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Introduction


Rehabilitation for FAI and associated labrum tears , requires a comprehensive strength and conditioning program for the trunk, pelvis, hip and lower extremity.


The changes in the hip bones or the labrum are not the only important aspect of this condition.


Research shows (Frasson et al 2020) the most affected hip muscles are Hip Extensor ( Glutes ) , Hip Flexors ( Psoas ) and Hip Adductors ( Inner thigh muscles ).


In my opinion, the weakness surrounding the hip joint is the most influential problem to solve in order to improve pain and tightness around the hip joint






Treatment of Femoro-Acetabular Impingement - FAI








Exercise-based treatments are recommended for people with hip-related pain.


Exercise-based treatment should be at least 3 months duration.


Following up from our previous blog post, here you have some the techniques and exercises we use for addressing muscle weakness around the joint.


















Conclusion:

  • FAI is a problem of the hip joint or its components: the ball or socket of the hip

  • Treatment of FAI requires a general approach with core and all aspect of the hip included.

  • Research shows that FAI is a common finding among athletes and soccer players and its only when painful that the FAI becomes a problem.

  • Conservative treatment with Physical Therapy for 12 weeks is the first line of treatment of this condition. In Adults ( + 40 y/o) surgey need to be considered only when the Physical Therapy has failed because of the Poor to Fair results of the Surgery in the long run

Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located  in the beautiful City of Weston,  where he treats Soccer Player, Runners and Athletes of all ages

Finally we would like to invite you to follow us  at our:

Facebook Page

Google Plus Page

Instagram Page

where you will receive information about your condition and other services we offer, always with the idea of keeping you healthy and fit to enjoy your favorite sport.

Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”

#westonhippain #hippain  #FAI #PulledMuscle #Soccerinjuries #Soccerhipinjury #westonsoccer #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston #whitebayphysicaltherapy



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Introduction


FAI is a pathological hip condition characterized by abnormal contact between the acetabulum ( socket ) and femoral head / neck junction ( ball).


Femoroacetabular Impingement (FAI) is generally used to describe symptoms pertaining to the ball and socket joint of the hip.


This can occur within the normal physiological range of motion as a result of osseous abnormalities ( bone overgrowth ) described as either CAM or PINCER deformities.





There are 2 types of hip impingement; they may occur alone or together.


1. Pincer-Type Impingement:


This condition affects men and women equally; symptoms often begin early, appearing at any time between 15 to 50 years of age.


In pincer-type impingement, the hip socket (acetabulum), which is usually angled forward, may be angled toward the back.


The overgrown bone or incorrect angle of the socket causes the labrum (a rim of connective tissue around the edge of the hip socket) to be pinched.


Over time, this leads to inflammation and eventually could result in a labrum tear.



2. Cam-Type Impingement


Here the shape of the bone around the head of the femur the ball at the top of the bone in the thigh is misshapen with an overgrown bone formed at the top and front. The nickname “pistol grip” deformity is given to the appearance of the bony overgrowth on x-rays.


This also leads to pain or can cause the labrum to  become worn, frayed, or torn.


This condition affects men to women at a ratio of 3 to 1; symptoms often manifest during the teen years and 20s.


Most individuals with FAI experiencing discomfort with hip flexion ( bringing knee up towards the chest) , adduction, and internal rotation.



A recent study found that 87% of teens and adults with hip pain showed evidence of hip impingement on diagnostic images taken of their hip joints.


To have a diagnosis of FAI it is not a sentence to a life of pain. Many patients get better with a comprehensive rehabilitation program.


Surgery is an option when the conservative treatment has failed


That’s why it’s important to assess the person and their goals and not solely base the prognosis on x-rays or MRIs.



FAI diagnosis is obtained through a combination of  symptoms + clinical signs + diagnostic imaging





SYMPTOMS






Hip impingement may cause:


Stiffness or deep aching pain in the front or side of the hip or front of the upper thigh while resting.


Sharp, stabbing pain when standing up from a chair, squatting, rising from a squat, running, "cutting," jumping, twisting, pivoting, or making lateral motions.


Hip pain described in a specific location by making a "C" with the thumb and hand and placing it on the fold at the front and side of the hip, known as the "C-sign."


Pain that most often starts gradually, but can also remain after another injury resolves.

Pain that increases with prolonged sitting or forward leaning.


Feeling less flexible at the hips, including a decreased ability to turn your thigh inward on the painful side.



To the physical exam patient with FAI will show:


Reduced ROM


Positive Hip Impingement Tests.

Several test can help with the diagnosis of FAI , for example “log roll” test where the therapist gently roll your leg in and out, or bend your hip up and in while turning the lower leg out to the side (the "FADDIR" test) to assess your condition.


Diagnostic Imaging ( Xrays ):

Antero-posterior radiograph of the pelvis and a lateral femoral neck view of the symptomatic hip to identify pincer or cam morphologies, and identify other causes of hip pain.


If further diagnosis is needed, your doctor may order diagnostic tests to help identify any joint changes, including x-rays, magnetic resonance imaging (MRI), or diagnostic injections. Hip impingement can occur at the same time as low back, buttock, or pelvic pain, or from conditions such as bursitis or groin strain.


