Is exercise therapy for femoroacetabular impingement in or out of FASHIoN? We need to talk about current best practice for the non-surgical management of FAI syndrome

Kemp, Joanne L; King, M.; Barton, Christian J; Schache, Anthony G.; Thorborg, Kristian; Roos, Ewa M.; Scholes, Mark J; Grimaldi, Alison; Semciw, Adam; Freke, Matthew; Risberg, May Arna; Reiman, Michael P.; Mayes, Susan Dickerson; Pizzari, Tania; Heerey, Joshua J; Lawrenson, Peter; Ingelsrud, Lina Holm; Crossley, Kay M

doi:10.1136/bjsports-2018-100173

Cited by 31 publications

(32 citation statements)

References 7 publications

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“…FASHIoN randomised controlled trial [15] and Palmer [16] both demonstrated that hip arthroscopy showed superior outcomes with arthroscopic hip surgery compared to personalised hip therapy [14]. The personalised hip therapy included exercise and activity modification but specific assessment and motor control retraining of individual MCI was not undertaken [21]. There is growing evidence in individuals with spinal pain of variations of neuromuscular adaptation [22].…”

Section: Discussionmentioning

confidence: 99%

“…A recent editorial challenged current best practice for non-surgical management of FAIS and asked the pertinent question: "are we providing high-quality, outcome driven, exercise therapy programs to these patients?" [21]. Specifically, the editorial by Kemp questioned whether the non-surgical treatment programmes included the type, dose and progression of exercises needed to generate a meaningful change in strength and function [21].…”

Section: Introductionmentioning

confidence: 99%

“…[21]. Specifically, the editorial by Kemp questioned whether the non-surgical treatment programmes included the type, dose and progression of exercises needed to generate a meaningful change in strength and function [21]. This includes questioning what constitutes (1) contemporary "optimal non-surgical care" for patients with FAIS, (2) contemporary "optimal post-surgical rehabilitation" and (3) an effective, contemporary return to sport programmes for patients with FAI syndrome [21].…”

Section: Introductionmentioning

confidence: 99%

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Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report

Mottram

Warner

Booysen

et al. 2019

JFMK

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Athletes with femoroacetabular impingement syndrome (FAIS) managed arthroscopically do not always return to sport. Inability to control back/pelvis, hip and lower limb movements may contribute to the onset and recurrence of symptoms. Our hypothesis is that results from a battery of cognitive movement control tests can inform a cognitive movement control (neuromuscular) retraining programme for improving the clinical presentation and quality of life in an athlete with FAIS. This case report presents a female elite rower with persistent left-sided anterior hip pain, four years post-arthroscopic surgery for FAIS, whose symptoms failed to respond to conventional physical therapy. Hip and groin outcome score (HAGOS), passive and active hip flexion range of motion (ROM) workload (time training on water), hip and pelvic kinematics (3-D motion analysis) and electromyography during a seated hip flexion movement control test, and a movement control test battery to identify movement control impairments (The Foundation Matrix), were assessed pre-intervention (week 0) and immediately post-intervention (week 16). Impaired movement control was targeted in a tailored 16-week cognitive movement control retraining exercise program. All measures improved: HAGOS (all 6 sub-scales); symptoms (61/100 pre-training to 96/100 post-training); physical activities participation (13/100 to 75/100); and active hip flexion ROM increased (78 to 116 and 98 to 118 degrees, respectively); workload increased from 4 to 18 h/week; and movement control impairment reduced (25/50 to 9/50). Pelvic motion on kinematic analysis were altered, and delayed activation onset of tensor fascia latae and rectus femoris muscles reduced. This proof-of-concept case report supports the hypothesis that cognitive movement control tests can inform a targeted cognitive movement control retraining program to improve symptoms, function and quality of life, in an elite rower with persistent hip pain. This training offers an alternative approach to conventional physical therapy, which has failed to restore function in FAIS, and the present study illustrates how specific cognitive movement control assessment can direct individual training programmes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report

