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REHABILITATION HIP IMPINGEMENT
et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics and Related Research 2003;417:112–120 39. Dienst M. Hip arthroscopy: technique for positioning and distraction. Orthopade 2006;35:33–40 40. Fontana A. Course notes: sports hip surgery, 2006 41. Crawford K, Philippon MJ, Sekiya JK, Rodkey WG, Steadman JR. Microfracture of the hip in athletes. Clinics in Sports Medicine 2006;25:327-0-3 42. Philippon M. Unpublished data, AANA, 2006 43. Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy 2008;24:1135–1145 44. Byrd T. Course notes: sports hip surgery, 2008 45. Philippon MJ, Briggs KK, Yen YM,
Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. Journal of Bone and Joint Surgery. British Volume 2009;91:16–23 46. Johnston TL, Schenker ML, Briggs KK, Philippon MJ. Relationship between offset angle alpha and hip chondral injury in femoroacetabular impingement. Arthroscopy 2008;24:669–675 47. Stalzer S, Wahoff M, Scanlan M. Rehabilitation following hip arthroscopy. Clinics in Sports Medicine 2006;25:337– 357
48. Lewis CL, Sahrmann SA, Moran DW. Anterior hip joint force increases with hip extension, decreased gluteal force, or decreased iliopsoas force. Journal of Biomechanics 2007;40:3725–3731 49. Lewis CL, Sahrmann SA. Acetabular labral tears. Physical Therapy 2006;86:110–121
THE AUTHOR
David Binningsley is employed by Sunderland Football Club as a senior physiotherapist. Originally from Durham,
he graduated from the University of Teesside in 1998 with a BSc(Hons) in physiotherapy. After a brief spell working for the NHS at the University Hospital of North Durham, he joined the medical team at Middlesbrough Football Club, where he worked for the highly successful academy for three years. In 2002, David was recruited by Sunderland Football Club. His role is to provide assessment, treatment and rehabilitation for the first-team playing staff. David has a special interest in the hip pathologies of young athletes. He has developed a strong working relationship with the world’s leading hip surgeons and has overseen a great many hip surgeries.
online
Launch the videos by clicking on the images below Videos and animations
n Chondroplasty procedure video – an edited video showing a right hip CAM lesion. The surgeon removes the articular cartilage layer as well as subchondral bone. The normal procedure takes up to one hour. The camera is from a posterior portal and the femoral head and labrum are to the left. The hip is assessed dynamically throughout the process to check for impingement.
n Hip ROM movie courtesy of Primal Pictures Ltd. – showing the bony articlulations of the hip joint
SUGGESTED EXERCISES FOR FEMORO-ACETABULAR IMPINGEMENT online
Launch the videos by clicking on the images below
1. Bosu lunge – work on strength and balance whilst stepping onto a upside down BOSU. A progression is to add in a medicine ball and/or bungee cord to add resistance. The drill can also be performed laterally.
2. Box step down – to facilitate gluteal muscles. Ensure the ASIS remain level and touch the heel onto the floor. The height of the box can be increased as the patient progresses.
5. Romans – begin in a standing position and lean forward and raise the leg behind you. The aim is to keep everything as flat as possible.
This exercise
is fantastic for recruiting both the gluteals and hamstrings, working on Vleemings sling principle. You can also progress this exercise with weights.
6. Split lunge – start with one foot on a raised surface (a box or stairs). Explode up, using the arms for propulsion. Change feet, with only the forefoot contacting the box. Four sets of four repetitions on each leg is a good starting point. Progression would include using a weighted vest or Vertimax.
3. Cable MR – to isolate the medial rotators of the hip, lie prone with a cable attached to the ankle. The knee is flexed to 90°. Add resistance as appropriate, rotate the hip across the body from full medial rotation. This can also be performed for lateral rotators. I prefer to do four sets to fatigue instead of a set number of repetitions.
4. Mirror drill – set up two boxes (approx 10m2) one person leads the other has to follow.
It is
best performed as a timed drill and jumps, forward rolls and slide tackle can be added. It can also be performed in opposite direction.
7. Squat hurdle – after performing a squat, immediately go into a series of explosive jumps over hurdles. Ideally to speed up the process, have two spotters take the Olympic bar after the squats have been performed.
8. Sidewinder (sw.mpg) – using an SAQ sidewinder attached to the ankles. Step forward and laterally, tapping the opposite foot on the swing through phase. The drill can be done purely laterally, or as if they were walking on a tightrope.
n Animation on arthroscopic surgery for femoro- acetabular impingement
n Exercise movies - the online version of this article allows you to play individual movie clips of all the rehabilitation exercises above
(go to the sportex.net website>e-content>Animations>for clients>SWARM animations and choose Orthopaedics/Hip)
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