Presentation on theme: "Diploma of Remedial Massage Case studies Hip & Groin"— Presentation transcript:
1 Diploma of Remedial Massage Case studies Hip & Groin
2 Hip & Groin injuries Common pathologies: Hip arthritis (Osteoarthritis)Hip flexor strainsOsteitis PubisAdductor Tendinopathy v’s Hamstring Origin Tendinopathy v’s ischiogluteal bursitis
3 Hip & Groin injuries Hip Arthritis / Osteoarthritis Degenerative joint diseaseGradual eroding of the surfaces of the hip joint with subsequent inflammation. Eventual wearing down of the bone ends so the surfaces are no longer smooth and may have small bony processes called osteophytesMay occur following a specific injury or repetitive forces going through the hip beyond what it can withstand over a period of time.Usually > 50 yo more common if overweightConfirmed by Xray / Bone scan
4 Hip & Groin injuries Hip Arthritis / Osteoarthritis Symptoms usually develop gradually over time. In patients with minor cases of hip arthritis, little or no symptoms may be presentAs condition progresses, there may be increasing hip pain with weight bearing activity and joint stiffness – particularly after rest and first thing in the morningDecreased hip flexibility, pain at night and grinding sensations during certain movements may also be experienced. Pain is typically felt in the buttock region and / or front of the hip and groin. Occasionally pain may be referred to the thigh or knee.
5 Hip & Groin injuries Hip Arthritis / Osteoarthritis When pain unrelenting – surgery usually necessaryInterim Rx:↓ aggravating activities,Stretching / maintaining flexibility without painNon weight-bearing exercisePain relief - CSIMassage / Myotherapy beneficially in recovery / rehab post surgerySee AAMT article re Mobility & Scar Tissue Rx
6 Hip & Groin injuries Osteitis Pubis Often misdiagnosed and poorly understoodSome theories suggest that osteitis pubis begins as separate pathologies i.e. Adductor tendinopathy that are either not Rx’d early or miss managed
7 Assessment to determine pathology Adductor Tendinopathy v’s Hamstring Origin Tendinopathy v’s ischiogluteal bursitisAssessment to determine pathologyTiming of painPain lessens during exercise, worsens after exercise, = inflammatory condition i.e. TendinopathyPain progressively worsen with exercise = stress fracture, bursitis or muscle strainLocation of painLx or buttock pain = possible referred pain i.e. Lx. Lx/Tx junction or SIJ
8 Assessment to determine pathology cont. Adductor Tendinopathy v’s Hamstring Origin Tendinopathy v’s ischiogluteal bursitisAssessment to determine pathology cont.Identify movements aggravate pain i.e. Kicking = illiopsoas or rec fem; twisting or adduction = adductor; situps = abdominal or inguinal herniaSpecial tests
9 Hip & Groin injuries Muscle strains: Muscle Strains range from grade 1 to grade 3 and are classified as follows:Grade 1 Tear: a small number of fibres are torn resulting in some pain, but allowing full function.Grade 2 Tear: a significant number of fibres are torn with moderate loss of function.Grade 3 Tear: all muscle fibres are ruptured resulting in major loss of function
10 Hip flexor strains Often associated with: overuse / miss-use, Excessive hip flexion i.e. kicking, sprintingpostural dysfunction / excessive lordosisusually a sudden sharp pain or pulling sensation in the front of the hip or groin at the time of injuryminor strains, pain minimal = cont activity.severe cases = severe pain, muscle spasm, weakness, inability to continue activity unable to walk without limping.
11 Hip flexor strains Signs and symptoms pain when lifting the knee towards the chest (especially against resistance) or during running, kicking or going upstairs.pain or stiffness after these activities with rest, especially upon waking in the morning.swelling, tenderness and bruising may also be present in the hip flexor muscles.grade 3 tear a visible deformity in the muscle may be evident
12 Hip flexor strains Contributing factors to a hip flexor strain muscle weakness - quads, hip flexors or glutealsmuscle tightness - hip flexors, quads, h/strings or glutealsinappropriate traininginadequate warm upjoint stiffness (lower back, hip or knee)poor biomechanicspoor postureinadequate rehabilitation following a previous hip flexor injurydecreased fitnessfatiguepoor pelvic and core stabilityneural tightness
13 Hip & Groin injuries Hip flexor strains Rx: ↓ aggravating activity StretchingMFTLx mobilisation
14 Adductor Tendinopathy v’s ischiogluteal bursistis Adductor Tendinopathy = tissue damage and inflammation to the adductor tendon at its attachment to the pelvis resulting in groin painThe ischiogluteal bursa lies between the hamstring tendon and the ischial tuberosity. This can become inflamed. It may exist in isolation or in conjunction with hamstring origin tendinopathy.Clinically, it is almost impossible to differentiate between the twoBoth present as pain aggravated by sitting or running, with local tenderness.
15 Adductor Tendinopathy Adductor muscles are responsible for stabilising the pelvis and adducting the leg. They are particularly active during running (especially when changing direction) and kickingusually an overuse injury, which commonly occurs due to repetitive or prolonged activities or rapid acceleration whilst running (particularly when changing direction) or when a footballer performs a long kick, also common in, hockey and athletics (particularly sprinters, hurdlers, and long jumpers) as well as in skiing, horse riding and gymnastics
16 Adductor Tendinopathy Signs and symptoms:Groin pain that develops gradually overtimePain on firmly touching the adductor tendon at its attachmentPain may increase with resisted adduction (squeeze test)In less severe cases, an ache or stiffness in the groin that increases with rest following activities requiring strong or repetitive contraction of the adductor muscles, may also warm up with activity in the initial stages of the condition.
17 Adductor Tendinopathy Contributing factors to the development of adductor tendinopathyAdductor, gluteals, hip flexors, hamstrings tightnesspoor biomechanicsmuscle weakness (especially of the groin, gluteals or core stabilisers)inadequate rehabilitation following a previous adductor injuryinappropriate training or techniquechange in training conditions or surfacespoor posture inc poor foot posture (e.g. flat feet)
18 Adductor Tendinopathy Contributing factors to the development of adductor tendinopathy cont.inappropriate footwearjoint stiffness (particularly the lower back, hip and knee)inadequate warm uppoor pelvic and core stabilityneural tightnessmuscle imbalances
19 Adductor Tendinopathy Rx:REST sufficiently from ANY activity that increases their pain until they are symptom freeOnce pain-free a gradual return to activities provided no increase in groin symptomsMassage / Myotherpay to ↓ pain ↑ ROM ALL hip / groin muscles / structuresOnce chronic, possible Osteitis Pubis and healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.
20 Adductor Tendinopathy Rx: / Managementhydrotherapyactivity modification advicetechnique correctionanti-inflammatory adviceprescription of orthoticsdevising and monitoring a return to sport or activity plan
21 Adductor Tendinopathy Rx: / ManagementSome do not improve adequately.Referral to physiotherapist, or doctorMay require investigations X-ray, ultrasound, CT scan or MRI, pharmaceutical intervention, corticosteroid injectionPodiatrist - prescription of orthoticsIn very rare cases surgical intervention may be considered.