THE HIP COURSE – MANAGING HIP INSTABILITY

COURSE DESCRIPTION

Hip Instability may be described as a direction-specific sensorimotor disorder of the hip and has emerged as a common condition in hip pain patients. Despite the anecdotal disability for this subgroup, active research is lacking in this area to guide diagnosis and treatment. This course will cover the clinical process of diagnostic distinction of those with frank instability of the hip and those who present with a direction-specific sensorimotor disorder, previously termed micro-instability. The specific management planning and execution for these different presentations will be reviewed. Leanne Rath (FACP) will present a three stage objective battery of tests, which can help identify the direction-specific sensorimotor disturbance and the active entry point for rehabilitation. Generous practical time will be allocated to practice the assessment process and to practice each entry-level exercise specific to each clinically identified direction. Information regarding presenting symptoms, adaptation to prolonged symptoms, adaptation to pain and potential course of resolution will be discussed based on exposure to this subgroup of hip pain patients clinically. Clinical Reasoning Tasks will be incorporated to consolidate learning.

 

 

At the end of the course, the Physiotherapist will be expected to be able to:

  1. List the related contexts for the development of instability of the hip or direction-specific sensorimotor disorder of the hip
  2. Develop special questions in the subjective examination in a direction-specific sensorimotor disturbance or of hip instability
  3. Describe the varied presenting symptoms on the sensorimotor disturbance continuum up to hip instability
  4. Read the radiological signs that link to instability on MRI and Xrayeg acetabular dysplasia
  5. Understand the facts of hip joint centre translation relative to direction-specific sensorimotor disorder of the hip and hip instability
  6. Perform clinical assessment to rule in or rule out the potential for instability
  7. Determine the possible contributing directions of instability / sensorimotor disturbance disorder
  8. Determine entry level active rehabilitation and facilitate this
  9. Identify who requires joint protection in the form of restricted WB, tape etc
  10. Plan a rehab programme
  11. Understand the limitations of evidence and areas for research in these presentations
  12. Identify who has other co-existing co-morbidities

 

THONGS

As the weather warms up many of us will reach for a trusty pair of thongs, but do you know what effect that have on your feet? Health professionals have been warning patients to limit their use for decades and now there is evidence to reinforce the message.
Research completed at Auburn University has found that thongs significantly change how you walk. When compared to bare feet, walking in thongs decreased stride length, decreased stance time, increased muscle activity in the lower leg, increased ankle dorsiflexion during swing and decreased hallux dorsiflexion. Furthermore when walking in thongs, plantar foot pressure is increased when compared to walking in runners (1)
What does this research mean? It is generally accepted that thongs don’t support or protect the foot. But what we now know is that thongs actually make more work for the foot. The research highlights how the wearer grips thongs by changing the angle of the foot and increasing muscle activity. These same muscles fatigue earlier and are less able to perform their primary role of supporting the foot.
Thongs have their place in any shoe closet as a ‘sometimes’ shoe. But what the research now confirms is they are not suited for long periods or for people with certain foot pathologies.
We do know that in the Australian summer it’s difficult not to reach for a pair of thongs or sandals when it gets hot however there are more supportive options available, something our podiatrists are trained to advise based on your foot type and footwear needs. If you have any questions about your footwear please make an appointment to see one of our podiatrists.

MEET THE PRESENTERS OF THE PFJ SYMPOSIUM – Dr Lachlan Giles

Dr Lachlan Giles

We are excited to welcome Dr Lachlan Giles on board for the PFJ Symposium.

Lachlan is both a clinician and researcher, having worked in private practice since 2009 and completing his PhD at La Trobe University in 2016.

He has multiple peer-reviewed publications investigating rehabilitation strategies in patellofemoral pain and his research won best poster at the 2013 Sports Medicine Australia National Conference. Lachlan recently presented his work on Blood Flow Restriction training at the Australian Physiotherapy Association Conference and Sports Medicine Australia’s National Conference.

 

Read about all our PFJ Symposium presenters by clicking here.

PAUL’S AMY GILLETT SHARE THE ROAD TOUR

The Amy Gillett Share the Road Tour is sadly over. I have just ridden from the Gold Coast to Sydney. An amazing experience with a committed group of riders and advocates for safer roads – cyclists and motorists together. We rode 1080km over 7 days in rain, sunshine, on gravel, up and down hills, up to 180km per day.

The point of the ride is to raise awareness and to raise funds. For more info go to http://www.amygillett.org.au.

 

Thank you to those who have helped so far by attending our first movie night or donating directly. If you would like to support this great cause you can do a number of things:

  1. Donate directly https://strt2017.gofundraise.com.au/payments/donate/page/451604
  2. Be an advocate for a change in legislation in Victoria, the only Australian state not to trial or adopt the 1m min distance Daniel Andrews et al need to be logical and make this happen. Ridiculous – drivers do this anyway!
  3. Do the Share the Road Tour next year!
  4. Check out this year’s itinerary https://strt2017.gofundraise.com.au/cms/ridebook and ride information https://strt2017.gofundraise.com.au/cms/rideinfo

Thanks for helping, donating or being aware. A metre matters!

