Identification of Abnormal Hip Motion Associated With Acetabular Labral Pathology

Andrea B. Austin, Richard B. Souza, John L. Meyer, Christopher M. Powers

STUDY DESIGN: Resident's case problem. BACKGROUND: Recent literature has suggested that acetabular labral pathology secondary to femoroacetabular impingement (FAI) may be a precursor to early-onset hip osteoarthritis. The purpose of this resident's case problem was to explore the extent to which abnormal movement at the hip is a possible contributor to acetabular labral pathology. DIAGNOSIS: The patient was a 25-year-old female with a 4-year history of anterior-medial groin pain. Based on a combination of the clinical examination and magnetic resonance imaging findings, she was given a diagnosis of acetabular labral tear by her orthopaedic surgeon and referred to a physical therapist for assessment. Movement analysis during a single-leg step down, running, and a drop jump maneuver revealed excessive hip adduction and internal rotation on the involved side, which reproduced her symptoms. Application of a hip-strapping device resulted in decreased hip adduction and internal rotation, and an immediate decrease in symptoms. DISCUSSION: The reduction in pain secondary to controlling hip motion suggests that excessive frontal and transverse plane hip motions may contribute to FAI. Accordingly, physical therapy intervention aimed at controlling and reducing hip adduction and internal rotation during activities may be indicated in patients who present with this movement pattern associated with anterior hip/groin pain. LEVEL OF EVIDENCE: Differential diagnosis, level 4.

J Orthop Sports Phys Ther. 2008;38(9):558-565, published online 3 June 2008. doi:10.2519/jospt.2008.2790

KEY WORDS: biomechanics, FAI, femoroacetabular impingement, hip labrum, motion analysis

Differential Diagnosis and Treatment of Subcalcaneal Heel Pain: A Case Report

John L. Meyer, Kornelia Kulig, Robert F. Landel
Study Design: Case report. Objective:To describe the examination and intervention strategy utilized in the differential diagnosis and treatment of a patient with subcalcaneal heel pain. Background: The patient was a 44-year-old man with an 8-month history of left subcalcaneal heel pain. He presented with a chief complaint of limited standing and walking tolerance secondary to pain in the left heel. He had not responded to previous treatments of rest, anti-inflammatory medication, cortisone injections, and exercise prescription. Materials and Methods: The patient’s subcalcaneal heel pain was reproduced utilizing the straight leg raise (SLR) in combination with ankle dorsiflexion and eversion to sensitize the tibial nerve. These findings suggested a neurogenic component to the dysfunction. Because restricted ankle dorsiflexion, excessive pronation, and posterior tibialis weakness were also found, mechanical dysfunctions also likely contributed to the etiology of heel pain. The patient was treated for 10 visits over a period of 1 month. Treatment consisted of active and passive motions aimed at restoring pain-free soft-tissue motion along the course of the tibial nerve. In addition, low-dye taping and therapeutic exercises were utilized to control excessive pronation and reduce stress on the plantar structures of the foot. Results: The patient’s SLR increased from 42° to 54° and became pain-free. Dorsiflexion range of motion increased from 3° to 8° in the left ankle, and left posterior tibialis strength was normalized. Over a period of 1 month the patient’s symptoms were resolved, and his standing and walking tolerance was fully restored. Conclusion: Assessment and potential contribution of neural dysfunction should be considered in patients with subcalcaneal heel pain.

J Orthop Sports Phys Ther. 2002; 32(3):114–124.

Key Words: neural entrapment, plantar fasciitis

Journal of Orthopaedic & Sports Physical Therapy - John L. Meyer, DPT

Identification of Abnormal Hip Motion Associated With Acetabular Labral Pathology

Differential Diagnosis and Treatment of Subcalcaneal Heel Pain: A Case Report