Do You Have Snapping Hip Syndrome?

 

Hip

Do you ever experience a snapping sensation when you bend or rotate your hip?

The most common reason for the snapping is stiffness in the iliotibial band or in the iliopsoas muscle.

As you bend or rotate your hip, the stiffness of the iliotibial band will cause a snapping sensation on the outside of your hip. This is caused by the iliotibial tendon snapping against the greater trochanter of your femur. By the same token, stiffness in the iliopsoas muscle will cause a snapping sensation on the inside of your hip. This is caused by the iliopsoas tendon snapping against the lesser trochanter of the femur.

You can read more by clicking HERE.

So what do you do about it? Come on in for a free screening and we will take a look. We need to get you on a stretching, strengthening and self-mobilization program in order to alleviate the imbalances that are causing the snapping.

 

SI Joint Pain & Dysfunction. Do U Have It?

The sacroiliac or SI joint is the articulation between the bone at the base of the spine called the sacrum and the bones on both sides of the pelvis called the ilium. Refer to the picture below.

Over 22 years of physical therapy, I have treated many patients with low back and buttock pain who were diagnosed with an SI joint dysfunction. The difficulty with diagnosing an SI joint dysfunction is that the SI joint has no specific distribution pattern of pain.  Pain directly over the SI joint does not necessarily mean that the joint itself is involved. SI joint pain can very often be referred pain from other structures such as the disc, nerve root, or facet joints of the lumbar spine. Many physical therapists or physicians attempt to diagnose an SI joint dysfunction through palpation of bony landmarks as well as assessment of SI joint mobility. There is only a very small amount of motion in the SI joint i.e. 2-3 mm or 2-3° of gliding or rotation thereby making an accurate diagnosis very difficult. In addition, evidence based research refutes the reliability and validity of accurately assessing bony landmarks and SI joint mobility. McGrath et al has published an article, entitled Palpation of the sacroiliac joint: an anatomical and sensory challenge in which the concept of SI joint palpation is scrutinized. Freburger and Riddle performed a literature review looking at our ability to perform SI joint motion testing. They found poor inter-tester reliability, low sensitivity, and low specificity in several commonly performed tests. Inter-rater reliability is essentially the ability for multiple practitioners to come to the same diagnostic conclusion. If you have multiple individuals perform the same test, the results should be the same. Riddle and Freburger in another study noted that the ability to detect positional faults of the SI joint also has poor reliability. At present, the only acceptable method of confirming or excluding a diagnosis of a symptomatic SI joint is a fluoroscope guided intra-articular anesthetic block ie an injection directly into the SI joint. (Laslett et al) So how can I, as your physical therapist, assist in the diagnosis of an SI joint dysfunction?  The answer: SI joint provocation tests!

Two recent studies by Laslett et al and Van der Wurff et al have demonstrated that there isn’t just one key or ideal SI joint provocation test. However, by performing several tests together, you can increase your sensitivity and specificity of detecting an SI joint dysfunction. Both studies reported that the accuracy of detecting SI joint dysfunction is increased if least 3 of the 5 tests are positive. Furthermore, if all 5 tests are negative, you can likely look at structures other that the SI joint. Van der Wurff et al reported that if at least 3/5 of these tests were positive, there was 85% sensitivity and 79% specificity for detecting the SI joint as the source of pain.  Interestingly, another study by Kokmeyer et al agreed with the previous findings, but also noted that the thigh trust test alone was almost as good at detecting SI joint dysfunction as the entire series performed together.

Combining the two studies, there are 5 provocation tests to perform when attempting to diagnose SI joint pain:

  1. Thigh thrust/Femoral Shear test
  2. SI Distraction Test
  3. SI Compression Test
  4. Gaenslen’s Test
  5. FABER / Patrick’s test

The following video will demonstrate these tests. I would like to thank Mike Reinold, PT for his blog information that was used to complete this explanation of SI Joint dysfunction.  Check out the video below!!

CORRECTION:  I would like to clarify the SI distraction test as described in Laslett. I believe that he considers the direct posterior shear of the innominates as a distractive force of the ilium away from the sacrum. I initially interpreted this test as a compression of the SI joint via a distraction of the ASIS’s. I guess it depends on HOW you apply the force to the ASIS’s.  Also, the sidelying “compression” test needs to be performed in a straight, linear fashion as well in order to compress the SI joint. It is important to place a towel roll under the lumbar spine in women in order to prevent sidebending stress t the lumbar spine. In OMT, we use the sidelying position to “distract” the SI joint using more of a rotational force on the lateral edge of the ilium in order to “open up” and distract the SI to get a feel for joint play. As you can see, these tests are not definitive for exactly HOW they stress the joint but they are specific for a stressing maneuver TO the SI joint.

