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14 Cards in this Set
- Front
- Back
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What is Anteromedial Impingement Syndrome?
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1. Secondary to an impaired instantaneous axis of rotation at the hip
2. The femoral head hunctions in a anterior position in relation to the normal joint axis 3. This is caused by TFL dominance |
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C of AMIS?
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Groin pain with hip flexion > 90* (especially when combined with ADD or IR)
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A of AMIS?
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Gluteal atrophy
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R of AMIS?
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1. AROM of flexion limited by pain at end range b/c axis of motion is not normal
2. PROM of flexion may become limtied over time- a. 2nd to adaptive shortening of the posterior and inferior hip jt capsule |
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R, STTT cont'd:
What is the source of pain? Is it contractile?? |
1. The source is C-L; the post glut med and hip flex tightness are contributing factors
2. NO, b/c the cause (TFL dominance) is, but not the source, therefore: PAIN FREE RESISTIVE MOTIONS |
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STTT cont'd:
What position should the hip be in to perform the isometric resistive tests at the hip? |
MIDRANGE
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T of AMIS?
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1. Length-
a. Short TFL (Ober, 2 jt hip flexor) b. Long posterior glut med 2. Strength: tight TFL and weak post glut med 3. Play, tone |
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Cause of impingement for AMIS?
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1. Hip Flexor dominance
a. TFL short and overactive b. Gluteals are weak |
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What is getting impinged in AMIS?
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Anteromedial aspect of capsule/lig
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Instantaneous Axis of Rotation (IAR) in AMIS?
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TFL dominance effects IAR- the greater trochanter migrates anterior during active hip flexion (instead of posterior normally)
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Management goals of AMIS?
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1. Restore precise axis of rotation
2. Reverse hip flexor dominance a. Strengthen hip lateral rotators in their shortened position b. Lengthen TFL *c. Strengthen Iliopsoas to pull capsule out of the way 3. Passive hip flexion prn a. Joint mob b. Iliopsoas sends slip to capsule c. Self mob supine or quadruped d. NOT SLR stretching 4. Retrain mvt pattern: want hip flexion w/o IR a. Heel side with neutral rotation b. Knee ext w/o IR...ETC... 5. Strengthen posterior glut med (in shortened range) 6. Increase length of TFL-ITB- with STM, A/P stretching, contract-relax, etc. 7. Correct faulty postural habits- a. Standing- waiting for a bus... elongates post glut med b. Sit to stand or stand to sit c. "W" sitting |
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How can you strengthen the post glut med (in its shortened range)?
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a. Prone foot pushes
b. Prone ER in figure 4 c. Prone hip ext with ER d. Sidelying ER e. Sidelying ABD with ER f. Bilateral standing ER spins with post tilt g. Unilateral standing ER spins h. Bilateral squats i. Unilateral squats j. Step ups/downs/diagonally k. Stairs ascent/descent l. Plyometrics (jumping straight up and down) ALL WITH GOOD ALIGNMENT |
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Diagnostic Groupings of AMIS?
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1. Groin pain with hip flexion greater than 90*
2. TFL dominance |
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Differential DX of AMIS?
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LOCATION can tell you if its->
AMIS vs Lumbar radiculopathy vs Inguinal Hernia |
