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1.  COMPARISON OF RANGE OF MOTION, STRENGTH, AND HOP TEST PERFORMANCE OF DANCERS WITH AND WITHOUT A CLINICAL DIAGNOSIS OF FEMOROACETABULAR IMPINGEMENT 
ABSTRACT
Background
Dancers commonly experience anterior hip pain caused by femoroacetabular impingement (FAI) that interrupts training and performance in dance. A paucity of literature exists to guide appropriate evaluation and management of FAI among dancers.
Purpose
The purpose of this study was to determine if dancers with clinical signs of FAI have differences in hip range of motion, strength, and hop test performance compared to healthy dancers.
Study Design
Quasi-experimental, cohort comparison.
Methods
Fifteen dancers aged between 18- 21 years with clinical signs of FAI that included anterior hip pain and provocative impingement tests were compared to 13 age-matched dancers for passive hip joint range of motion, isometric hip strength, and performance of the medial triple hop, lateral triple hop, and cross-over hop tests.
Results
No statistically significant differences in range of motion were noted for flexion (Healthy = 145° + 7°; FAI = 147° + 10°; p=0.59), internal rotation (Healthy = 63° + 7°; FAI = 61° + 11°; p=0.50), and external rotation (Healthy = 37° + 9°; FAI = 34° + 12°; p=0.68) between the two groups. Hip extension strength was significantly less in the dancers with FAI (224 + 55 Newtons) compared to the healthy group (293 ± 58 Newtons; F(1,26) = 10.2; p=0.004). No statistically significant differences were noted for flexion, internal rotation, external rotation, abduction, or adduction isometric strength. The medial triple hop test was significantly less in the FAI group (354 ± 43 cm) compared to the healthy group (410 ± 50 cm; F(1,26) = 10.3; p = 0.004). Similar results were observed for the lateral hop test, as the FAI group (294 ± 38 cm) performed worse than the healthy controls (344 ± 54cm; F(1,26) = 7.8; p = 0.01). There was no statistically significant difference between the FAI group (2.7 ± 0.92 seconds) and the healthy group (2.5 ± 0.75 seconds) on the crossover hop test.
Conclusion
Dancers with FAI have less strength of the hip extensors and perform worse during medial and lateral hop triple tests compared to healthy dancers. Clinicians may use this information to assist in screening of dancers with complaints of hip pain and to measure their progress for return to dance.
Level of Evidence
3B, non-consectutive cohort study
PMCID: PMC4970843  PMID: 27525177
Dancers; femoroacetabular impingement; functional performance; hop test.
2.  Pendulum Exercises After Hip Arthroscopy: A Video Technique 
Arthroscopy Techniques  2016;5(4):e897-e900.
Advanced hip joint–preserving arthroscopic techniques have been shown to improve patient-reported functional outcomes with low rates of postoperative complications. Prior work has shown that formation of adhesive scar is a potential source of persistent pain and cause for revision surgery. As resources for postoperative in-studio physical therapy become scarce, a home-based strategy to avoid scar formation without adding formal therapy cost may be beneficial. The purpose of this technical note is to introduce a patient-centered educational video technique for home-caregiver delivery of manual hip pendulum exercises in the postoperative setting. This video technique offers access to our method for pendulum exercise as part of early recovery after advanced hip arthroscopy.
doi:10.1016/j.eats.2016.04.013
PMCID: PMC5040594  PMID: 27709055
3.  The effect of Astym® Therapy on muscle strength: a blinded, randomized, clinically controlled trial 
Background
Astym® therapy is a manual therapy intervention used to stimulate tissue healing, decrease pain, improve mobility, and improve muscle performance associated with musculoskeletal pathology. The purpose of this study was to determine if Astym therapy administered to the lower extremity would result in an immediate change of maximal force output during a unilateral isometric squat test among individuals with a lower extremity injury.
Methods
Forty-five subjects (14 males; 31females) between 18 and 65 years of age were randomized into 3 treatment groups: 1) Control group – received no treatment 2) Placebo group – received a sham Astym treatment 3) Astym therapy group– received Astym therapy to the lower extremity. A baseline measure of maximal force output (pre-test) during a unilateral isometric squat was performed. The subjects then received the designated treatment intervention. Immediately following the treatment intervention, maximal force output (post-test) was retested using identical testing procedures by an investigator who was blinded to the treatment intervention received by the subjects. The percent change of maximal force output from pre-test to post-test measures was compared using a one-way analysis of variance. A Tukey’s post-hoc analysis determined the statistical differences between the groups.
Results
The treatment intervention had a significant effect on the percent change of maximal force output [F(2,42) = 7.91, p = 0.001]. Tukey’s post hoc analysis demonstrated that the percent change of maximal force output was significantly greater in the Astym group (15 ± 18 % change of Newtons) compared to the placebo (−6 ± 11 % change of Newtons; p = 0.0001) and control (−1 ± 17 % change of Newtons; p = 0.0014) groups. No significant difference (p = 0.68) was noted between the control and placebo groups.