 

Reebok pays 25M – Kick in the Butt!

As an addendum to the my last post “Whats Up with the Shape-Ups?”, guess what happened to Reebok? They have to pay 25 million due to false “toning” claims. Talk about a kick in the butt!! Read on.

PORTLAND, Ore. — Reebok will need to tone down advertising for its shoes that claim to reshape your backside.

The athletic shoe and clothing company will pay $25 million in customer refunds to settle charges by the Federal Trade Commission that it falsely advertised that its “toning” shoes could measurably strengthen the muscles in the legs, thighs and buttocks. As part of the settlement, Reebok also is barred from making some of these claims without scientific evidence.

“Settling does not mean we agree with the FTC’s allegations,” Dan Sarro, a Reebok spokesman, said in a statement Wednesday. “We do not. We have received overwhelmingly enthusiastic feedback from thousands of EasyTone customers.”

It’s the latest controversy surrounding so-called toning shoes, which are designed with a rounded or otherwise unstable sole. Shoemakers say the shoes force wearers to use more muscle to maintain balance and consumers clamored for them, turning toning shoes into a $1.1 billion market in just a few years. Companies such as Reebok, New Balance and Skechers have faced lawsuits over their advertising claims. But the FTC settlement, announced Wednesday, is the first time the government has stepped in.

Reebok International Ltd. makes a range of toning products, including its RunTone running shoes, EasyTone walking shoes and flip flops and some clothing. The company, which is owned by Adidas AG, said that its toning shoes were one of its most popular product launches ever when they debuted in 2009. The company marketed them heavily with ads featuring women in short shorts and with shapely bottoms; one ad even said the shoes would “make your boobs jealous”.

The FTC took issue with Reebok’s ads that claimed its EasyTone footwear had been proven to lead to 28 percent more strength and tone in the buttock muscles and 11 percent more strength and tone in hamstring and calf muscles than regular walking shoes. The FTC said it could not disclose if it was pursuing similar actions against other shoe makers.

“We think this is a real victory for consumers,” said Dana Barragate, an FTC attorney involved in the case. “We hope it sends a message to businesses that if they are going to make claims they must be justified.”

Shoe makers, including Reebok, have funded studies and say they have anecdotal evidence that proves they are effective. Several experts have questioned their validity and the American Council on Exercise, a nonprofit fitness organization, conducted a study that found toning shoes failed to live up to the claims of shoe makers. However, the council said the shoes could be beneficial to one’s health if they motivate people to get moving.

Christopher Svezia, with the Susquehanna Financial Group, said many shoemakers have changed their advertising approach as criticism has mounted. “The emphasis has moved to fitness instead of making these kinds of claims and promises,” he said. “The question is who is next and how much is it going to cost them.”

The industry has faced other issues. There have been some injuries reported by wearers who have found themselves with shin splints, twisted ankles and sore muscles from the new gear and motions. Shoe makers suggest new wearers ease into wearing them.

Toning shoes were once the fastest-growing segment in the footwear industry, but recently lost some ground. SportsOne Source Group said that the $1.1 billion market of 2010 is expected to fall about 40 percent to $650 million in 2011 after Skechers flooded the market with products, forcing prices down. However, SportsOne Source said the number of shoes sold is only expected to fall 5 percent, suggesting there is still fairly strong demand.

Rebecca Sayre of Seattle, who bought a pair of Skechers more than a year ago, said they made her legs stronger and posture better. But, she says: “They’ve lost their luster.”

(Copyright 2011 by The Associated Press. All Rights Reserved.)

Story posted 2011.09.28 at 08:41 PM EDT

How “HIP” is your knee pain?

“The knee bone’s connected to the…hip bone” may be your therapist’s greatest clue to solving your knee pain.  How many patients have gone to physical therapy for knee pain and received an ultrasound & quad exercises only to be disappointed in his or her outcome?   What exactly is the link between knee pain and hip weakness?  What does the research tell us?

