Lateral Hip and Buttock Pain

Sunday, 28 April 2019 09:00 - 17:00 (GMT)


Pure Sport Medicine - Canary Wharf
Level 2
Cabot Place West
London
E14 4QT

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Do you have a list of possible diagnoses that jump to mind when someone presents with lateral hip or buttock pain?

Do you consider posterior joint stability, extra-articular impingements of the lesser or greater trochanter or peripheral nerve entrapments?

What is your strategy for working through the differential diagnoses and which subjective and objective markers determine your pathway towards each particular diagnosis?

Once you have determined the most likely diagnosis, are you also able to identify and develop a plan to address the most potent drivers for each individual’s presentation?

Would you like to Fast Track your lateral hip and buttock Rehab?

Lateral hip and particularly buttock pain can often present a diagnostic dilemma. The lumbar spine and sacroiliac joints may refer into these regions; intra-articular hip pathologies may be accompanied by lateral hip and/or buttock pain; local soft tissues & neural structures may be primary sources of nociception.

The first step is determining the most likely contributors to the patient’s pain presentation. Developing an optimal management program with positive effects past the short term, will also require an evaluation of physical & psychological drivers. Intrinsic & extrinsic factors should be considered within the overall context of workload. While non-modifiable factors (e.g. bony morphology) are by nature unable to be modified, awareness of these factors can be integral to providing advice and interventions (active or passive) that ‘do no harm’ and development of strategies that allow maximal function with minimisation of adverse effects.

Learning Objectives: This practical workshop will teach skills that allow participants to

  • Perform pain provocation tests for gluteal tendinopathy & associated soft tissue pathologies, and reason through the differential diagnosis for lateral hip pain
  • Provide evidence-based load management and exercise strategies for lateral hip pain
  • Assess and develop management strategies for posterior hip joint instability
  • Recognise occurrence of and potential drivers for extra-articular impingements such as ischiofemoral and posterior greater trochanteric impingement
  • Develop management strategies for these extra-articular bony impingements
  • Differentially diagnose ischial pain, including diagnostic tests for proximal hamstring tendinopathy
  • Apply neurodynamic assessment and mobilisation techniques relevant to the lateral hip and buttock, and consider the impact of soft tissue interfaces
  • Recognise the important anatomical relationships and functional roles of the deep external rotators

Online Learning Component (4-6 hours)

Understanding definitions, pathology & mechanisms

Learning Objectives: The online component aims to

  • Clarify definitions and diagnoses of lateral hip and buttock pain
  • Explore factors which may influence loads and integrity of the posterior capsuloligamentous structures.
  • Explore factors which may influence extra-articular loads in the lateral hip and buttock region a. morphological variants (e.g. bony structure, soft tissue - neural relationships); b. adverse soft tissue loading associated with kinematics and neuromotor function (focus on hip abductors and short external rotators).
  • Provide an overview of key load management and therapeutic exercise strategies for lateral hip and buttock pain, particular to the patient presentation and associated difficulties with mechanical load transfer.*
  • Provide an update on scientific evidence for underlying diagnostic and management approaches

Practical Workshop (1 Day)

The practical workshop will guide participants through diagnostic tests and management strategies for lateral hip and buttock pain. There is now high-quality evidence for assessment and management of gluteal tendinopathy from the ‘LEAP’ lateral hip pain randomised clinical trial, of which Alison was a key investigator.

Participants will receive first-hand instruction on techniques, advice regarding how best to apply this approach in clinical practice and valuable troubleshooting for slow or non-responders. The workshop with then delve into the other lesser-known problems associated with buttock pain that may present diagnostic and management challenges – posterior joint instability, bony impingements, peripheral nerve entrapments and musculotendinous overload, particularly of the proximal hamstring tendon and deep hip external rotators.

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Tutor:

Dr Alison Grimaldi PhD, MPhty(Sports), BPhty


Alison completed a Bachelor of Physiotherapy at the University of Queensland in 1990, a Masters of Sports Physiotherapy in 1997, and her Doctorate in Philosophy in the Field of Physiotherapy (PhD) in 2008. Her PhD studies were concerned with improving our understanding of hip muscle function and the relationship with hip joint pathology and weightbearing stimulus. These studies involved research collaboration with the European Space Agency.

