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The Athletic Hip Series: Ischiofemoral Impingement and Tendinopathies

Post by Maggie Gebhardt, PT, DPT, OCS

In the clinic, therapists tend to see injuries happen in waves. One month its shoulders and the next it’s a completely different body part. Recently, I have had a rash of patients coming in with the diagnosis of ischiofemoral impingement. As the time for my monthly blog approached, I thought it would be the perfect opportunity to delve into this diagnosis a little bit more.

What is it you ask? Ischiofemoral impingement is the result of contact between the lesser trochanter of the femur and the ischium (or lower part of the pelvis.) Patients usually report buttocks or groin pain and this can often mimic symptoms of a hip flexor or hamstring tendinopathy. Hamstrings and the hip flexor can be involved, but usually it is a lesser known muscle- the quadratus femoris- that is getting pinched between the two boney structures. It has just recently come to the table as a diagnosis for hamstring or buttocks pain that has not resolved with conventional treatments for either area. In fact, it was not even thought of as a diagnosis for the unreplaced hip joint. Surgical treatments are not great and so far the treatment of this condition really rests in the therapists hands. Therapy revolves around improving the hip mechanics so that there is more space between these structures.

Treatment also has to focus on the muscle and any associated tendinopathies. So, what is a tendinopathy? It is the diagnosis term used to identify any type of disease process happening to a tendon (the connection from a muscle to a bone.) Everyone has heard of tendinitis (inflammation of a tendon,) but the term tendinosis is not so familiar. Tendinosis is an advanced state of pathology for the tendon indicating that the sheath surrounding the tendon is degenerating. Due to the fact that it is an advanced state, this diagnosis is often the more difficult one to treat. Common sites of tendinopathy in the hip are the hamstrings, hip flexors and adductors. Therapy must focus on the entire lower extremities mechanics. Usually tendinopathies are an overuse injury and addressing the factors that led up to this point will ensure a more complete recovery. There are many medical treatment options for tendinopathies and in conjunction with physical therapy most people are able to recover and return to their daily activities.

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