The final diagnosis of hip impingement may take some time, especially when other conditions are present




Treatment of Femoro-Acetabular Impingement - FAI



Exercise-based treatments are recommended for people with hip-related pain. Exercise-based treatment should be at least 3 months duration.


Physical Therapy Interventions:










1. Improve the strength of your hips and trunk.


Strengthening of the hips and trunk can reduce abnormal forces on an already injured joint and help with strategies to move pain-free.


People with FAI will benefit from a comprehensive program that addresses all the imbalances in the hip - pelvis - lumbar area that may be causing the impingement.


A very important point to consider with FAI patients is to select exercises that don't get the hip in the position of the impingement for example dip squat positions most likely will aggravate the condition.


Furthermore, the position of the pelvis is crucial to avoid or decrease the amount of contact between the femur and acetabulum.


Therefore a combination of  core +  hip  strengthening along with postural exercises are necessary in people with FAI.


The goal here is to create stability at the lumbo-pelvis complex to allow a normal movement of the hip


2. Improving hip muscle flexibility and joint mobility


As we mention before restoring some movement back into the hip is very important.


Feeling less flexible at the hips, including a decreased ability to turn your thigh up outwards or inwards on the painful side is very common in patients with FAI.


stretching and mobility exercises must be selected carefully because if patients push too hard into the stretch it may be exacerbate their pains.



3. Improving tolerance of daily activities through activity modification


Analyzing your job and the recreational activities you do to maintaining postures that are healthier for your hip and. Often this involves limiting the amount of bending at the hip to avoid further hip damage.


Tips for stretching with FAI


Warm up with aerobic exercises ( elliptical / treadmill ) .


Don’t force the movement too much, just get to the end and push a tiny bit more


Work on repetitive movements more than pushing hard .


Keep core muscle active throughout the mobilization to avoid excessive strain in lumbar spine




Conclusion:

  • FAI is a problem of the hip joint or its components: the ball or socket of the hip

  • Treatment of FAI requires a general approach with core and all aspect of the hip included.

  • Research shows that FAI is a common finding among athletes and soccer players and its only when painful that the FAI becomes a problem.

  • Conservative treatment with Physical Therapy for 12 weeks is the first line of treatment of this condition. In Adults ( + 40 y/o) surgey need to be considered only when the Physical Therapy has failed because of the Poor to Fair results of the Surgery in the long run

Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located  in the beautiful City of Weston,  where he treats Soccer Player, Runners and Athletes of all ages

Finally we would like to invite you to follow us  at our:

Facebook Page

Google Plus Page

Instagram Page

where you will receive information about your condition and other services we offer, always with the idea of keeping you healthy and fit to enjoy your favorite sport.

Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”

#westonhippain #hippain  #FAI #PulledMuscle #Soccerinjuries #Soccerhipinjury #westonsoccer #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston #whitebayphysicaltherapy



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Introduction


Hamstring Injury Treatment has changed a lot in the last decade. Professional Soccer teams are putting a lot of emphasis on prevention and quicker recovery. There is good consensus now to safely accelerate the recovery process so player can return to play earlier and most important avoiding a re-injury






Rehabilitation Process - Grade II hamstring Injury


We will use a Grade II injury as an example (see picture above ) . As we mention in our previous posts about HSI, many patients with a hamstring start to feel better within a few days of the injury. However, there is an extremely high hamstring re-injury rate due to a poor rehabilitation process.


Hamstring strains are one injury that professional guidance is highly recommended for both an accurate diagnosis but also provide you with the best chance of avoiding re-injuries. Repeat hamstring injuries have sidelined soccer players for months.


Guidelines


In Physical Therapy the treatment we provide will follow these guidelines:

  1. Reduce hamstring pain and inflammation.

  2. Normalize your muscle range of motion and extensibility. Remember one of the causes of HSI is short and tight Hamstrings.

  3. The hamstrings create Hip Extension and Knee flexion simultaneously . Even though that in the beginning we may concentrate in improving each movement in isolation at some point The rehabilitation should address both the knee flexion and hip extension roles of the hamstrings together. High Speed Running is ultimate expression of the hamstrings doing this double action.

  4. Strengthen your knee muscles and hamstrings. A key factor in the recovery process is Eccentric Load of the Hamstrings. Regular exercises will not do it for this condition reason why we have developed a progressive and comprehensive Strengthening program with this in mind

  5. Strengthen your lower limb muscles: calves, hip and pelvis muscles.

  6. Normalize lumbo-pelvic control and stability - a co-factor in many hamstring strains. Another super important factor is your pelvic position. Almost every Hamstring Injury goes with excessive curvature in the lumbar spine called hyperlordosis and anterior pelvic tilt causing your hamstrings to be under tension constantly just from standing and even more tension during High Speed Running

  7. Improve your game speed, proprioception, agility and balance. Remember most of the HSI are the result of High Speed Running so this should be part of your rehabilitation process but most of the time it does not happened. At White Bay Physical Therapy this HSR and running mechanics drills are mandatory before we release players to train and prevent a re-injury.