Mottram

Warner

Booysen

et al. 2019

JFMK

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“…As Dwyer et al 4 have reported, the optimal type of physiotherapist-led treatment remains unclear, although preliminary evidence suggests exercise-based treatment is likely to be effective. 12,13 I look forward to the publication of clinical trials of physiotherapist-led treatment for FAI syndrome in the future to assist patients and clinicians alike in making informed decisions about which treatment option is best for them.…”

Section: Found a Small Statisticallymentioning

confidence: 99%

Editorial Commentary: A Commentary on a Meta-analysis of Short-Term Outcomes

Kemp

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Hip pain is prevalent and costly, and young patients with hip femoroacetabular impingement have similar levels of pain and quality of life to older patients with hip osteoarthritis. Hip arthroscopic surgery for femoroacetabular impingement is increasing in prevalence, and the benefits of operative treatment compared with nonoperative treatment require consideration. Hip arthroscopy should not be a first-line treatment but can be necessary in cases in which highquality, exercise-based nonsurgical treatment options have been exhausted. Patients should be informed that surgery is not necessarily cost-effective and may have an increased risk of comorbidities such as chronic pain and insomnia. Patientreported outcomes may improve by up to 20% with either surgery or physical therapy but are not likely to return to those seen in patients without hip pain. Although most patients return to sport after hip arthroscopy, the ability to participate at a preinjury level is seen in fewer than a quarter of patients. Return-to-sport rates with physiotherapist-led nonoperative treatment are not known.

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“…A recent expert clinical commentary, written in response to these randomised controlled trials highlights that the included exercise interventions either failed to target known impairments in hip-related pain or reach the threshold of biological plausibility to address clinical deficits. 115 Non-surgical, exercise based management may provide a low risk and cost-effective alternative to surgery with the potential for improved outcomes, if exercise based interventions are optimally designed.…”

Section: Management Of Hip-related Painmentioning

confidence: 99%

Muscle activity and morphology in hip-related pain

Lawrenson¹

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Hip-related pain is common in young active people and is associated with intra-articular pathology and the pathogenesis of early onset osteoarthritis (OA). Hip-related pain can impact athletic participation and quality of life, as well as pose an ongoing financial burden to society through costs associated with long term management, including surgery. Improved knowledge of factors that contribute to the symptoms of hip-related pain and progression of joint degeneration are important. Muscles surrounding the hip are proposed to influence joint forces and dynamic stability, which can impact joint health and symptoms, yet little is known about muscle activity or morphology in hip-related pain. A greater understanding of the role that muscles play in hip-related pain may identify pathways for targeted treatment and primary prevention strategies in the future. A systematic review and meta-analysis (Study 1) was undertaken to ascertain the current best evidence regarding muscle morphology in hip-related pain. This review investigated all stages of articular hip pathology across the pathological continuum, identifying the presence of altered muscle morphology in moderate to advanced hip OA. The magnitude of difference in muscle size was not uniform across all muscles, suggesting they may be uniquely influenced by demand in articular pathology. Hypertrophy of deep anterior muscles, spanning the hip joint, in populations with compromised passive stability supports a hypothesis of increased activity to augment joint stability. Limited research has examined muscle activity in earlier stages of hip pathology, highlighting the need for further investigation of muscles surrounding the hip joint to clarify their role in hip-related pain. Iliocapsularis is a pericapsular muscle orientated over the anterior hip with direct attachments to the capsule. Because of its location and capsular insertions, it is theorised to play a dynamic role in joint stability which may be important in hip-related pain. Intramuscular electromyography (EMG) of Iliocapsularis has not been undertaken, due in part to its relative anonymity, and close proximity to the femoral neurovascular bundle posing technical 3.2.5

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Is exercise therapy for femoroacetabular impingement in or out of FASHIoN? We need to talk about current best practice for the non-surgical management of FAI syndrome

Cited by 31 publications

References 7 publications

Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report

Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report

Editorial Commentary: A Commentary on a Meta-analysis of Short-Term Outcomes

Muscle activity and morphology in hip-related pain

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