What is not included in the abstract and important to the article. Per PT evaluation and post Kenalog intra articular injection pt presented with mild functional deficits such as a pain free squat and lateral step down test. However pt did score poorly with eyes closed balance as compared to norms and contra lateral side as eyes closed requires greater glute and hip corrective responses. ROM was limited in hip flexion by 15 degrees and strength as measured with a handheld dynamometer was decreased greatest in hip ER followed by hip abduction and mildly in hip IR.
Pt received 5 physical therapy treatments at a frequency of 1x a week.
Week 1: multiple angle isomtetrics for hip ER and IR, single leg balance (SLB) EC 3x 30 sec, side lying quad and TFL stretch contract relax 3×10 seconds
Week 2: elliptical, hip IR/ER isometrics, SLB EC 3×30 sec, half kneeling EC balance on foam pad 3×30 sec, half kneeling chops EO on foam, SLB on foam
Week 3: 10 min walk on treadmill with 4.5 minutes total of running, standing hip abd /c 5 sec holds, SLB EC on foam, SLB with hip IR/ER, half kneeling balance with EC and chops on foam pad, initiated return to running program
Week 4: 10 minutes treadmill running, standing hip abd and extension /c 5 sec holds, SLB EC on foam pad, SLB with hip IR/ER and EC on foam, half kneeling balance with chops on foam pad and EC, Y balance exercises
Week 5: same as week 4 with additions of lunges with 4.5 kg weights, plyometrics single limb hops, triple hop, triple crossover
As pointed out in the articles discussion the pt had good outcomes with PT and corticosteroid injections. They also note that the poor hip stability may not have been a result of the labral tear but potentially could have been a cause of the tear. She was also young, athletic, and relatively mild symptoms. We still don’t have a ton of great research on PT for labral tears and FAI. This is a case study and only pertained to this one individual. Level 4 evidence. We need more research.
Intra-articular hip pathologies can be difficult to diagnose, and evidence to guide physical therapy interventions is lacking. The purpose of this case report is to describe a clinical pathway for conservative management of a patient with an acute acetabular labral tear and femoroacetabular impingement.
The patient was an 18-year-old woman with recent onset of right groin pain who underwent intra-articular corticosteroid injection and therapeutic exercise for the management of an acute acetabular labral tear identified on radiographic imaging. Prior to physical therapy, the patient received an intra-articular hip injection for diagnostic purposes and pain relief. Upon initial evaluation, the patient presented with improved pain but with continued kinesthetic deficits, inflexibility, muscle imbalances, and reproduction of symptoms with end-range hip motions. A physical therapy plan was implemented using neuromuscular re-education to address her continued impairments.
Marked improvements were noted at discharge and 6-month follow-up for pain, strength, and function as demonstrated on the Patient-Specific Functional Scale, global rating of change scale, and International Hip Outcome Tool-33.
This case demonstrates a clinical pathway for collaborative medical management of a patient with confirmed intra-articular pathology. Details illustrate the clinical reasoning and rationale used to guide the clinical decision-making process.
Level of Evidence
Therapy, level 4. J Orthop Sports Phys Ther 2016;46(11):965–975. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6573
written by: JOEL R. NARVESON, DPT1,2 • MATTHEW D. HABERL, DPT2 • PATRICK J. GRABOWSKI, PT, PhD1