Thoughts from the journey… Excerpts from a day in the life of Sherry McLaughlin

5Oct/091

FAI and Hip Labral Tears

I frequent a running site where I get to hear about injuries that plague this group of athletes. There has been a recent increase in people complaining of hip pain, femoroacetabular impingement and labral tears. Some have had success with surgery, while many remain frustrated and have not been able to return to running.

The question that has to be asked is how did this happen to begin with? If the hip is sitting funny in the socket, then that is what ultimately causes a labral tear or wearing away of the femoral head.

For you people suffering with hip pain, know that there is a fix and it doesn't necessarily include a knife. We have had people contact us via email, receive a few exercises based on their answers to a few questions and they have become significantly pain-free in 1-2 weeks. It started out as my little pilot study and has yielded some really great results.

For you clinicians out there, there is a biomechanical fix.

Here are the things you want to check first:

1. Pelvic alignment - innominate inflares/outflares or anterior/posterior rotations will cause the hip to bind or pinch with IR/ER.

2. 90/90 hamstring test - if this is tight, check to see if they have a posteriorly displaced fibular head. You can fix that with a muscle energy technique or mobilization and it should improve hamstring length.

3. FABER's test - if this is (+) or limited on one side, the things to check are - latissimus dorsi flexibility (do the lat squeeze for those of you familiar with our techniques), correct inflare/outflares and mobilize the hip (this should be done last). If that doesn't work, check the opposite iliopsoas for a trigger point and if you find one, counterstrain it. Your goal is to normalize this motion as activating the glute is more difficult if this is restricted.

4. Piriformis test- If the patient gets a pinch in the groin with passive internal rotation, this also will impair the ability of the gluteal muscles to be activated during weight bearing activities. Common causes for this are inflares/outflares, a sacral torsion, trigger points in the iliopsoas or piriformis. Check these out on these patients and "fix what you find".

Remember, it's almost always about the butt... FAI and labral tears occur in hips where the gluteus medius and maximus were not functioning properly and more times than not it is due to a muscle imbalance or pelvic malalignment.

As for exercise intervention, once you determine why the glute muscles have taken a vacation, there are very specific ways to wake it back up. Stay tuned for more on this part.

Until next time...

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  1. Sherri, this is very timely. Our ortho fellows are all hot on FAI right now. If a patient gets seen by them with an xray with a positive cross over sign, forget it, they are getting cut. Hopefully we can intercept some of these patients and work these techniques to some success. I’ll spread the word to the rest of the clan. Great tips!


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