Evaluating Functional Performance Tests in those with Non-arthritic Intra-articular Hip Pain: An International Consensus Statement

Background

Non-arthritic intra-articular hip pain, caused by various pathologies, leads to impairments in range of motion, strength, balance, and neuromuscular control. Although functional performance tests offer valuable insights in evaluating these patients, no clear consensus exists regarding the optimal tests for this patient population.

Purpose

This study aimed to establish expert consensus on the application and selection of functional performance tests in individuals presenting with non-arthritic intra-articular hip pain.

Study Design

A modified Delphi technique was used with fourteen physical therapy experts, all members of the International Society for Hip Arthroscopy (ISHA). The panelists participated in three rounds of questions and related discussions to reach full consensus on the application and selection of functional performance tests.

Results

The panel agreed that functional performance tests should be utilized at initial evaluation, re-evaluations, and discharge, as well as criterion for assessing readiness for returning to sports. Tests should be as part of a multimodal assessment of neuromuscular control, strength, range of motion, and balance, applied in a graded fashion depending on the patient's characteristics. Clinicians should select functional performance tests with objective scoring criteria and prioritize the use of tests with supporting psychometric evidence. A list of recommended functional performance tests with varying intensity levels is provided. Low-intensity functional performance tests encompass controlled speed in a single plane with no impact. Medium-intensity functional performance tests involve controlled speed in multiple planes with low impact. High-intensity functional performance tests include higher speeds in multiple planes with higher impact and agility requirements. Sport-specific movement tests should mimic the patient's particular activity or sport.

Conclusion

This international consensus statement provides recommendations for clinicians regarding selection and utilization of functional performance tests for those with non-arthritic intra-articular hip pain. These recommendations will encourage greater consistency and standardization among clinicians during a physical therapy assessment.

Utilizing MSK Ultrasound for Comprehensive Assessment of the Femoral Trochlea: A Game Changer in Sports Medicine

Musculoskeletal (MSK) ultrasound has emerged as a valuable tool for sports physical therapists in the assessment and treatment of various knee pathologies. Its ability to provide high-resolution images of soft tissue and superficial bone surfaces makes it especially useful for sports physical therapists and orthopedic clinicians. Specifically, MSK-ultrasound is increasingly recognized as a potent tool for the assessment of the femoral trochlea. Its non-invasive nature and dynamic imaging capabilities make it particularly suited for visualizing the femoral trochlea, a critical component in knee function and biomechanics. The use of MSK ultrasound in the evaluating the femoral trochlea provides sports medicine professionals with a dynamic, non-invasive, and cost-effective means to diagnose, and monitor knee-related injuries. This article delves into the utility of MSK ultrasound in the anatomical and functional assessment of the femoral trochlea, elucidating its benefits, limitations, and clinical implications for athletes.

Cross-sectional study of characteristics and prevalence of musculoskeletal complaints in 1170 male golfers

Objectives

The primary aim was to describe the characteristics and prevalence of musculoskeletal complaints of a large group of non-professional golfers. Secondary aims were to compare golfers different in (A) skill-level, (B) presence of low back pain (LBP) and (C) performance of prevention exercises.

Methods

A sample of 1170 male golfers (mean age 54.98, SD=13.3) were surveyed online on personal and golf-specific characteristics, medical history and complaints in the preceding 7 days. Subgroups (A) with different golfing handicap (0 to 5, >5 to 10, >10), (B) with and without LBP and (C) who performed versus did not perform injury prevention exercises were compared using analysis of variance and χ2test.

Results

The prevalence and severity of musculoskeletal complaints was similar in everyday life and when playing golf. More than one-third of the golfers (n=436; 37.3%) reported LBP in the preceding 7 days, while other frequently affected body parts were the shoulder and knee. Golfers with different skill level differed in age and most golf-related characteristics but not in prevalence and severity of musculoskeletal complaints. Golfers with and without LBP were similar in almost all variables. Golfers who performed prevention exercises (n=371; 27.1%) were older and had a higher prevalence of complaints.

Conclusion

The prevalence and severity of musculoskeletal complaints in golfers were similar to the wider population. It seems that injury prevention exercises were implemented after injury, rather than as primary prevention. Prospective studies looking at the epidemiology of injury, risk factors and interventions are required.

