Outpatient sports physical therapists have seen a steady increase in the number of patients with a hip related pathology over the last 5-10 years. One of the primary reasons for this dramatic increase is the direct result of the increased number of hip surgeons being trained specifically in the delivery of arthroscopic hip surgery. The skill-sets of clinicians are now being tested to deliver effective rehabilitation strategies and provide satisfactory outcomes to these patients. The evidence is clearly illuminating the dissatisfaction of these patients, and often times, the inability for these patients to return to prior levels of function. The goal of this webinar is to provide insight to the most current strategies that are available to rehabilitate these patients with hip related pathology. Current evidence for methods related to a global systems approach for assessment of the hip will be reviewed. These cutting-edge assessment strategies will excite clinicians and provide a platform for a unique discussion as to how these methods may inform new ways of prescribing therapeutic exercises for the hip and pelvis. The webinar will clearly demonstrate these assessment techniques and exercises, allowing the clinician to leave this webinar with practical applications that will immediately impact their clinical “toolbox."
Dr. Steven Dischiavi is an assistant professor in the Department of Physical Therapy at High Point University (HPU), as well as the Director of Rehabilitation for the Department of Athletics at HPU. Dr. Dischiavi brings over 20 years of experience in sports medicine to MedBridge, including 10 years with a professional sports team. Dr. Dischiavi served as the team physical therapist and certified assistant athletic trainer for the Florida Panthers of the National Hockey League from 2004 to 2014, where he gained a specialized treatment approach for the hip and pelvis. He holds a relatively rare combination of credentials as a licensed physical therapist and a certified athletic trainer, giving him a unique appreciation of the athlete. He also holds a manual therapy certification from the Ola Grimsby Institute. He is board certified by the American Physical Therapy Association as a Sports Clinical Specialist (SCS). Dr. Dischiavi is a faculty member at the Herman & Wallace Pelvic Rehabilitation Institute. He has developed his own course that he presents nationally titled Biomechanical Assessment & Treatment of the Hip & Pelvis. Dr. Dischiavi is currently pursuing his PhD at the University of Ulster in Ireland under the direction of Dr. Chris Bleakley. His current research focus is on optimizing therapeutic exercises for the hip to prevent lower extremity injuries and enhance physical performance. Dr. Dischiavi attended Slippery Rock University, where he earned his bachelors degree in athletic training. He earned a Master of Physical Therapy from SUNY Upstate Medical University and a Doctor of Physical Therapy from A.T. Still University.
Human movement is an extremely intricate sequence of events that are all coordinated amongst many different body systems. A complex systems-based approach to the global perception of human movement may help clinicians appreciate the interactions between systems. The concepts of reductionism and holism will also be presented and how they are applied to current evidence surrounding the hip and pelvis.
The terms “proximal control” or “proximal strengthening” are being utilized across various lines of research to describe the concept of how the hip is the integral component of lower extremity strength and motor control. The discrepancies found in the literature with regard to how the hip is the “proximal” influence for the lower extremity will be discussed.
The musculoskeletal architecture of the human body is a tension dependent system existing within a biotensegrity design. The concept of biotensegrity will explored, and the overall importance will be related to the global systems approach. Myofascial chains have been described, using various descriptors, for decades within the physical therapy profession. The evidence regarding these interconnected muscular chains will be reviewed, as well as a discussion as to how these chains might inform rehabilitative strategies for the hip and pelvis.
Current evidence-based concepts utilizing the global systems approach to evaluate range of motion specifically related to the hip and pelvis will be presented. New and innovative ways to assess human movement utilizing the global systems approach will also be demonstrated. The assessment methods discussed in this chapter will directly relate to exercise prescription presented in the next chapter.
Physical therapists are constantly challenged by the compliance issues that are associated with dispensing a home exercise program to patients. The idea of utilizing a complex systems approach, where multiple joint movements occur across multiple planes of motion, will be presented. The clinician will be challenged by having to decide if choosing a more inclusive complexity design would be preferred over a reductionist linear model offering exercises that progressively get more complicated.
This chapter is a viewer-submitted question and answer session, facilitated by Steve Dischiavi.