Patello-femoral pain syndrome (PFPS) (pain under the kneecap) is the most common condition seen in an orthopedic practice.  It is the most prevalent injury in persons who are physically active.  Iliotibial band syndrome (ITBS) is the second most common overuse injury in runners.  Anterior cruciate ligament (ACL) injuries are one of the most common ligament injuries in people who engage in athletics.  What common factor contributes to ALL of these orthopedic conditions?  You guessed it!!  Weak hips!  Read on for the proof.

In a recent review of the literature, Reinman cited 51 articles that provide some degree of evidence correlating hip weakness to knee loading and knee injury.  The position of the knee relative to the hip during weight bearing activities is a predictor of dysfunction.  Excessive hip adduction and internal rotation (turning in of the knee such as being bow-legged) can adversely affect the motion and forces that act upon the entire lower extremity.  This combined motion produces a “dynamic” knee valgus.  A valgus force places a tensile strain on the iliotibial band as well as the soft tissue restraints on the inside of the knee, particularly the ACL and medial collateral ligament. Claiborne et al and Hollman et al have reported that reduced hip strength is related to greater knee valgus angles.  In the presence of hip abductor weakness (muscle that raises your leg out to the side), the opposite hip may drop during single-leg support causing a Trendelenberg sign.  This is especially apparent during a slow, “controlled” descent down a step.  A great functional test!

Why is it that the incidence of ACL injuries and PFPS is greater in women?   Prins et al concluded that females with PFPS exhibit impaired strength of the hip extensors, abductors, and external rotators.  Chen and Powers report that females with PFPS exhibit excessive “dynamic” Q-angles, especially with descending stairs.  Pollard et al states that females demonstrate insufficient utilization of the hip extensors due to decreased knee and hip flexion during a jump squat for example.  This leads to increased quad activation in the presence of a valgus knee and localizes the impact load onto the patella to a much smaller surface area.  Hence, more pain!

So what if you’re a runner?  Ferber et al looked at 283 studies that examined running-related injuries and concluded that the connections between weak hips and running were far more conclusive than the connection with flat feet (over-pronation).  Interestingly, Earl et al prescribed a hip strengthening program to healthy female runners for 8 weeks and, in addition to improved hip strength, they measured a 57% decrease in pronation (flat foot) while running.  Strengthen the hips and ditch the orthotics?  Maybe.

If it hasn’t become obvious yet, hip weakness has been proven as a predictor of knee dysfunction.  So in addition to your runs or to your crunches, you need a hefty dose of hip resistance training.  Call us and we can get you started!!

IT HURTS!! HEAT or ICE?

As your therapist, one of my most important roles in your recovery is teaching you the fundamentals of proper healing.  Healing of injured tissue is a physiological process that can be inhibited by many factors.  Pain management strategies, activity modification, and proper exercise are three such factors that need to be examined.

PAIN MANAGEMENT

All new injuries or aggravation of old injuries need to be addressed with the acronym P.R.I.C.E.  –  Protect, Rest, Ice, Compress, Elevate.  We will talk about the protection aspect in the next section on activity modification.  After an acute injury, there is resulting tissue trauma and inflammation.  Inflammation is part of the healing process as the body attempts to bathe the injured tissue with protein rich fluid as well as cells that cleanse and repair the injured tissue.  Inflammatory cells can be present up to 21 days after an injury, but are the most prevalent during the acute inflammatory stage i.e. first 7-10 days.  Uncontrolled inflammation is what delays healing and it is what we attempt to control with R.I.C.E.  Ice should be applied for 10-15 minutes only in order to prevent frostbite.  You can use soft, gel cold packs, bags of frozen peas or ice, or submerge the injured part into an ice water bath.  You can ice every hour if you wish, but at a minimum of 2-3 times per day, for at least the first 7-10 days.  Remember that the inflammatory process (in the controlled environment) can last 21 days.  The adage “ice for the first 48 hours only” does not make physiological sense.  Icing is not only anti-inflammatory, but it is also a great pain reliever.  You should also consult with your physician regarding an anti-inflammatory medicine.  Examples would be medicines such as Aleve 2x/day or 600-800mg of ibuprofen i.e. Advil or Motrin 3x/day for at least 7-10 days.  Compression and elevation of the injury helps to prevent uncontrolled inflammation as well.  Athletic taping, neoprene or Acewrap sleeves for ankles or knees, and back braces are examples of compression as well stabilization of an injury.  Heating tissue can be relaxing and pain relieving, but it also causes the blood vessels to dilate, hence, increasing the flow of fluids to the area.  If you wish, heating for 15-20 minutes can be added after the first 7-10 days as long it does not increase the swelling.