Conclusions
Astym therapy to the involved lower extremity increased maximum force output during an isometric squat test immediately following treatment. The results of this study suggest that Astym therapy can immediately improve muscle performance (maximal force output) for patients presenting with muscular weakness caused by a lower extremity musculoskeletal injury.
Trial registration
Clinicaltrials.gov NCT02349230. Registered 23 January 2015.
doi:10.1186/s12891-015-0778-9
PMCID: PMC4625642  PMID: 26510526
4.  RELIABILITY AND VALIDITY OF FUNCTIONAL PERFORMANCE TESTS IN DANCERS WITH HIP DYSFUNCTION 
Study Design:
Quasi-experimental, repeated measures.
Purpose/Background:
Functional performance tests that identify hip joint impairments and assess the effect of intervention have not been adequately described for dancers. The purpose of this study was to examine the reliability and validity of hop and balance tests among a group of dancers with musculoskeletal pain in the hip region.
Methods:
Nineteen female dancers (age: 18.90±1.11 years; height: 164.85±6.95 cm; weight: 60.37±8.29 kg) with unilateral hip pain were assessed utilizing the cross-over reach, medial triple hop, lateral triple hop, and cross-over hop tests on two occasions, 2 days apart. Test-retest reliability and comparisons between the involved and uninvolved side for each respective test were determined.
Results:
Intra-class correlation coefficients for the functional performance tests ranged from 0.89-0.96. The cross-over reach test had a SEM of 2.79 cm and a MDC of 7.73 cm. The medial and lateral triple hop tests had SEM values of 7.51 cm and 8.17 cm, and MDC values of 20.81 cm and 22.62 cm, respectively. The SEM was 0.15 seconds and the MDC was 0.42 seconds for the cross-over hop test. Performance on the medial triple hop test was significantly less on the involved side (370.21±38.26 cm) compared to the uninvolved side (388.05±41.49 cm); t(18) = −4.33, p<0.01. The side-to-side comparisons of the cross-over reach test (involved mean=61.68±10.9 cm; uninvolved mean=61.69±8.63 cm); t(18) = −0.004, p=0.99, lateral triple hop test (involved mean=306.92±35.79 cm; uninvolved mean=310.68±24.49 cm); t(18) = −0.55, p=0.59, and cross-over hop test (involved mean=2.49±0.34 seconds; uninvolved mean= 2.61±0.42 seconds; t(18) = −1.84, p=0.08) were not statistically different between sides.
Conclusion:
The functional performance tests used in this study can be reliably performed on dancers with unilateral hip pain. The medial triple hop test was the only functional performance test with evidence of validity in side-to-side comparisons. These results suggest that the medial triple hop test may be a reliable and valid functional performance test to assess impairments related to hip pain among dancers.
Level of Evidence:
3b. Non-consecutive cohort study
PMCID: PMC3812843  PMID: 24175123
Hop test; reach test; reliability; validity
5.  FUNCTIONAL PERFORMANCE TESTING OF THE HIP IN ATHLETES: A SYSTEMATIC REVIEW FOR RELIABILITY AND VALIDITY 
Purpose/Background:
The purpose of this study was to systematically review the literature for functional performance tests with evidence of reliability and validity that could be used for a young, athletic population with hip dysfunction.
Methods:
A search of PubMed and SPORTDiscus databases were performed to identify movement, balance, hop/jump, or agility functional performance tests from the current peer-reviewed literature used to assess function of the hip in young, athletic subjects.
Results:
The single-leg stance, deep squat, single-leg squat, and star excursion balance tests (SEBT) demonstrated evidence of validity and normative data for score interpretation. The single-leg stance test and SEBT have evidence of validity with association to hip abductor function. The deep squat test demonstrated evidence as a functional performance test for evaluating femoroacetabular impingement. Hop/Jump tests and agility tests have no reported evidence of reliability or validity in a population of subjects with hip pathology.
Conclusions:
Use of functional performance tests in the assessment of hip dysfunction has not been well established in the current literature. Diminished squat depth and provocation of pain during the single-leg balance test have been associated with patients diagnosed with FAI and gluteal tendinopathy, respectively. The SEBT and single-leg squat tests provided evidence of convergent validity through an analysis of kinematics and muscle function in normal subjects. Reliability of functional performance tests have not been established on patients with hip dysfunction. Further study is needed to establish reliability and validity of functional performance tests that can be used in a young, athletic population with hip dysfunction.
Level of Evidence:
2b (Systematic Review of Literature)
PMCID: PMC3414072  PMID: 22893860
Functional Testing; hip; reliability; validity

Results 1-5 (5)