Assessment and Functional Testing
of the Hip and Pelvis
2014 PAC Symposium
Niagara Falls, ON
Dr. Wade Elliott
Burlington, ON
Key to a good clinical
exam is a great clinical
history!
Clinical Considerations
Mechanism of Injury?
n  Overuse?
n  Frequency – 1st episode, “seasonal strain”,
“always get a groin injury”
n  Training strategies / gym program
n  Sport specific requirements
n  Traumatic / repetitive
n
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Conditions Not To Miss
Intra-abdominal conditions
n  GU (ovarian, pregnancy, testicular, urinary tract,
etc)
n  Referred pain from lumbar spine
n  Femoral hernias
n  Ilioinguinal nerve entrapment
n  Slipped epiphysis
n  AVN, tumours, etc
n
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Intra-Articular Disorders
Osteoarthritis
n  Stress fracture femoral neck
n  Avascular necrosis femoral head
n  Labral pathology
n  Anterior impingememt
n  Femoroacetabular impingement
n  Pediatric
n
n  Slipped
n  L-C-P
capital epiphysis
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Extra-Articular Disorders
n
Strains
n  Adductors,
hip flexors, iliopsoas, abdominal
n  avulsions
Snapping hip (psoas, ITB, Glut fibres)
n  Osteitis Pubis
n  Hernias (direct, indirect, sports hernia)
n  Bursitis (trochanteric, psoas bursitis)
n  Nerve entrapments
n
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Anatomical Considerations
The lumbopelvic girdle:
n  Hip
n  Groin
n  Lumbar Spine
n  Pelvis
n  SI joints
Functions to:
•  stabilize the trunk
•  provide a stable anchor
for peripheral muscles
•  integrate neuromuscular
control between the
trunk & lower extremities
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Hip & Groin Examination
Observation – static and gait, muscle
development
n  ROM – active and passive
n
n  Pain
and restrictions
Resisted testing
n  Palpation
n  Special Tests / Functional Testing
n
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ROM
Flexion – Extension – Int Rotation – Ext
Rotation
n  Compare to opposite side
n  Pain and location of pain during ROM testing
n
n  Ie.
Pain at end range think of IA pathology
n  Pain during passive stretching think more likely
muscular
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ROM Testing
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Resisted Testing
Hip Flexors
n  Adductors
n  Abductors
n  External Rotators
n
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Resisted Testing
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Special Tests
Quadrant testing – articular integrity
n  SI joint shearing
n  Thomas Test (iliopsoas vs rec fem)
n  SLR –
n
n  passive
(neural tension, hamstring,
n  Active (rec fem, iliopsoas)
n
Hop test / squat
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Quadrant Testing
n
n
n
Terminal flexion and
Internal Rotation
Presence of pain
Presence of click or
catching
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Thomas Test (Hip Flexors)
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Straight Leg Raise (active and
passive)
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Functional Assessment of Hip &
Pelvis
Quick tests, good screen for specific hip /
pelvis / trunk pathology
n  Easy to perform
n  Help direct if patient requires further
treatment / investigations
n
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Functional Testing
n
Deep Squat
Pain and or decreased
depth of squat indicator
of possible IA abn
n  Ie. FAI, OA, labral
pathology etc
n  Look also for muscle
coordination patterns
n
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Functional Testing
n
Single Leg Squat
Coordination hip and
trunk stabilizers
n  Alignment of knee and
trunk during active squat
n
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Functional Testing
n
Single Leg Stance
Hip abductor / core
integrity
n  Balance
n  Compensatory movement
patterns
n
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Functional Testing
n
Hop Test
n
n
n
Pain
Coordination
Weakness hip abductors
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Basic Concepts of Functional
Rehabilitation
n
n
n
n
n
n
Train joint stability before joint mobility
Train movements instead of isolated muscles
Functional movements activate the entire kinetic chain
– usually closed>open
Movements are not isolated unidirectional - all three
planes must work together concurrently
Functional movements balance body segments over the
base of support and challenge the body to maintain
optimal posture
Movements and exercises must progress dynamically
and systematically
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Stacey, 2006
Basic Concepts of Functional
Rehabilitation (cont’d)
n
n
Learn the Basics – begin with simple body weight movements
Progress:
n
n
n
n
n
n
n
from slow (tonic) to fast (phasic)
simple to complex
known to unknown
low force (tonic) to high force (phasic)
static to dynamic
un-weighted to weighted
Sport Specificity? - take the athlete from a challenging
position they can control and progress
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Summary Concepts
Focused functional assessment of hip and pelvis
n  Use to
n
n  Identify
potential pathologic causes of patients sx
n  Identify specific weaknesses and inappropriate
muscle patterning
n  Identify potential conditions that need assessment by
MD
n
Assist in optimizing possible foot orthosis role
in treatment of patients condition
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