Spine & Sports Institute

Hip pain… who hasn’t had hip pain? The real question is what is it and how do you get rid of it? There are a plethora of hip injuries, but the most common that I see clinically is the infamous Gluteus Medius Tendinopathy. Let’s call it “Glute Med Tendinopathy” for short.

Tendon-what, you ask? Tendinopathy translates as “pathology of the tendon”. Once a tendon is injured, inflammation and fluid starts to accumulate around the strained tendon. This initial injury is called “tendonitis” or inflammation of the tendon. If you are lucky and your musculoskeletal system is in tiptop shape, the tendonitis will heal and you will continue with your activity pai- free in one to two weeks.

If the tendonitis does not heal properly, then you are left with a tendinopathy. Glute Med Tendinopathy consists of chronic nagging posterior hip pain worsened by activity. This is commonly linked to bursitis of the hip. A bursa is a fluid filled sack that helps the tendons glide smoothly over the joints. This is the type of injury that you don’t want to “wait it out.” The best time to take care of a tendinopathy is to address it right away.

Now that we know what it is, how do you get rid of it? Contrary to belief, a tendinopathy is easily treatable. Seeking early treatment and a proper diagnosis is the biggest hurdle with this injury. Deep tissue sports massage, active release technique, PRP injections, Prolo therapy injections, or, the beloved, foam roller will help heal this chronic injury by causing micro trauma to the injured tendon. The controlled (key word here) injury sustained from this type of treatment will cause swelling and inflammation to occur at the targeted damaged site. This is a key factor in the natural healing process of the body. Surprise! Inflammation is not all bad.

The second, and equally important, treatment for Glute Med Tendinopathy is to strengthen it. Strengthening the gluteus medius muscle correctly and all the other hip muscles, as well as the core, will give the injured tissue a break and allow it to heal without complications.

If you suspect that you are suffering from Gluteus Medius Tendinopathy and two weeks of “at home treatment” doesn’t seem to be working, it is time to seek treatment from a sports provider.

Adolescence is a critical period for attainment of PBM, an important predictor of future fracture risk. Encouraging adolescents to consume adequate calories and nutrients, such as calcium and vitamin D, is important for healthy progression through puberty and for optimal skeletal health. Enhancement of normal skeletal development can be achieved with the addition of frequent weight bearing exercise in the presence of adequate nutrition. While we do not yet have an ideal exercise prescription, it is now widely believed that activities that confer high-impact forces in unusual loading patterns are osteogenic. Ground reaction forces in addition to the pull of muscles on bone can enhance bone building during adolescence and beyond. Because prevention is better understood and has fewer potential negative side effects than adult treatments for low bone density, we need to enforce good habits early to prevent development of any of the components of the female athlete triad, and to optimize bone mass acquisition in adolescent athletes.

Abstract: Platelet-rich plasma (PRP) is an autologous blood-derived product with an increased concentration of platelets in plasma, which are used to deliver supraphysiological levels of growth factors. Platelet-rich plasma has been used in many fields, including oral, maxillofacial, and plastic surgery. Its use in sports medicine has been increasing after recent evidence and media publicity suggest that it may augment the treatment of muscle strains, as well as tendon and ligament healing. Basic science and animal studies show promising results, but high-level clinical trials have yet to prove its efficacy. With increasing media coverage on the use of PRP in athletes, it is paramount that orthopedic surgeons and sports medicine physicians understand the various methods of preparation and administration, potential clinical applications, and available clinical results to best counsel patients on its advantages and disadvantages.

There remains limited evidence for or against the clinical efficacy of PRP therapy. Continued research is needed to establish the potential clinical uses and biological effects of PRP and to assess whether PRP is more effective than conventional approaches in the treatment of sports injuries. Whether the established molecular and cellular effects of PRP on human tendon cells and chondrocytes translate to a clinical benefit remains to be determined. Furthermore, due to qualitative differences in methods of preparation, it is difficult to generalize results of clinical studies without an in-depth understanding of the specific method of preparation and administration, and if these factors affect the outcome of PRP use. Although PRP may provide an alternative to surgical intervention for many common orthopedic sports injuries, more evidence is needed to confirm preliminary results and validate its efficacy to support its current widespread use. Until then, its clinical use should be approached cautiously with appropriate indications.

