Hip and pelvis injuries in runners: careful evaluation and tailored management

Activity of lower limb muscles during treadmill running at different velocities

[Purpose] The present study aimed to determine changes in muscle activity while moving on a treadmill at various speeds. [Subjects] The activities of the left vastus lateralis, vastus medialis, hip adductors, lateral head of gastrocnemius, medial head gastrocnemius, soleus, and tibialis anterior of 10 healthy male university students were analyzed. [Methods] University students walked, jogged, and ran for 10 minutes each in random order, and then myogenic potentials were measured 10 minutes later for 30 seconds. The flexion angle of the lower limb upon initial contact, mid stance, and toe off were measured. [Results] The average walking, jogging, and running speeds were 3.6 ± 0.4, 6.7 ± 0.6, and 10.4 ± 1.3 km/h, respectively. The average electromyographic activities of the vastus medial, tibialis anterior, medial head of gastrocnemius, and lateral head of gastrocnemius significantly differed. All muscles were more active during jogging and running than walking. Only the soleus was more active during running than walking, and the activities of the hip adductors and vastus lateralis did not significantly differ. [Conclusion] Velocity is faster and the angles of the lower limbs and ground reaction force (GRF) are larger during running than walking. The vastus medialis and soleus worked more easily according to the angle of the knee joint, whereas the tibialis anterior worked more easily at faster velocities and the medial and lateral heads of the gastrocnemius worked more easily with an increased GRF.

Late presentation of a subiliacus haematoma after an apophyseal injury of the anterior inferior iliac spine

Apophyseal injuries are particularly common in adolescents when the growth spurt that accompanies puberty places increased strain on developing bones and muscles. Bone growth in particular exceeds that of soft tissues resulting in relatively tight musculature and subsequent excessive strain at these sites of tendon insertion into bone. We describe a case of a young athlete who presented with chronic hip pain after an anterior inferior iliac spine apophyseal injury with subsequent haematoma formation under the iliacus muscle. There was no evidence of a bleeding disorder. In view of the late presentation, he was managed non-operatively. This injury requires a low threshold for early cross-sectional imaging. The delay in management in this case did not lead to any long-term sequelae.

High hamstring tendinopathy in 3 female long distance runners

OBJECTIVE

The purpose of this case report is to describe and discuss the clinical presentation, diagnosis, and management of 3 female long distance runners with high hamstring tendinopathy.

CLINICAL FEATURES

Three female runners presented to a chiropractic office with proximal hamstring pain that was aggravated by running. Increasing mileage, hills, and/or interval training preceded the onset of symptoms in each case. The subjects all displayed weakness of the hip abductors, pelvic joint dysfunction, hamstring tightness, and ischial tuberosity tenderness. Other clinical findings included overpronation, proprioceptive weakness, and lumbar dysfunction.

INTERVENTION AND OUTCOME

All 3 patients were treated with Graston Instrument Assisted Soft Tissue Mobilization, lumbopelvic manipulation, and electrical muscle stimulation with ultrasound. Active exercise focused on hamstring stretching and strengthening, gluteal strengthening, and proprioceptive training. The 3 runners seen in this clinic had resolution of hamstring pain in an average of 13 treatments and were able to continue competing without restriction.

CONCLUSION

Runners with high hamstring tendinopathy may respond favorably to conservative chiropractic treatment and active rehabilitation with minimal time off of training.

Diagnosis and management of posttraumatic piriformis syndrome: a case study

OBJECTIVE

The aim of this study is to describe the clinical management of a young male patient with sciatica symptoms that developed after an avulsion of the ischial tuberosity. This is a rare injury, but complications may occur.

CLINICAL FEATURE

A 19-year-old patient developed sciatica 6 months after a football injury. The patient described his symptoms as a shooting pain from the buttock to the lateral part of the foot, along the back of his thigh and calf, sometimes accompanied by paresthesia. Physical examination showed restricted hip range of motion and a positive Bonnet's test. X-ray analysis revealed a bony overgrowth of the right ischial tuberosity.

INTERVENTION AND OUTCOME

A treatment plan was designed to decrease the pain level, increase sacroiliac and lumbar joint mobility, and augment muscular extensibility. The patient received 20 treatments over a period of approximately 3 months. Complete recovery was observed 5 months later.

CONCLUSION

Although many differential diagnoses were contemplated, it is most likely that changes in muscular tension and gait pattern, resulting from the ischial tuberosity avulsion, contributed to overuse of the piriformis muscle leading to a piriformis syndrome.

Chiropractic management of hip pain after conservative hip arthroplasty

OBJECTIVES

To describe a case involving postsurgical hip pain that was successfully treated with a combination of chiropractic manipulation of the lumbar and pelvic region and low-tech rehabilitation 14 months postsurgery.

CLINICAL FEATURES

A 45-year-old man had pain and difficulty with walking. He was diagnosed with bilateral avascular necrosis at the femoral heads. He had successful right hip arthroplasty (HA) surgery at the time of the original diagnosis and had 2 previous surgeries to the left hip joint to treat avascular necrosis, with the latter being hip arthroplasty. He had a chief complaint of left hip pain that radiated down the lateral thigh to the knee with a "clicking" of the hip noted at end range abduction and adduction, as well as an altered gait pattern associated with dysfunction of the left hip.

INTERVENTION AND OUTCOME

He was treated with chiropractic manipulative therapy of the lumbar and sacroiliac joints and a rehabilitation program that consisted of in-office and home exercise programs. The patient experienced a decrease in the pain and an improvement in the flexibility and strength that led to an improved gait pattern and decreased pain. Outcomes were measured through active range of motion comparisons and use of the Harris Hip Scale Evaluation.

CONCLUSIONS

Treatment of hip pain through chiropractic manipulation and rehabilitation is described. The patient had increases in active ranges of motion and Harris Hip scores. Additional studies should be done to evaluate the effects of chiropractic manipulations on patient outcomes following such surgeries.