Hip Injuries

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					Hip Injuries In Ballet Dancers
  Dance Medicine Program
Physical Therapy Of Los Gatos

        Ariel Lehaitre M.S.P.T.




        Ariel Lehaitre MSPT   http://www.pilates-sante.com
3 Typical Injuries

 Iliopsoas tendonopathy
 Iliotibial band syndrome (external
 snapping hip)
 Labral tear




           Ariel Lehaitre MSPT   http://www.pilates-sante.com
Hip Anatomy
                                        The hip is a ball and socket
                                        joint composed of the head
                                        of the thigh bone (femur)
                                        and a cavity in the pelvis
                                        (acetabulum)
                                        A layer of smooth cartilage
                                        covers both the head of the
                                        femur (ball) and the
                                        acetabulum (socket), which
                                        allows the joint surfaces to
                                        move on each other with
                                        little friction
                                        A fibrocartilagenous ring,
                                        called a labrum surrounds
                                        the acetabulum, helping
                                        provide the joint with
                                        stability

        Ariel Lehaitre MSPT   http://www.pilates-sante.com
Anatomy of the Hip

 The ball-and-socket permits a wide
 range of motion in three planes:
   Extension and flexion (moving the hip
   front and back)
   Abduction and Adduction (moving the
   hip side to side)
   Internal and External rotation (moving
   the hip in semicircle)
       – Questions?

            Ariel Lehaitre MSPT   http://www.pilates-sante.com
What is the iliopsoas?
 The iliopsoas tendon is actually
 formed by 2 muscles: the iliacus and
 the psoas major
   The psoas major travels from the lumbar
   vertebra (T12-L5) to the femur/thigh
   bone
   The iliacus is along the inner surface of
   the ilium (pelvic bone) and travels to the
   femur/thigh bone
     Together these muscles form the iliopsoas
     tendon
     Role is to perform flexion of the hip joint
                                 position (discussed later)
     Also effects pelvichttp://www.pilates-sante.com
             Ariel Lehaitre MSPT
Ariel Lehaitre MSPT   http://www.pilates-sante.com
Ariel Lehaitre MSPT   http://www.pilates-sante.com
Internal snapping hip
 What is causing the click or snapping
 sound in the front of my hip?
   Sliding of the iliopsoas tendon over a bony
   surface on the femur/thigh bone (called
   iliopectineal eminence)
   Usually occurs when the hip moves from flexed,
   turned out (externally rotated) position to
   extension
   This is associated with iliopsoas tendonopathy
       – Has anyone experienced this?


             Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliopsoas tendonopathy

 How do I know I have this?
   Pain is located in the front of the hip or
   groin area
   You may have an audible snapping or
   clicking in the hip or groin that is painful
   or painless
   Pain would typically occur with repetitive
   or sustained hip flexion (battement or
   develop at or above 90 degrees)
            Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliopsoas Tendonopathy

 4 Stages of tendon breakdown:
   Stage 1: pain occurs only after activity,
   not before or during
   Stage 2: pain preset at beginning of
   activity, decrease with warm up,
   reappears after activity
   Stage 3: pain present during and after
   activity, affecting performance
   Stage 4: tendon ruptures causing a
   chronic weakness of tendon
            Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliopsoas Tendonopathy

 Why does it occur?
   Excessive stress to the tendon because
   of a poor muscle balance
     The muscle balance here is created
     between the abdominals and the iliopsoas: if
     the abdominals are unable to create enough
     force to counter pose the iliopsoas,
     excessive forces will be placed on the
     iliopsoas tendon


            Ariel Lehaitre MSPT   http://www.pilates-sante.com
The Role of Iliopsoas
 Its relation to pelvic position: if the iliopsoas
 is tight it will pull the pelvis forward
 (anterior pelvic tilt), and the spine into
 extension because it is attached to the
 lumbar spine
   Your lower back will look arched
   Your abdominals are lengthened and cannot
   counter pose the shortened iliopsoas, altering
   the muscle balance (previously discussed)
      Therefore maintaining this muscle length is important
      in achieving good spinal alignment and muscle
      balance – preventing tendonopathy

