Sep 18, 2013

Bilateral Femoral Acetabular Impingement In a Collegiate Soccer Player

Today's case comes to us from one of my colleagues and classmates, Kathryn Deterding, ATC. Kathryn consulted with me about this case and then went on to implement a treatment protocol based off our discussion.

A Case of Bilateral Femoral Acetabular Impingement(FAI) and Labral Tears in a Collegiate Soccer Player. 


History: This was a 21 year old male collegiate soccer player. In the fall of 2011 he began to experience hip pain that he played through. In the upcoming spring of 2012 he was diagnosed with bilateral FAI and tried to rehabilitate his injury to prepare for the fall season of 2012. The fall season was just as painful as the previous season. This athlete then underwent two different surgical procedures in the winter of 2012. One for each hip, in attempt to lessen his FAI and correct additional labral tears of the hip. The athlete had minimal rehab for a month or so after his surgeries and refrained from heavy activity for a few months. 

Upon increasing activity to prepare for the fall 2013 season of soccer the athlete began to experience the same pain and symptoms. He consulted with an orthopaedic surgeon during the preseason and the physician told him that he may not see any improvements and that this was something that he most likely was going to have to live with.

It was at this point that Kathryn and I discussed the athlete's case together and came up with a plan of care.  The first thing that I did was discuss thought viruses with the athlete and talked about how current neuroscience is teaching us that pain is not necessarily patho-anatomically based but is a construct of the central nervous system. The athlete admitted to thinking that all of this discussion was a load of hogwash and didn't buy into any of what I said. Nevertheless, we continued on with our plan of care.

  • Light IASTM over the lateral thigh/proximal IT band was performed first bilaterally. 
  • The Psoas Release from the following video was performed bilaterally(athlete thought this was hogwash as well)

  •  The next step in the treatment was the use of the Edge Mobility Band. The mobility band was wrapped around the proximal thigh and used for repeated hip flexion while the clinician simultaneously applies distraction of the femur by gripping the band for a set of 15-20 reps.
  • The band was then kept on and two different types of hip IR mobilization were done for a set of 10-15 reps each. Below are videos of the two separate band techniques.

Outcomes: These manual therapy treatments were done daily in the morning and during treatments before games/practices. There was an immediate and rapid change in mobility after the first treatment and the athlete began to experience decreased pain within two days of beginning this routine.

The athlete has been very compliant(always a must) with his rehab.  Upon writing this post I am not sure if he had a home-exercise program prescribed to him but he definitely was doing rehab multiple times a day with his athletic trainer, Kathryn.

This athlete has progressed to having zero pain and reports that he has never felt this good in his entire life.  He is so happy with his results that he wants to buy his own Edge Mobility Band to use on his own and for when traveling to away games.

Before implementing any treatment Kathryn did some baseline goniometry of hip flex/ext and ER/IR. Those values were as follows:
9/6/2013 - Before
Right Leg: Flexion= 111deg.   Extension= 2deg.   Internal Rotation= 20deg.   External Rotation= 22deg.
Left Leg:   Flexion= 111deg.   Extension= 7deg.   Internal Rotation= 20deg.   External Rotation= 25deg.

9/13/2013 - After, 1 week later

Right Leg: Flexion= 131deg.   Extension= 19deg.   Internal Rotation= 25deg.   External Rotation= 35deg.
Left Leg:   Flexion= 120deg.   Extension= 14deg.   Internal Rotation= 27deg.   External Rotation= 34deg.

While this athlete still has some room for growth it is evident that those are some phenomenal changes in mobility after only a week. This solidifies to me as evidence that he had this mobility all along but needed help accessing it.

How can you ask for more when he has regained his mobility, reduced his pain to nothing, and is able to play the sport he loves competitively. Even better is his ability to go about his daily activities without the constant hip pain that doctors told him he would live with for the rest of his life or until they were replaced.


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