by clicking the arrows at the side of the page, or by using the toolbar.
by clicking anywhere on the page.
by dragging the page around when zoomed in.
by clicking anywhere on the page when zoomed in.
web sites or send emails by clicking on hyperlinks.
Email this page to a friend
Search this issue
Index - jump to page or section
Archive - view past issues
Chiropractic Journal of Australia : CJA December 2012
126 Chiropractic Journal of Australia Volume 42 Number 4 December 2012 INTRODUCTION Femoroacetabular impingement (FAI) is a condition resulting from morphologic abnormalities of the acetabular rim and proximal femur. The pathomechanics of FAI leads to abnormal contact between the acetabular rim and femoral head-neck junction, creating chondral lesions, labral pathology and secondary degenerative joint disease (DJD).1,2 Recent investigation has indicated that FAI might be the underlying etiology in most DJD cases that were previously identifed as “idiopathic.” 2 FAI can manifest through two different mechanisms, namely Cam-type (femoral-based) or pincer-type (acetabular- based), although a combination of both is often seen in clinical practice.3,4 The Cam-type impingement is characterized by an absent or decreased offset between the femoral head and neck.5 Pincer-type impingement results from focal or generalised acetabular abnormalities.2,5,6 Femoroacetabular Impingement and its Relevance to Chiropractors. Part 2: A Case Series ABSTRACT: Objective: The purpose of this case series is to present the clinical diagnosis of femoroacetabu- lar impingement (FAI) in three athletic patients, and to describe and discuss the outcomes of a multi-modal management approach provided by a chiropractor.Clinical Features: Three athletic patients, two male and one female aged from 31 to 42 years old (mean age, 35.3 years), presented with hip and groin pain. A clinical diagnosis of FAI was made through synthesis of the patient history, physical examination and presence of morphological abnormalities on radiographic examination. Intervention and Outcome: Treatment addressed the entire kinetic chain including the cervical and thoracic spine, lumbopelvic-hip complex, and lower extrem- ity. Long-axis traction, high-velocity, low-amplitude (HVLA) mechanically assisted adjusting techniques (MAT) were applied to the involved hip, utilizing a chiropractic drop-piece table. Motion restriction of spinal, sacro-iliac and lower extremity articulations were treated with HVLA manipulation; joint mobilisations and/or MAT. Pre/ post manipulative soft tissue techniques were applied to the involved hip, and corrective exercise therapy was prescribed. All three patients reported subjective improvements in hip pain and function. Objectively, all three patients had improvements in resisted muscle testing, hip fexor mobility, PHE testing and hip fexion range of motion. Conclusion: Three patients clinically diagnosed with FAI had subjective and objective improvements in hip function and symptoms following multi-modal chiropractic management. Further research involving larger randomized controlled and clinical trials with long-term follow up are both required and warranted to clarify the effectiveness of a multi-modal chiropractic treatment approach in the management of FAI. BRETT S JAROSZ Index Terms: (MeSH): ATHLETIC INJURIES; CHIROPRACTIC; HIP INJURIES; OSTEOARTHRITIS, HIP. (Other): FEMOROA- CETABULAR IMPINGEMENT. Chiropr J Aust 2012;42: 126-36. Brett S. Jarosz, BAppSc(CompMed), MClinChiro, ICSSD, CertPT Sessional Lecturer, RMIT University, Discipline of Chiropractic, Bundoora, Victoria; Chiropractor, Private Practice of Chiropractic, Gisborne, Victoria. Received: 19 May 2012 Accepted: 14 June 2012 Confict of Interest Notifcation: There were no funding sources for this study and no conficts of interest have been identifed. The diagnosis of FAI should be made through synthesis of the patient history, physical examination, and radiographic fndings. Typically, FAI presents as insidious onset groin pain in physically active adults aged 20 to 50 years (average age: 33-35 years).3,6 Athletic activities that involve extreme ranges of motion, especially repetitive hip hyperfexion, hyperextension, internal and external rotation typically cause an increase in intensity or duration of symptoms.3,6-10 Range of motion of the hip is restricted, and often painful, in hip fexion and internal rotation in fexion, as a result of the morphologic abnormalities.1,3,11 Almost 90% of hips reproduce pain symptoms with the anterior impingement test - possibly the most important clinical fnding indicative of FAI.3,10 When detected, the radiographic signs of Cam and pincer morphological abnormality confrm the diagnosis of FAI, provided they are consistent with the clinical fndings.6 An inability to recognise the morphological abnormalities, or a lack of access to imaging, does not surpass an indicative patient history and physical examination fndings, which includes a positive impingement test.10 Many patients with symptomatic FAI experience delays in diagnosis, incorrect diagnosis, and ineffective treatment recommendations.3 FAI is often misdiagnosed and mismanaged as groin strain, early osteoarthritis, inguinal hernia or a low back disorder.10,11 However, recently it has been hypothesised that conditions including osteitis pubis, sports hernia, infammation of the sacro-iliac joint (SIJ), adductor strain, rectus femoris strain, and posterior hip
CJA September 2012
CJA March 2013