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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'arthritis'

It is time to clear out some product inventory this year.  To that end, I am offering a 50% off sale for one week only.  This sale is on all physical products as well as e-books.  I am also offering this discount on my printed version of the Ultimate Rotator Cuff Training Guide, of which I only have five remaining copies.

Simply enter code BFIT50 at checkout to save 50% on your entire order.  Click Here to view all products.

This sale will end Monday July 18, so act now while supplies last.

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I hope you and your families had a wonderful Thanksgiving holiday! Starting today and running all week you can save 30% on any and all of my DVDs. Take advantage of this offer on any of my Fit Knee series (osteoarthritis, running, or ACL) as well as my Ultimate Rotator Cuff Training one. The sale will end on Sunday Dec. 7.

Please share this offer with friends, colleagues and family who may benefit from any of these products.  Simply enter code DVD30 at the checkout and hit apply coupon to save 30% today.  Click here to order.

Femoroacetabular impingement (FAI) is often a hidden and misunderstood cause of hip pain.  I currently work with a physician who has studied under some of the best hip arthroscopists in the US, and he is performing arthroscopic procedures to resolve hip impingement.  For many years, this has likely been a source of misdiagnosed, under treated and debilitating hip pain for people.

As things advance in medicine, hip arthroscopy is expanding and allowing for easier surgical correction of these issues. However, it is not an easy surgery technically speaking.  As such, finding the right surgeon (if needed) is critical to attaining a positive outcome.  Who normally gets it?  Unfortunately, many people are predisposed to it, much like we see the natural genetic architecture (shape) of the acromion affecting impingement in the shoulder.

If you have an overhang of the hip acetabulum (socket) or non-spherical shape of the femoral head (or both) this can compromise the joint space and injure the joint cartilage and/or labrum.  Destruction can occur at a very young age.  I am currently rehabbing a 19 y/o male who recently underwent hip arthroscopy to debride his labrum and smooth out the hip socket and re-shape the femoral head.  He had extensive damage at an early age due to his joint architecture and shows some signs of impingement on the other side as well.

How do you know if you have hip impingement?  Generally, you may have hip joint pain along the front, side or back of the hip along with stiffness or a marked loss of motion (namely internal rotation).  It is common in high level athletes and active individuals.  However, other things may cause hip pain as well such as iliopsoas tendonitis, low back pain, SI joint pain, groin strain, hip dysplasia, etc. so a careful history, exam and plain films are necessary to confirm the diagnosis.  If suspected, an MR athrogram is usually ordered to confirm if there are labral tears present.  Physicians also use an injection with anesthetic to see if the pain is truly coming from the hip joint.  This may be done under fluoroscopy to ensure it is in the joint space.

Signs and symptoms of FAI may include:

  • Pain with sitting
  • Pain or limited squatting
  • Stiffness and decreased internal rotation
  • Pain with impingement testing (see picture below of hip flexion, adduction and internal rotation - examiner will move the hip into this position and marked stiffness/loss of internal rotation and pain indicates a positive test)

hip-impingement-test

Conservative treatment typically involves limiting or avoiding squats, strengthening the core and hip stabilizers as well as attempting to maximize mobility of the joint.  Due to the fact that by the time pain brings patients in to see the doctor there has already been marked labral and joint damage, a cautious and proactive approach to managing hip pain is warranted especially in younger active patients and athletes.

The types of lesions seen are either Cam or Pincer lesions.

Cam lesion - involves an aspherical shape of the femoral that causes abnormal contact between the ball and socket leading to impingement

Pincer lesion - involves excessive overgrowth of the acetabulum resulting in too much coverage of the femoral head and causing impingement where the labrum gets pinched

You can also see a mixed lesion where Cam and Pincer lesions are involved.  FAI may lead or contribute to cartilage damage, labral tears, hyperlaxity, sports hernias, low back pain and early arthritis.

fais

The good news is that these patients typically do well post-operatively.  Dr. Philipon et al reported in 2007 in the Knee Surg Sports Traumatol Arthrosc. (click here to read the abstract) on 45 professional athletes who underwent arthroscopic management of FAI with an average follow-up of 1.6 years.   In this time period 78% of them were able to return to their sport.

Following surgery, weight bearing may be restricted for the first 4 weeks or so to protect the labrum if it is repaired.  With a simple debridement and re-contouring of the acetabulum, weight bearing may be initiated earlier.  Avoiding twisting motions and excessive external rotation is a must in the first month or so as well.  Typically, impact and twisting restrictions are lifted around 3 months post-op.

In the end, proper diagnosis and treatment is necessary to preserve the hip joint and maximize function and return to sport.  If you or someone you know suffers from chronic and persistent hip pain that has failed conservative treatment, then consider getting a second look to rule out FAI.

It is common knowledge in the medical community that treating patellofemoral joint pain (PFJP) is one of the most frustrating and difficult tasks to complete as there appears to be no standard way to do so.  While clinicians strive to find the right recipe or protocol (I don’t believe there is just one by the way), researchers press on to find more clues.

A new article released in the April 2011 Journal of Orthopaedic & Sports Physical Therapy seeks to bring clarification to a particular exercise pattern commonly used in rehab circles.  The three exercises they looked at were:

  • Forward step-up
  • Lateral step-up
  • Forward step-down

In the study, the authors looked at 20 healthy subjects (ages 18-35 and 10 males/females) performing the separate tasks with motion analysis, EMG and a force plate.  The goal was to quantify patellofemoral joint reaction force (PFJRF) and patellofemoral joint stress (PFJS) during all three exercises with a step height that allowed a standard knee flexion angle of 45 degrees specific to each participant.

Key point:  Previous research has been done to indicate that in a closed chain setting, knee flexion beyond 60 degrees leads to increased patellofemoral joint compression and this may be contraindicated for those with PFJ pain or chondromalacia.  Also keep in mind that most people with PFJ complain of more pain descending stairs than ascending stairs.

patellofemoral-force

In the study, the participants performed 3 trials of 5 repetitions of each exercise at a cadence of 1/0/1 paced with a metronome.  The order of testing was randomized for each person.  The authors used a biomechanical model to quantify PFJRF and PFJS consisting of knee flexion angle, adjusted knee extensor moment, PFJ contact area, quadriceps effective lever arm, and the relationship b/w quadriceps force and PFJRF.

Now on to the results……


Continue reading…

For those who know me well, it is safe to say I am an “ACL geek” of sorts.  I love studying, reading and searching for the best way to rehab and prevent these injuries.  As I have grown in the profession, I have become increasingly concerned with articular cartilage damage and the long term effects it has on our young athletes.

Perhaps I am getting more concerned as my knees aren’t getting any younger either (lol).  Anyway, I truly believe we often underestimate how deleterious cartilage injuries can be long term.  In addition, I feel we, as rehab and conditioning professionals, need to better understand how our training impacts the cartilage regardless of whether patients had a concomitant bone bruise with their ACL injury or not.

One of my favorite prehab exercises is a single leg hop and stick (see below)

single-leg-stick-finish

I typically begin with an alternate leg approach (push off right and land on left) prior to initiating takeoff and landing on the same leg to teach proper landing mechanics.  By now, we know increasing hip and knee flexion, as well as shifting center of mass forward reduces ACL strain and injury risk through a diminished extension moment.

However, what we may not know as much about is how an ACL reconstruction alters tibiofemoral joint mechanics at such a landing.   I want to share some interesting information from a recent article in the September edition of The American Journal of Sports Medicine.  The article by Deneweth et al. looked at tibiofemoral joint kinematics of the ACL reconstructed knee during a single-legged hop landing.


Continue reading…