  8. One note on Hamstring Stretching: Injured Hamstrings respond much better to strengthening exercises and movement than it does to vigorous stretching. Any tight muscle denotes some type of weakness, lack of movement control or postural deficit. In these situations the muscle gets “tight” to compensate for these other problems. So please, Stop stretching your hamstrings vigorously, it won’t get much softer. There is a type of contraction called Eccentric contraction where the muscle lengthens as it moves a weight ( own body weight or external weight). These types of exercises are the ones recommended for most of the muscular injuries because of this double benefit: strength + lengthening. We ,as therapist, know when to introduce these type of exercises in the rehabilitation process.

  9. To summarize, Long and Strong Hamstrings are the goals of the rehabilitation process


Stage I - Acute Injury

In the Acute phase we focus on resolving the pain with Ice , Ultrasound , Electrical Stimulation for Pain and We initiate an early mobility routine to safely put stress in the muscle to promote healing.


Hamstring Extenders - Mobility Workout



Setup

  • Begin lying on your back with one leg straight and the other leg bent

Movement

  • Bring your knee toward your chest and grab the back of your thigh with both hands. Slowly straighten your knee until you feel a stretch in the back of your thigh and return to original position. Repeat 10 Times.

Tip

  • Make sure to keep your back flat on the floor during the stretch and the opposite heel pushing against the ground during the stretch.




Hamstring Isometrics Strengthening




Bridge on Heels - Isometric HS contraction

Setup

  • Begin lying on your back with your knees bent and your feet resting flat on the ground.

Movement

  • Keeping your heels on the ground, lift your toes up.

  • Engage your abdominals and slowly lift your hips off the floor into a bridge position. You will feel your hamstring muscles contracting.

  • Hold contraction for 5 seconds. Then, Lower back down to the ground and repeat. Be aware this exercise can make your hamstrings to cramp. If that happens.

  • Repeat a few more times exercise 1. Do this exercise in 3 different angles: 90, 45 and 10-15 degrees of Knee Flexion to target the whole muscle group

Tip

  • Make sure to keep your abdominals engaged and do not arch your back during the exercise.





Stage II - Strengthening Phase

In the strengthening phase we will load the muscle progressively to assure proper scar mobilization and remodeling of the muscle to sustain higher loads everyday. We progress from simple contractions like Hold and Relax, then typical Hamstring exercises like leg curls and more Function-related exercises like eccentric contractions which not only make the muscle stronger but also increase the length of it. Remember we mentioned before that Short Hamstrings are highly related with HSIs.



Deadlifts




Setup

  • Begin bending forward with your back straight and feet hip width apart, holding a barbell that is resting on the ground with your hands placed slightly wider than your feet.

Movement

  • Keeping your back straight, stand up, engaging your back, buttock, and thigh muscles. Slowly reverse the movement and repeat. Allow body to move till you feel the workout in your hamstrings and Glutes. Mild discomfort at the injury site is ok .

Tip

  • Make sure to keep your abdominals tight, back straight, and do not shrug your shoulders during the exercise. Try to keep the barbell close to your body as you stand and bend over.




Single Leg RDLs



Setup

  • Begin in a standing upright position holding a landmine or dumbbell in one hand.

Movement

  • Lift the uninvolved leg off the ground and bend forward at your hips, lowering the weight toward the ground. Then return to an upright position and repeat.

  • Allow body to move till you feel the workout in your hamstrings and Glutes. Mild discomfort at the injury site is ok .

Tip

  • Make sure to keep your back straight during the exercise and try not to let your knee move forward as you lower the weight.



Stage III - Return to Play Phase

Finally in the third phase we simulate soccer activities to reproduce the demands of the game in a closed environment and assure the scar tissue will tolerate the activity. This includes some field drills by the end of the phase and right before allowing you to play.

Key factors in this recovery are restoring Eccentric strength of the Hamstrings, restoring hip and knee range on motion, restoring proper core strength, and finally restoring dynamic balance and control of the Lumbo - Pelvic - Hip area.

Once all these factor were addressed we expose the injured players to Running Mechanics and High Speed Running itself.

You can see that our rehabiliation process is comprehensive and it covers the gap between the Clinic / Gym and the fields to return to play safely with the only goal of preventing another HSI.




Conclusion


  • Hamstring Injuries (HSI) are the second most common muscular injury in soccer players (quadriceps is #1)

  • Grade I injuries recover quick, while Grade II and III will take long time to recover and have an unfortunate high risk of re-injury and becoming chronic ( Proximal Hamstring Tendinopathy)

  • Most of these injuries does not require expensive MRIs or Test. The clinical examination by a professional specialized in HSI is usually enough to make the diagnosis and treatment





Do you want to find out more about what you can do to get better from your Hamstring Strain?



Click the link below to get access to our PDF E-Book

where you'll find valuable information about Muscle Injuries in general

and Hamstring Injuries in Particular





#Hamstringpain #HamstringStrain #PulledMuscle #Soccerinjuries #Soccergroinpain #westonsoccer #westonhippain #hippainsucks #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston

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