Hip Pain – High School Track


M. Taylor, G. Rozea, K. Vanic, East Stroudsburg University, PA & L. Zaparzynski, Mansfield University, PA email: grozea@esu.edu (Sponsor: K. N. Waninger, FACSM)

HISTORY: A 19-year-old female field hockey athlete presented with pain over the left anterior inferior iliac spine (AIIS) and pain/stiffness in her hip joint (Asian descent). Past medical history revealed pain initially recognized two year prior to currents complaints and bilateral hip fracturing during childbirth.

PHYSICAL EXAMINATION: No deformity noted over greater trochanter and hip flexor region. Pain elicited during hip flexor manual muscle testing. Point tender over illiopsoas and rectus femoris tendons. The patient pronates and internally rotates hip during gait cycle. There is anterior medial clicking when the patient is retroverted and externally rotated. Inflammation apparent around AIIS. Athlete does excessively pronate and does present with internally rotated hips.

DIFFERENTIAL DIAGNOSIS: Hip Dysplasia (Adult Form), SI dysfunction, Lumbar Radiculopathy, Trochanteric Bursitis, Piriformis Syndrome, Psychosomatic Pain Disorder, Iliopsoas Tendinitis/Tendonitis/Tendinosis, Adductor Strain, Sports Hernia, Iliac Apophysitis, Quadriceps Strain, Endometriosis, Deep Gluteal Syndrome, Hamstring Tendinitis/Tendinosis, Chronic Pain Syndromes, Osteonecrosis, Labral tears

TEST AND RESULTS: Supine AP Pelvis view and a Hip Cross Table Lateral View was taken. MRI revealed signs of osteoarthritic changes. Alpha angle greater than 50o

FINAL/WORKING DIAGNOSIS: CAM hip and femeroacetabular impingement/dysfunction

TREATMENT AND OUTCOMES: After 4 weeks of rehabilitation, pain did not subside. The athlete not returned to full contact. She is not pain free and she is working on the proper biomechanical field hockey stance. Rehab protocol included: leg raises, stretching hip flexors, quads and hamstrings and therapeutic electrical modalities. .

Manual muscle therapy included separation of the rectus femoris from the iliopsoas while holding laterally and internally rotating. Sustained pressure on pelvic girdle and pectineus and iliofemoral stretching. A normal end feel with posterior capsule stability has been potentially obtained. FAI rational may contribute to the low squat position during athletic play.

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