              Ariel Lehaitre MSPT   http://www.pilates-sante.com
Role of the Iliopsoas




         Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliopsoas Tendonopathy

 Treatment
   Will depend on stage of condition
   Self treatment in initial stages: ice, anti-
   inflammatory medications, rest and self
   massage
   Need for Physical Therapy once dance
   performance limited in any way by pain
   or condition


            Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliopsoas Tendonopathy
 Treatment – When do I need to see a
 professional?
           Dependent on stage of condition
     Stage 1 - self treat with rest, ice, modification of
     technique
     Stage 2- continue like stage 1, increase cross training
     (pilates), beneficial to see MD or PT to prevent
     Stages 3 and 4
     Stage 3 – see MD and or PT, necessary for tissue to
     be treated by professional, decrease dance time
     Stage 4 – Must stop dancing. Must see MD to
     determine amount of tissue damage. PT needed for
     full recovery of function.

             Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliopsoas Tendonopathy
 Physical Therapy: Comprehensive treatment to
    return to activity without pain or reoccurrence
    Iliacus and psoas length and soft tissue
    mobility
    Core strengthening: Correct muscle
    imbalance - exercise demonstration
    Hip strengthening: gluteals, medial and lateral
    rotators
    Correct or control dance technique or
    biomechanics: pelvic position
    Preparation for return to Dance
       –   Pilates based strengthening
           » Questions?


             Ariel Lehaitre MSPT   http://www.pilates-sante.com
Demonstration of Exercise
 Transverse
 abdominus
 strengthening
   90/90 leg lowering
   and reaching




            Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliotibial Band Syndrome or
tendonopathy
  Iliotibial Band
   What is it?
      The continuation of the tensor fascia lata
      (TFL)muscle
      Dense fascia/tissue which travels from the
      pelvis (iliac crest) to the tibia/shin bone
      Role is to assist the TFL muscle in
      abduction, internal rotation, and flexion of
      hip


             Ariel Lehaitre MSPT   http://www.pilates-sante.com
Ariel Lehaitre MSPT   http://www.pilates-sante.com
External Snapping Hip
 What is causing the snapping at the side of
 my hip?
   Sliding of the iliotibial band over a bony
   prominence on the femur/thigh bone (greater
   trochanter)
   May occur when standing on one leg, with hip
   slightly turned inward (internally rotated) and/or
   abducted
   This is associated with iliotibial band syndrome
       – Anyone experienced this?


             Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliotibial Band Syndrome

 How do I know I have this?
   Pain typically on the outside of hip or
   buttock region (may also occur on the
   outside of the knee)
   You may have audible snapping in the
   same region




           Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliotibial Band Syndrome
 Why does it occur?
   Excessive stress to the iliotibial band
   because of a poor muscle balance
   The muscle balance here is created by
   the gluteus medius versus the tensor
   fascia lata (TFL): if the gluteus medius is
   unable to create enough force to counter
   pose the pull of TFL, excessive force will
   be put on the TFL and its continuation,
   the iliotibial band.

            Ariel Lehaitre MSPT   http://www.pilates-sante.com
The Role of Gluteus Medius
                                        To maintain a level
                                        pelvis during single
                                        leg stance and
                                        ambulation
                                        Very important for
                                        supporting leg
                                        stability in ballet
                                        Standing hip drop
                                        demonstration

        Ariel Lehaitre MSPT   http://www.pilates-sante.com
Role of the Gluteus medius




         Ariel Lehaitre MSPT   http://www.pilates-sante.com
Role of Gluteus Medius




        Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliotibial Band Syndrome

 Treatment
   Will depend on stage of condition
   Self treatment in initial stages: ice, anti-
   inflammatory medications, rest and self
   massage
   Need for Physical Therapy once dance
   performance limited in any way by pain
   or condition


            Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliotibial Band Syndrome
 Treatment – When do I need to see a
 professional?
           Dependent on stage of condition
     Stage 1 - self treat with rest, ice, modification of
     technique
     Stage 2-same as stage 1, increase cross training
     (pilates), beneficial to see MD or PT to prevent stage
     3 and 4
     Stage 3 – see MD and or PT, necessary for tissue to
     be treated by professional, decrease dance time
     Stage 4 – Must stop dancing. Must see MD to
     determine amount of tissue damage. PT needed for
     full recovery of function.