The 2022 International Society for Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS): an international consensus statement

The 2022 International Society of Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS) was intended to present a physiotherapy consensus on the assessment and surgical and non-surgical physiotherapy management of patients with GTPS. The panel consisted of 15 physiotherapists and eight orthopaedic surgeons. Currently, there is a lack of high-quality literature supporting non-operative and operative physiotherapy management. Therefore, a group of physiotherapists who specialize in the treatment of non-arthritic hip pathology created this consensus statement regarding physiotherapy management of GTPS. The consensus was conducted using a modified Delphi technique to guide physiotherapy-related decisions according to the current knowledge and expertise regarding the following: (i) evaluation of GTPS, (ii) non-surgical physiotherapy management, (iii) use of corticosteroids and orthobiologics and (iv) surgical indications and post-operative physiotherapy management.

International consensus statement: methods for recording and reporting of epidemiological data on injuries and illnesses in golf

Epidemiological studies of injury in elite and recreational golfers have lacked consistency in methods and definitions employed and this limits comparison of results across studies. In their sports-generic statement, the Consensus Group recruited by the IOC (2020) called for sport-specific consensus statements. On invitation by International Golf Federation, a group of international experts in sport and exercise medicine, golf research and sports injury/illness epidemiology was selected to prepare a golf-specific consensus statement. Methodological stages included literature review and initial drafting, online feedback from the consensus group, revision and second draft, virtual consensus meetings and completion of final version. This consensus statement provides golf-specific recommendations for data collection and research reporting including: (i) injury and illness definitions, and characteristics with golf-specific examples, (ii) definitions of golf-specific exposure measurements and recommendations for the calculation of prevalence and incidence, (iii) injury, illness and exposure report forms for medical staff and for golfers, and (iv) a baseline questionnaire. Implementation of the consensus methodology will enable comparison among golf studies and with other sports. It facilitates analysis of causative factors for injuries and illness in golf, and can also be used to evaluate the effects of prevention programmes to support the health of golfers.

Treatment of articular cartilage defects of the knee with autologous chondrocyte implantation

The treatment of focal full thickness articular defects in the knee has continued to present a challenge, with no traditional treatment method providing consistent acceptable long-term clinical results. Patients with significant chondral defects frequently have persistent joint line pain, swelling, and catching in the knee. In contrast to marrow stimulation treatment techniques, such as abrasion arthroplasty, drilling, or microfracture which populate the defect with pluripotential stem cells, the use of cultured autologous chondrocytes fills the defect with cells of a committed pathway to develop hyaline-like cartilage. This hyaline-like cartilage more closely recreates the wear characteristics and durability of normal hyaline cartilage than the fibrous or fibrocartilage repair tissue formed by pluripotential stem cells. The purpose of this paper is to review the efficacy of available treatment options as well as the basic science rationale, indications, technique, postoperative rehabilitation, and clinical results of using cultured autologous chondrocytes in the treatment of focal full thickness chondral defects of the knee.

Comparison of two methods for measuring hamstring reaction time using the Kin-Com isokinetic dynamometer

Methods for quantifying deficits in proprioceptive feedback need to be examined. The purpose of this study was to compare two protocols measuring hamstring reaction time. Forty subjects, 13 males and 27 females, between 21 and 31 years of age (means = 24.3, SD = 2.04) were tested bilaterally on the Kin-Com isokinetic dynamometer with simultaneous use of the KC-EMG electromyograph. Subjects were instructed to maximally contract their hamstring musculature in response to a sudden lever arm movement. The peak torque time (PTT) protocol quantified the time lapse between initial lever arm movement and the generation of maximum torque. The electromyograph time (EMGT) protocol measured the time lapse between initial lever arm movement and initial myoelectrical activity of the hamstring musculature. Both PTT and EMGT were found to be reliable (Cronbach alpha 0.823-0.896), with no significant difference (p < .05) between dominant and nondominant limbs. These results indicate that PTT and EMGT are effective for quantifying hamstring reaction time and that the uninvolved lower extremity may be used as a control.

The role of the scapula

The scapular musculature is often neglected in designing a rehabilitation protocol for the shoulder. Weakness of the scapular stabilizers and resultant altered biomechanics could result in: 1) abnormal stresses to the anterior capsular structures of the shoulder, 2) increased possibility of rotator cuff compression, and 3) decreased performance. This article presents known facts about the biomechanics of the scapula and surrounding muscles and suggests methods for evaluation of scapular muscle weakness. Exercise techniques to maximally strengthen the scapular musculature are also described. As our ability to document strength of these muscles improves, we will be able to determine the effect of scapular strengthening on improving symptoms related to impingement and instability. Scapular strengthening exercises are usually nonstressful to the rotator cuff and are easily implemented into a rehabilitation program for the shoulder.