Regards

Paul

MEET THE PRESENTERS OF THE PFJ SYMPOSIUM – Professor Bill Vicenzino

Professor Bill Vicenzino – PhD, MSc, BPhty 

Bill Vicenzino is the Chair of Sports Physiotherapy, Director of the Master of Physiotherapy (Musculoskeletal and Sports) programs and Director of the Sports Injuries Rehabilitation and Prevention for Health (SIRPH) research unit at the University of Queensland. Bill’s research interests include musculoskeletal health, pain and injury with an emphasis on sport and physical activity, with a focus on establishing evidence based approaches to rehabilitation and prevention. His latest research aims to gain a better understanding of persistent musculoskeletal conditions and  impairments (including patellofemoral pain) and their management; these projects include a number of randomized clinical trials attracting NHMRC funding that are being published in high impact medical journals (BMJ, Lancet, JAMA).

 

Read about all our PFJ Symposium presenters by clicking here.

MEET THE PRESENTERS OF THE PFJ SYMPOSIUM- Dr Jean-Francois Esculier

Dr Jean-Francois Esculier – PT, PhD, Cert. Sport Physiotherapy (SPC) 

Jean-Francois Esculier completed his bachelor of physiotherapy at the University of Ottawa, Canada, before undertaking graduate studies (Masters and PhD) at Laval University, Canada. Over the past few years, he has conducted studies on patellofemoral pain in runners (treatment approaches, biomechanics, footwear), and shows particular interest for clinical research. Jean-Francois is also an active clinician and currently practices as a physiotherapist at the Allan McGavin Sports Medicine Clinic in Vancouver, Canada. He is currently a post-doctoral research fellow at the University of British Columbia. Given his interest for knowledge translation, Jean-Francois enjoys teaching continuing education courses pertaining to the prevention and treatment of running injuries through The Running Clinic.

 

Read about all our PFJ Symposium presenters by clicking here

MEET THE PRESENTERS OF THE PFJ SYMPOSIUM – Professor Kay Crossley

Professor Kay Crossley – PhD (Melb), BAppSci(Physio) 

Professor Kay Crossley is the Director of the La Trobe Sport and Exercise Medicine Research Centre. Kay’s main research focus is on the prevention and management of patellofemoral pain and early-onset osteoarthritis after sports-related injuries. Kay is a physiotherapist with many years of experience in clinical sports physiotherapy.  She has contributed to a number of sports medicine and physiotherapy texts, including every edition of “Brukner and Khan’s Clinical Sports Medicine”. Kay maintains a strong research interest in optimising treatments for patellofemoral conditions (pain and osteoarthritis). Additionally, she has developed a new focus of research, which encompasses three major fields.  The major focus is on the development and prevention of osteoarthritis following sports related injuries, with fields in patellofemoral osteoarthritis following patellofemoral pain, knee osteoarthritis following ACL reconstruction and hip OA following hip-related injuries (including FAI and labral tears).

 

Read about all our PFJ Symposium presenters by clicking here.

 

3 REASONS TO STRENGTH TRAIN AFTER INJURY

Strength or resistance training involves much more than simply going to the gym a couple times a week. To gain the most from strength training it’s crucial to understand the science behind exercise choice, dosage and planning. This is the foundation of designing a strength training program.

 

In fact, strength training is more about the design of the program than the exercises themselves. Recent evidence highlighting the significance of concepts such as load management and periodization emphasize this point. These concepts include progressively building your training volume and intensity, providing appropriate variety in the program and accounting for the physical profile and injury history of the patient.

 

The idea of strength training can make some people who’ve been previously or currently injured apprehensive. However, the risk of aggravating an injury must be balanced with the risk of staying in a deconditioned state and maintaining a higher re-injury risk. Which brings me to one of the most common questions I get asked by patients, ‘what can I do to prevent this happening again?’ Thankfully these days my answer is both simple and based on sound scientific evidence – improve your strength.

 

It would be wonderful if improving strength were an easy process. Though physical and mental effort is required to complete the actual strength program, it’s structure need not be complicated. With the guidance from an appropriately qualified Physiotherapist, a simple yet highly effective strength training program can be designed to progress your injury rehabilitation and reduce your injury risk.

 

In summary there are three main reasons you should strength train following an injury:

 

1. Resistance Training is a valid treatment option for musculoskeletal rehabilitation.

A recent systematic review using data from 1545 rehabilitation patients demonstrated that strength training improved outcomes in chronic low back pain, knee osteoarthritis, chronic tendinopathy and post hip replacement patients (Kristensen and Franklin-Miller, 2012. Other studies have shown that a structured resistance training program can reduce pain and improve function in neck pain (Gross, 2015), groin pain (Jensen, 2012), shoulder pain (Andersen, 2014) and also osteoporosis (Gomez-Cabello, 2012).

 

2. Strength training reduces sports injury risk
A recent systematic review using data from over 26000 patients showed that ‘strength training reduced sports injuries to less than a third’ and suggested that strength training may also halve overuse injuries (Lauersen et al, 2014).

 

3. Strength Training is easy to start
As most patients following injury are starting from a low base of fitness, strength training doesn’t need to involve large weights, squat racks, benches or sweaty mats in a gym with blaring music. In most cases to achieve an appropriate training stimulus simple bodyweight training is ideal.

 

IN SUMMARY, RESISTANCE TRAINING:

  • is effective in treating a range of common musculoskeletal conditions
  • is effective in reducing sports injury risk
  • is easy to perform.

 

By John Contreras

APA Sports Physiotherapist, S&C Coach, Pilates Instructor

 

Find out more about John’s Strength & Conditioning Essentials for Physiotherapists Course