Conservative management acutely improves functional movement and clinical outcomes in patients with pre-arthritic hip pain

Abstract

Conservative management for individuals with pre-arthritic hip pain is commonly prescribed prior to consideration of surgical management. The purpose of this study is to determine if patients with pre-arthritic hip pain will improve their functional movement control and clinical outcome measures following the implementation of physical therapy and a home-exercise programme. Information was retrospectively collected on consecutive patients and included: demographics, diagnosis, initial and follow-up evaluation of the single leg squat test (SLST) and step-down test (SDT), and patient-reported outcome measures. An independent t-test and one-way analysis of covariance were performed for continuous patient-reported outcome measures and a Fisher’s exact test was performed for patient satisfaction. Forty-six patients (31 female and 15 male) diagnosed with pre-arthritic hip pain were included. A total of 30 patients improved their functional movement control during performance of the SLST, whereas 31 patients improved performance of the SDT. There was a statistically significant difference between patients that improved and did not improve (P ≤ 0.017). Patients with pre-arthritic hip pain who improved their functional movement control following a prescribed rehabilitation intervention are likely to report less pain and greater functional ability in their daily and sports-related activities. This study supports conservative management to acutely improve outcomes for patients with pre-arthritic hip pain.

The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of femoroacetabular impingement syndrome (FAIS): an international consensus statement

“…A classification-based treatment plan can be developed according the evaluation algorithm in conjunction with identified impairments. Interventions should be directed at a prioritized problem list that looks to address deficits in strength, ROM, flexibility and neuromuscular control, while considering biomechanical abnormalities [ 8 , 13 ].…”

“…Strengthening activities for the muscles of the hip and lumbosacral spine may improve weakness and muscle imbalance. Exercises directed at improving neuromuscular control may help compensate for the boney deformities [ 13 ]. Therapeutic interventions need to be implemented with consideration for movements that provoke symptoms and should be executed in a pain-free manner that does not create additional joint irritation [ 8 ].…”

Impaired Lower Extremity Biomechanics, Hip External Rotation Muscle Weakness, and Proximal Femoral Morphology Predict Impaired Single-Leg Squat Performance in People With FAI Syndrome

“…In combination, these previous studies demonstrate a need for further research into SLS squat performance in patients with FAIS. 11,12,18,24 Specifically for FAIS, it is important to determine the modifiable factors related to squat performance, such as hip biomechanics, muscle strength, and pain, as well as factors to identify how related nonmodifiable factors, such as bony morphology, are associated with this performance.…”

The Single Leg Squat Test: A “Top-Down” or “Bottom-Up” Functional Performance Test?

“…Further support of this "top-down" approach to assessing SLST performance can be seen in intervention studies in which treatments targeting proximal muscle function have been shown to improve SLST performance. 1,60,61 These factors indicate that the evidence-based SLST protocol used in the current study and commonly implemented in the clinic may best be used to assess proximal, rather than distal, contributors to functional movement of the lower extremity kinetic chain. Furthermore, the results suggest that clinical screening of hip abductor strength by manual muscle test and Trendelenberg test is not adequate to detect a dysfunction that may result in MKD during the SLST.…”

“…The SLST is commonly used for injury prevention screening and physical rehabilitation evaluation. The test has been applied to individuals with non-arthritic hip pain, 1 patellofemoral pain syndrome, [2][3][4][5][6] knee osteoarthritis, 7 and anterior cruciate ligament (ACL) reconstruction. 8,9 Excessive medial knee deviation (MKD) during the eccentric phase of the squat is a common finding 10,11 and is used as a marker of aberrant movement patterns in both visual rating scales [12][13][14][15][16] and kinematic measurements.…”