ACTIVITY MODIFICATION

Protecting the injury will prevent uncontrolled inflammation, thus encouraging proper healing.  Pain is a warning sign.  It is your body’s attempt to remind you that something is wrong.  Pushing “through the pain” is NEVER a good idea.  When a lower extremity joint is injured and walking becomes painful or limited, we advise and instruct patients in using crutches or canes.  This is a temporary modification of activity in order to prevent reoccurrences of pain as the body is healing.   Our patients use an assistive device as long as is needed, but most typically for the first 7-10 days.  Proper posture and body mechanics are also very important in removing the stresses to an injured back or spinal condition.  Remember that causing pain during activity is like taking a hammer and “banging” on the injured tissue.  Take frequent breaks and pace your activity as to not provoke your pain.  It is important to wean slowly back into walking or running.  We will help to guide you in that process.

PROPER EXERCISE

Proper exercise can be initiated after the acute inflammatory stage.  Movement of joints and tissues during exercise causes a mechanical “pumping”.  This “pumping” can help to “push in the good and push out the bad”, prevent post-traumatic stiffness, and encourage a quicker return to function.  Proper technique in these early stages would entail pain free, high rep, and low weight exercises.  We will guide you in that process.  Creating a global circulatory effect via pain free cardiovascular exercise is also beneficial to healing as it helps to cleanse and nourish the injured area.

I hope that helps!!

Chris Dukarski, PT

The importance of closed-chain exercise.

Closed chain exercises for the lower extremities (exercise with you feet contacting the floor) should be an integral part of your rehabilitation program.  They are important in terms of regaining dynamic stability and improving neuromuscular control.  Co-contraction of the muscles on all sides of a joint occurs only thru closed chain or weight bearing activities.  An effective program for a patient with an ACL tear of the knee should include exercises such as squats, lunges, and step-ups.  A patient recovering from an ankle sprain should perform balance board activities.  In terms of patello-femoral dysfunction or pain in the region of your kneecap, the literature describes a strong link between hip weakness (especially the hip abductors and external rotators) and P-F pain.  Open chain exercises such as straight leg raises should be performed in every plane of motion.  Closed chain exercises should incorporate multi-planar strengthening as well.  The following exercises include hip abductor resistance during a functional squat exercise and hip adductor resistance during a lunge.  Creativity is the key to devising a more functional and sport specific program.

At OrthoWell/WalkWell, we use evidence-based and creative strategies to get you better- FASTER!  The following testimonial is from a recent “graduate”.

“I’ve had major ankle issues for over 15 years and have seen several PT’s and specialists but saw no progress until I came to WalkWell.  After only 10 visits, I have made more progress than in the 15 years combined.  The individual attention and rehab is without peer.  And on the 8th day, God created WalkWell!” – Tom Lynch, Ipswich, MA

CLOSED CHAIN CREATIVITY

Closed chain exercises for the lower extremities should be an integral part of your rehabilitation program. They are important in terms of regaining dynamic stability and improving neuromuscular control. Co-contraction of the muscles on all sides of a joint occurs only thru closed chain or weight bearing activities. An effective program for a patient with an ACL tear of the knee should include exercises such as squats, lunges, and step-ups. A patient recovering from an ankle sprain should perform balance board activities. In terms of patello-femoral dysfunction or pain in the region of your kneecap, the literature describes a strong link between hip weakness (especially the hip abductors and external rotators) and P-F pain. Open chain exercises such as straight leg raises should be performed in every plane of motion. Closed chain exercises should incorporate multi-planar strengthening as well. The following exercises include hip abductor resistance during a functional squat exercise and hip adductor resistance during a lunge. Creativity is the key to devising a more functional and sport specific program.

At OrthoWell/WalkWell, we use evidence-based and creative strategies to get our patients better- FASTER!   The following testimonial is from a recent “graduate”.

“I’ve had major ankle issues for over 15 years and have seen several PT’s and specialists but saw no progress until I came to WalkWell. After only 10 visits, I have made more progress than in the 15 years combined. The individual attention and rehab is without peer. And on the 8th day, God created WalkWell!” – Tom Lynch, Ipswich, MA