             Ariel Lehaitre MSPT   http://www.pilates-sante.com
Iliotibial Band Syndrome
 Physical Therapy: Comprehensive treatment to
    return to activity without pain or reoccurrence
    TFL, Gluteul, ITB length and soft tissue
    mobility
    Hip strengthening :Correct muscle imbalance-
    exercise demonstration
    Standing single leg strength/control of hip,
    knee, and foot muscles
    Correct or control dance technique or
    biomechanics: single leg stance position
    Preparation for return to Dance
       –   Pilates based strengthening

             Ariel Lehaitre MSPT   http://www.pilates-sante.com
Demonstration of Exercise

 Gluteus Medius strengthening
   Prone
   Sidelying
   Standing




           Ariel Lehaitre MSPT   http://www.pilates-sante.com
Gluteus Medius Exercises




        Ariel Lehaitre MSPT   http://www.pilates-sante.com
Gluteus Medius Exercise




        Ariel Lehaitre MSPT   http://www.pilates-sante.com
Labral Hip tear
 There is not much literature in regards to
 labral hip tears
   However, I would like you to be aware of this
   because it can lead to chronic hip pain and joint
   degeneration/arthritis
 The hip labrum is the fibrocartilagenous
 supportive ring around the acetabulum of
 the pelvis (as mentioned before)
 How does it occur?
   A tear can occur with trauma (ie- a fall) or
   gradually over time
             Ariel Lehaitre MSPT   http://www.pilates-sante.com
Hip Labrum




        Ariel Lehaitre MSPT   http://www.pilates-sante.com
Labral Hip Tear

 How do I know I have this?
   You will experience sharp groin pain,
   that may spread down the front of your
   thigh
   Pain is worst in extension and turned out
   (externally rotated) position of the hip
   You may also have pain with end range
   hip flexion or repetitive hip flexion
   (similar to iliopsoas tendonopathy)
           Ariel Lehaitre MSPT   http://www.pilates-sante.com
Labral Hip Tear

 Why does this occur?
   Excessive activities in turn out or
   extension causing abnormal distribution
   of forces to the labrum
 A professional must distinguish
 iliopsoas tendonopathy from a labral
 tear because symptoms may be
 similar

           Ariel Lehaitre MSPT   http://www.pilates-sante.com
Labral Hip tear
 Treatment – When do I need to see a
 professional?
   Immediately (if you experience significant,
   unrelieved hip pain)
   MD’s rule out other diagnoses by imaging the
   hip
     magnetic resonance arthrography as shown to be
     most successful; standard MRI’s and computed
     tomography have shown not to be less successful
   May need arthroscopic surgery to debride
   labrum or labrum repair
             Ariel Lehaitre MSPT   http://www.pilates-sante.com
Take Home Message

 Why do injuries occur?
   Sudden trauma
     Less common, usually when fatigued
   Poor biomechanics (improper technique)
   or muscle imbalances
     Forces to tissues that the body cannot
     tolerate
   Other:
     Chronic repetitive use
     Inadequate warm up
           Ariel Lehaitre MSPT http://www.pilates-sante.com
     Sudden increases in amount of dancing
Take Home Message

 Injury Prevention:
   Key to dancing without pain
     Better technique (but not the only issue):
      – Forced turnout
      – Poor supporting leg position
      – Poor working leg position (battement, develop,
        etc)
     Imagery – knowing and imagining the proper
     alignment may help achieve it


            Ariel Lehaitre MSPT   http://www.pilates-sante.com
Prevention continued
    Need Cross training/dance conditioning
     – Pilates – supplemental strengthening
         » Lack of ”center”/core increase load on lower
           extremities
    Proper rest, with progressive return to
    activity
    Proper warm up!!! Ie. Franklin theraband or
    pilates mat exercises




           Ariel Lehaitre MSPT   http://www.pilates-sante.com
Questions?

 Contact for injury evaluation:
   Ariel Lehaitre M.S.P.T.
   Physical Therapy of Los Gatos: Dance
   Medicine Program
   408-358-6505




           Ariel Lehaitre MSPT   http://www.pilates-sante.com

				
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