with techniques continued from the first phase of treatment. Foam rolling of the lumbopelvic and lower extremity soft-tissues and pain-free self-mobility exercise, such as band assisted mobilization with movement of the hip 29,30 was implemented to continue to improve regional mobility as appropriate while promoting self-efficacy and avoid reliance on manual therapy. ...
... 1,6 Initial treatment focused on pain reduction while promoting exercise that addressed identified functional impairments and risk factors, and is consistent with conservative management of similarly described cases. 4,5,48,49 While morphological presentation may the stress on irritated structures. As described in the second subject, there is a high risk of re-injury risk following an initially successful bout of conservative care, thus, high priority was placed on graded sport reconditioning throughout rehabilitation, as it is important to avoid any drastic increases in training load (i.e appropriate acute:chronic workload ratio) in order to reduce the risk of re-injury while returning to prior levels of participation. ...
Background/purpose:
Athletes experiencing hip, groin, and low back pain often exhibit similar clinical characteristics. Individuals with hip, groin and low back pain may have the presence of multiple concurrent pathoanatomical diagnoses. Regardless, similar regional characteristics and dysfunction may contribute to the patient's chief complaint, potentially creating a sub-group of individuals that may be defined by lumbopelvic and hip mobility limitations, motor control impairments, and other shared clinical findings. The purpose of this case series is to describe the conservative management of elite athletes, within the identified aforementioned sub-group, that emphasized regional manual therapy interventions, and therapeutic exercise designed to improve lumbopelvic and hip mobility, stability and motor control.
Case descriptions:
Five elite athletes were clinically diagnosed by a physical therapist with primary pathologies including adductor-related groin pain (ARGP), femoral acetabular impingement (FAI) with acetabular labral lesion and acute, mechanical low back pain (LBP). Similar subjective, objective findings and overall clinical profiles were identified among all subjects. Common findings aside from the chief complaint included, but were not limited to, decreased hip range of motion (ROM), impaired lumbopelvic motor control and strength, lumbar hypomobility in at least one segment, and a positive hip flexion-adduction-internal rotation (FADIR) special test. A three-phase impairment-based physical therapy program was implemented to resolve the primary complaints and return the subjects to their desired level of function. Acute phase rehabilitation consisted of manual therapy and fundamental motor control exercises. Progression to the sub-acute and terminal phases was based on improved subjective pain reports and progress with functional impairments. As the subjects progress through the rehabilitation phases, the delivery of physical therapy interventions were defined by decreased manual therapies and an increased emphasis and priority on graded exercise.
Outcomes:
Significant reductions in reported pain (>2 points Numeric Pain Rating Scale), improved reported function via functional outcome measures (Hip and Groin Outcome Score), and continued participation in sport occurred in all five cases without the need for surgical intervention.
Discussion:
The athletes described in this case series make up a common clinical sub-group defined by hip and lumbopelvic mobility restrictions, lumbopelvic and lower extremity motor control impairments and potentially other shared clinical findings. Despite differences in pathoanatomic findings, similar objective findings were identified and similar treatment plans were applied, potentially affecting the movement system as a whole. Subjects were conservatively managed allowing continued participation in sport within their competitive seasons.
Conclusion:
Comprehensive conservative treatment of the athletes with shared impairments, as described in this case series, may be of clinical importance when managing athletes with hip, groin, and low back pain.
Level of evidence:
Therapy, Level 4, Case Series.
... The overloading of the pubic symphysis and insertional tendons could be induced by the strength imbalance between the hypertonic adductor muscle and hypotonic large flat muscular sheets of the abdomen 18 . Besides, also iliopsoas tendinopathy, internal snapping hip and iliopectineal bursitis could provoke groin pain and the three pathologies could be collectively indicated as iliopsoas syndrome 19 . While the incidence is not well investigated, an MRI study showed that prevalence of iliopsoas tendon and myotendinous injuries was 0.66% in a large sample of 4862 consecutive hip MRI 20 . ...
... While the incidence is not well investigated, an MRI study showed that prevalence of iliopsoas tendon and myotendinous injuries was 0.66% in a large sample of 4862 consecutive hip MRI 20 . This condition not exclusively affect athletes, but could be secondary to hip arthroplasty and arthritis 19 . The complexity of the biomechanics of the hip and the consequent problems of differential diagnosis determine the difficulty for the clinicians to endorse an appropriate treatment protocol. ...
Background: The anatomy of hip is widely complex and several anatomical structures interact and contribute to its functioning. For position and role, hip and the surrounding tendons, which have their insertion around, are overstressed and often overloaded, especially in athletes. This could lead to the developing of several tendinopathies, among which the differential diagnosis is often complicated. Many conservative treatments are used in clinical practice, while actually, no defined conservative protocol is recommended. Methods: This is a review article. The aim of this manuscript is to evaluate the current evidences about the effectiveness of conservative management in hip tendinopathies. Conclusion: Conservative treatment is effective in the management of hip tendinopathies and may be considered the first-line approach for patients affected. However, there is lack of evidences about which is the most effective treatment. Exercise therapy seems to provide long-term pain relief, but the literature is still lacking about the correct type, dose, posology, intensity of exercise prescribed. Further studies about different local approaches, as PRP or hyaluronic acid injections, may be encouraged. Level of evidence: I.
... The overloading of the pubic symphysis and insertional tendons could be induced by the strength imbalance between the hypertonic adductor muscle and hypotonic large flat muscular sheets of the abdomen 18 . Besides, also iliopsoas tendinopathy, internal snapping hip and iliopectineal bursitis could provoke groin pain and the three pathologies could be collectively indicated as iliopsoas syndrome 19 . While the incidence is not well investigated, an MRI study showed that prevalence of iliopsoas tendon and myotendinous injuries was 0.66% in a large sample of 4862 consecutive hip MRI 20 . ...
... While the incidence is not well investigated, an MRI study showed that prevalence of iliopsoas tendon and myotendinous injuries was 0.66% in a large sample of 4862 consecutive hip MRI 20 . This condition not exclusively affect athletes, but could be secondary to hip arthroplasty and arthritis 19 . The complexity of the biomechanics of the hip and the consequent problems of differential diagnosis determine the difficulty for the clinicians to endorse an appropriate treatment protocol. ...
Background:
The anatomy of hip is widely complex and several anatomical structures interact and contribute to its functioning. For position and role, hip and the surrounding tendons, which have their insertion around, are overstressed and often overloaded, especially in athletes. This could lead to the developing of several tendinopathies, among which the differential diagnosis is often complicated. Many conservative treatments are used in clinical practice, while actually, no defined conservative protocol is recommended.
Methods:
This is a review article. The aim of this manuscript is to evaluate the current evidences about the effectiveness of conservative management in hip tendinopathies.
Conclusion:
Conservative treatment is effective in the management of hip tendinopathies and may be considered the first-line approach for patients affected. However, there is lack of evidences about which is the most effective treatment. Exercise therapy seems to provide long-term pain relief, but the literature is still lacking about the correct type, dose, posology, intensity of exercise prescribed. Further studies about different local approaches, as PRP or hyaluronic acid injections, may be encouraged.
Level of evidence:
I.