This review summarizes evidence from randomized controlled trials to examine whether strength training influences anxiety, chronic pain, cognition, depression, fatigue symptoms, self-esteem, and sleep. The weight of the available evidence supported the conclusion that strength training is associated with reductions in anxiety symptoms among healthy adults (5 trials); reductions in pain intensity among patients with low back pain (5 trials), osteoarthritis (8 trials), and fibromyalgia (4 trials); improvements in cognition among older adults (7 trials); improvements in sleep quality among depressed older adults (2 trials); reductions in symptoms of depression among patients with diagnosed depression (4 trials) and fibromyalgia (2 trials); reductions in fatigue symptoms (10 trials); and improvements in self-esteem (6 trials). The evidence indicates that larger trials with a greater range of patient samples are needed to better estimate the magnitude and the consistency of the relationship between strength training and these mental health outcomes. Plausible social, psychological, and neural mechanisms by which strength training could influence these outcomes rarely have been explored. This review revealed the high-priority research need for animal and human research aimed at better understanding the brain mechanisms underlying mental health changes with strength training.

It is hypothesized that patients with patellofemoral pain syndrome (PFPS) have hip and core muscle weakness leading to dynamic malalignment of the lower extremity. Thus, hip strengthening is a common PFPS treatment approach.

Purpose: To determine changes in hip strength, core endurance, lower extremity biomechanics, and patient outcomes after proximally focused rehabilitation for PFPS patients.

Study Design: Case series; Level of evidence, 4.

Methods: Nineteen women (age, 22.68 ± 7.19 years; height, 1.64 ± 0.07 m; mass, 60.2 ± 7.35 kg) with PFPS participated in an 8-week program to strengthen the hip and core muscles and improve dynamic malalignment. Paired t tests were used to compare the dependent variables between prerehabilitation and postrehabilitation. The dependent variables were pain; functional ability; isometric hip abduction and external rotation strength; anterior, lateral, and posterior core endurance; joint range of motion (ROM; rearfoot eversion, knee abduction and internal rotation, and hip adduction and internal rotation); and peak internal joint moments (rearfoot inversion, knee abduction, and hip abduction and external rotation) during the stance phase of running.

Results: Significant improvements in pain, functional ability, lateral core endurance, hip abduction, and hip external rotation strength were observed. There was also a significant reduction in the knee abduction moment during running, although there were no significant changes in joint ROM.

Conclusion: An 8-week rehabilitation program focusing on strengthening and improving neuromuscular control of the hip and core musculature produces positive patient outcomes, improves hip and core muscle strength, and reduces the knee abduction moment, which is associated with developing PFPS.

An ipsilateral hip adduction/abduction strength ratio of more than 90%, and hip adduction strength equal to that of the contralateral side have been suggested to clinically represent adequate strength recovery of hip adduction strength in athletes after groin injury. However, to what extent side-to-side symmetry in isometric hip adduction and abduction strength can be assumed in soccer players remains uncertain.

Purpose: To compare isometric hip adduction and abduction strength on the dominant and nondominant side in injury-free soccer players.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: One hundred elite soccer players were included. Maximal unilateral isometric hip adduction and abduction strength on the dominant and nondominant side were measured with a handheld dynamometer, using a reliable test procedure.

Results: The dominant side was stronger than the nondominant side for both isometric hip adduction (2.45 ± 0.54 vs 2.37 ± 0.48 Nm/kg, P = .02) and hip abduction (2.35 ± 0.33 vs 2.25 ± 0.31 Nm/kg, P < .001), corresponding to a 3% and 4% difference, respectively. Isometric hip adduction was greater than isometric hip abduction for both the dominant (2.44 ± 0.53 vs 2.35 ± 0.33 Nm/kg, P = .04) and nondominant (2.37 ± 0.48 vs 2.26 ± 0.33 Nm/kg, P = .03) side. Isometric hip adduction/abduction ratio was not different between the dominant (1.04 ± 0.18) and nondominant (1.06 ± 0.17, P = .40) side. A post hoc analysis showed that isometric hip adduction/abduction ratio was significantly lower in players with groin pain during hip adduction testing compared with players with a pain-free test (0.80 ± 0.14, P < .001)

Conclusion: The marginal difference between the dominant and the nondominant side is within the measurement variation of the test procedure, and contralateral isometric hip adduction strength can therefore be used as a simple clinical reference point of full recovery of hip adduction muscle strength in soccer players. Furthermore, it is suggested that the ipsilateral hip adduction/abduction strength ratio is used as a guideline for evaluating hip adduction strength recovery in soccer players with bilateral groin problems.