One‐year outcomes following physical therapist‐led intervention for chronic hip‐related groin pain: Ancillary analysis of a pilot multicenter randomized clinical trial

Harris‐Hayes, Marcie; Steger-May, Karen; Bove, Allyn M; Mueller, Michael J.; Clohisy, John C.; Fitzgerald, G. Kelley

doi:10.1002/jor.24985

Cited by 5 publications

(3 citation statements)

References 34 publications

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“…38 Improving hip flexor flexibility has also been proposed as a target, although limited research suggests that addressing hip flexor flexibility in isolation does not lead to carryover in functional tasks. 58 Training specific movements with improved pelvic motor control may be of benefit, 23,59,60 however generalized strength and flexibility interventions may produce similarly beneficial patient-reported outcomes 60 and more research is needed in this area. While there are several potential targets, it is not established if pelvic tilt can be changed because of a specific or generalized rehabilitation plan, or if specifically tracking the change in pelvic tilt might be a useful prognostic factor for a successful outcome.…”

Section: Discussionmentioning

confidence: 99%

Clinical Measures of Pelvic Tilt in Physical Therapy

Suits

2021

International Journal of Sports Physical Therapy

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Pelvic tilt refers to the spatial position or motion of the pelvis about a frontal horizontal axis on the rest of the body in the sagittal plane. It is relevant for several musculoskeletal conditions commonly seen in physical therapist practice, particularly conditions affecting the hip and groin. Despite the relevance of pelvic tilt identified in biomechanical studies, and the historical precedence for assessing pelvic tilt, there is a lack of clarity regarding the utility of clinical measures that are practical in a rehabilitation setting. There are several options available to assess pelvic tilt which are discussed in detail in this commentary. All of these options come with potential benefits and considerable limitations. The purpose of this commentary is to provide an overview of the relevance of understanding pelvic tilt in the pathology and rehabilitation of conditions affecting the hip joint, with a focus applying evidence towards identifying clinical measures that may be useful in the rehabilitation setting and considerations that are needed with these measures.

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Section: Discussionmentioning

confidence: 99%

Clinical Measures of Pelvic Tilt in Physical Therapy

Suits

2021

International Journal of Sports Physical Therapy

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“…Standard postoperative care +in-patient physiotherapy for gait aid +written education material +requested to not undertake formal rehabilitation programme. 80 Wright et al 72 (n=18) showed a large but non-significant between-group difference on HOS-Sport at 6-week follow-up in favour of hip exercises performed at home versus manual therapy and supervised physiotherapy for FAI syndrome (mean difference: 21.1 points, 95% CI −9.1 to 51.3, Hedges g=1.27) (very low quality of evidence).…”

Section: Prescribed Post-operative Physiotherapy Vs Advicementioning

confidence: 99%

“…22 However, 12-month follow-up suggests that within-group improvements are retained, indicating a potential long-term effect of nonoperative treatment outcome. 80 Due to the heterogeneity of physiotherapy interventions between these studies, it seems difficult to recommend a specific non-operative treatment approach (eg, movement pattern training vs hip strengthening) beyond exercise-based treatment. 12 The mechanisms of improvements following exercise-based treatment are yet to be elucidated, but may be related to improvements in hip muscle strength 14 and altered hip joint kinematics (ie, reduced hip adduction angle during single leg squatting) 111 potentially reflecting better load-bearing capacity of the hip joint.…”

Section: Diagnosis and Clinical Informationmentioning

confidence: 99%

Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment—a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

et al. 2021

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This statement summarises and appraises the evidence on diagnostic tests and clinical information, and non-operative treatment of femoroacetabular impingement (FAI) syndrome and labral injuries. We included studies based on the highest available level of evidence as judged by study design. We evaluated the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation framework. We found 29 studies reporting 23 clinical tests and 14 different forms of clinical information, respectively. Restricted internal hip rotation in 0° hip flexion with or without pain was best to rule in FAI syndrome (low diagnostic effectiveness; low quality of evidence; interpretation of evidence: may increase post-test probability slightly), whereas no pain in Flexion Adduction Internal Rotation test or no restricted range of motion in Flexion Abduction External Rotation test compared with the unaffected side were best to rule out (very low to high diagnostic effectiveness; very low to moderate quality of evidence; interpretation of evidence: very uncertain, but may reduce post-test probability slightly). No forms of clinical information were found useful for diagnosis. For treatment of FAI syndrome, 14 randomised controlled trials were found. Prescribed physiotherapy, consisting of hip strengthening, hip joint manual therapy techniques, functional activity-specific retraining and education showed a small to medium effect size compared with a combination of passive modalities, stretching and advice (very low to low quality of evidence; interpretation of evidence: very uncertain, but may slightly improve outcomes). Prescribed physiotherapy was, however, inferior to hip arthroscopy (small effect size; moderate quality of evidence; interpretation of evidence: hip arthroscopy probably increases outcome slightly). For both domains, the overall quality of evidence ranged from very low to moderate indicating that future research on diagnosis and treatment may alter the conclusions from this review.

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Incorporating Functional Strength Integration Techniques During Total Hip Arthroplasty Rehabilitation: A Randomized Controlled Trial

Judd,

Cheuy,

Peters

et al. 2023

Physical Therapy

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Objective Total hip arthroplasty (THA) is a common orthopedic procedure that alleviates pain for millions of individuals. Yet, persistent physical function deficits, perhaps associated with movement compensations, are observed after THA. These deficits negatively affect quality of life and health for many individuals. Functional strength integration (FSI) techniques combine muscle strength training with specific movement retraining to improve physical function. This study aimed to determine if FSI would improve functional performance through remediation of movement compensations for individuals after THA. Methods A double-blind randomized controlled trial was conducted. Ninety-five participants were randomized to the FSI or control (CON) group for an 8-week intervention. The FSI protocol included exercise to improve muscular control and stability around the hip to minimize movement compensation during daily activity. The CON protocol included low-load resistance exercise, range-of-motion activities, and patient education. Functional performance, muscle strength, and self-reported outcomes were measured preoperatively, midway and after intervention, and 6 months after THA. Change from preoperative assessment to each time point was measured and between-group differences were assessed. Results There were minimal differences in outcomes between groups at the first postoperative assessment. There were no statistically significant between-group differences in the later assessments, including the primary endpoint. Both groups improved functional outcomes throughout the study period. Conclusions The FSI intervention did not result in greater improvements in function after THA compared to the CON intervention. Future work should further investigate additional biomechanical outcomes, timing of the FSI protocol, effective dosing, and patient characteristics predictive of success with FSI. Impact Recovery after THA is complex, and individuals after THA are affected by persistent movement deficits that affect morbidity and quality of life. The present study suggests that either approach to THA rehabilitation could improve outcomes for patients, and that structured rehabilitation programs may benefit individuals after THA.

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One‐year outcomes following physical therapist‐led intervention for chronic hip‐related groin pain: Ancillary analysis of a pilot multicenter randomized clinical trial

Cited by 5 publications

References 34 publications

Clinical Measures of Pelvic Tilt in Physical Therapy

Clinical Measures of Pelvic Tilt in Physical Therapy

Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment—a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

Incorporating Functional Strength Integration Techniques During Total Hip Arthroplasty Rehabilitation: A Randomized Controlled Trial

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