Core Muscle Injuries and FAI: Diagnosis and Management

Core Muscle Injuries and FAI: Diagnosis and Management

Struan H Coleman MD, PhD MLB Winter Meetings Las Vegas, NV December 8th, 2018

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DISCLOSURES

? NO DISCLOSURES RELATED TO THIS TALK

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HIP AND CORE INJURIES

? IMPORTANT TO UNDERSTAND KINETIC CHAIN OF THROWING

? ANGULAR MOMENTUM GENERATED IN LOWER BODY

? FOOT PLANT ? PELVIC ROTATION ? ENERGY TRANSFER TO:

? CORE ? TRUNK ? ARM ? BASEBALL

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HIP AND CORE INJURIES

? KINETIC CHAIN ? TRAIL HIP IR ? LEAD HIP ER ? FOOT PLANT

TOWARD TARGET ? TRUNK AND ARM

ROTATE SQUARELY TOWARD TARGET

HIP IR TRAIL LEG

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PITCH VELOCITY STODDEN ET AL.

J APPL BIOMECH 2001

HIP AND CORE INJURIES

LOSS OF HIP IR = PLANT FOOT CLOSED POOR PELVIC ALIGNMENT

PITCHER THROWS ACROSS BODY

REDUCED TRANSFER OF POWER LB TO UB

INCREASED TORQUE ON ELBOW AND SHOULDER

INCREASED INJURY

WRIGHT ET AL. SPORTS BIOMECH. 2004

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HIP AND CORE INJURIES

? CORE: Weakness/Instability ? Force anterior shoulder ? Shoulder injuries ? Elbow injuries

? Endo et al J of PT Science 2014; 26; Chaudhari et al, AJSM, 2014; 42 (11); Raduar et al Int J PT; 2014; 9(1)

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EPIDEMIOLOGY HIP AND GROIN

BODY PART (RANK) 1. Hand / Finger / Thumb 2. Shoulder / Clavicle 3. Knee 4 . Upper Leg (Thigh) 5, Lower Leg / Achilles Tendon 6. Elbow 7. Lower Back / Sacrum 8. Foot / Toes 9. Hip / Groin

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EPIDIOMOLOGY

? Hip and Groin Injuries

? Resulted in Avg 15 days missed

? Majority are extra-articular

? treated non-operatively

? Intra-articular injuries

? 40.2% required surgery

? Intra-articular injuries 2x days missed vs Extra-articular injuries

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HSS/METS PILOT STUDY

? DOES A DECREASE IN HIP MOTION CORRELATE WITH AN INCEASE IN INJURY INCIDENCE IN MLB PLAYERS

? IS THERE A DIFFERENCE BETWEEN

? PITCHERS ? CATCHERS ? OTHER POSITION PLAYERS

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RESULTS

? PITCHERS AND CATCHERS HAVE LESS IR AND ARC OF HIP MOTION COMPARED TO POSITION PLAYERS

? LESS IR/ARC OF HIP MOTION NOTED IN PLAYERS WITH HIP/ABDOMINAL/HAMSTRING INJURIES DURING THE SEASON

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DISCUSSION

? RECOMMENDATIONS

? HIP STRETCHING ? CORRECT "GIRD OF

THE HIP OR HIRD" ? ABDUCTOR

STRENGTHENING ? CORE

STRENGTHENING ? PREVENT INJURIES

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FAI AND CMI

? Groin Pain In The Athlete ? Challenging Diagnosis ? Due to a Complex Anatomy ? And Concomitant

Pathologies ? An Algorithmic

Multidisciplinary Approach Is Critical for Accurate Diagnosis and Management

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FAI AND CMI

? FAI and Core Muscle Injuries

? Are Common pathologies especially among athletes

? They can occur independently or simultaneously

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CMI

? Core muscle injuries (CMI) ? Are Common sports injuries ? And Involve muscles from the

chest to the mid-thigh ? The "Harness" Muscles

? Are Most Commonly Involved ? As they Attach to the pubic bone ? And are comprised of the rectus

abdominis, adductor longus, aductor brevis and pectineus

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Pubic Symphysis and Floor Anatomy

Rectus Abdominis creating supero-posterior tension Adductors creating infero-anterior tension

Adductors creating a infero-lateral force

Quadratus Femoris Obturator Externus

Pectineus

Adductor Brevis Adductor Magnus

Gracilis

Arrows indicate the direction of force

Adductor Longus

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CMI

? CMI Injuries ? Occur when the

adductors and RA pull in opposites directions ? These structures can pull away from the pubic bone

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CMI

Cartilagenous Plate

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CMI

? Exam ? Pain above/on pubic Symphysis ? Tenderness ? Pain with Sit-up or Valsalva ? Coughing/Sneezing ? Worse with Activity

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? Imaging

? MR

CMI

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CMI

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CMI

? Rx ? Conservative ? 3-6 Months Rest/Core strengthening ? Surgical ? Repair of Rectus aponeurosis to Pelvic Plate ? +/- Adductor Release

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CMI

? Clinical Results: 5 Prospective Studies

Author Year Study Holmich 1999 68 patients randomized to 2 types of PT Meyers 2000 157 non-randomized patients Ekstrand 2001 66 patients randomized to four treatments Meyers 2011 114 non-randomized women patients Paajanen 2011 60 patients randomized to surgery vs. PT

Result RTS 23/68 97% 88% 90% 90%

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CMI

? Dr. William Meyers ? Pioneered the Diagnosis

and Management of Athletic Pubalgia ? Core Muscle Injury

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FAI AND CMI

? Relationship of CMI to FAI has well been Established

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