Alison continues to be passionate about extending our understanding of why we develop problems around the hip and pelvis, and what we can do to most effectively prevent and manage these problems. She is currently involved with research studies through the University of Queensland and University of Melbourne, co-supervises a number of PhD students, and has pioneered the use of Real Time Ultrasound technology for the assessment and retraining of muscle function around the hip & pelvis. Due to her voluntary contributions to research at the University of Queensland, Alison has been awarded the title Adjunct Research Fellow in the School of Health & Rehabilitation Sciences.

It is one of Alison’s core beliefs that research should be relevant to clinical practice and helping the patients we treat every day, and that physiotherapists in the community should have access to this valuable information to allow them to transfer this knowledge into clinical practice as quickly as possible. To this end, Alison continues to publish, present and provide practical workshops for other health professionals. Alison has published a number of papers in scientific journals, has contributed detailed information freely accessible via podcasts by PhysioEdge (itunes) and the British Journal of Sports Medicine (SoundCloud), and has recently contributed to 3 leading physiotherapy and sports medicine text books.

Alison’s publications: Link to publications

Alison continues a clinical load, working with patients with complex hip and lumbopelvic conditions, and across a broad spectrum of sports, including elite level triathlon, running, dance, cricket, athletics & swimming. She also spends a considerable amount of time mentoring her excellent staff, ensuring they are up-to-date and able to provide a high level of clinical expertise for management of musculoskeletal problems.

Further information about Alison and her courses can be found at: dralisongrimaldi.com

Follow Alison on Twitter: @alisongrimaldi

The course venue

Pure Sport Medicine - Canary Wharf

Level 2

Cabot Place West
London
E14 4QT

Pure Sport Medicine - Canary Wharf website


How to get there

Travel Information:

CANARY WHARF - DOCKLANDS LIGHT RAILWAY (DLR) Travel time: 1 min walk Distance: 0.05 km + fly of stairs

CANARY WHARF - JUBILEE LINE UNDERGROUND Travel time: 5 min walk Distance : 0.2 km

Pure Sports Medicine practice is above the Tesco supermarket in Canary Wharf

AIRPORTS:

City Airport: 8 km/ 5 miles away Travel: 15 min by car/taxi or 15 min via DLR DLR: take a DLR train towards Lewisham/ Canary Wharf, may need to change in Poplar.

Heathrow Airport: 36 km / 22 miles away Travel: 60 min by car/taxi or 1h 20 min via London Underground + DLR Underground: take Piccadilly Line to Holborn and change for Central Line from Holborn to Bank DLR: take any DLR train from Bank going in directions to Lewisham/Canary Wharf

Stansted Airport: 56 km / 35 miles away Travel: 53 min by car/taxi or 1h 20min via Stansted Express train + Underground + DLR or 1 h 40 min via Stanstead Airport Bus + DLR Stanstead Express Train: from airport to Liverpool Street Station + London Underground on Central Line ( 1 stop to Bank Station) or Circle line (2 stops to Tower Hill Station). DLR: from Bank or Tower Hill Station (both, 5 stops away to Canary Wharf). Take any DLR train going in directions to Lewisham or Canary Wharf. Bus from the Airport: National Express or Terravision to Stratford Station + direct DLR train from Stratford to Canary Wharf

Gatwick Airport: 81 km / 50 miles away Travel: 70 min by car/taxi or 1- 1.30 min by train + Underground + DLR Train: Gatwick Express from airport to Victoria Station (40 min) or National Railway train from airport to Victoria Station (45 - 60 min) or to London Bridge (50 min - 1.10min) Underground: from Victoria Station take Victoria line to Oxford Street and change for Central Line to Bank Station / from London Bridge take Jubilee Line directly to Canary Wharf DLR: from Bank take any DLR train going in directions to Lewisham/ Canary Wharf