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 increase your skills and confidence in your assessment and management of lateral hip and buttock pain?

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 and 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.

This course aims to:

• Enhance clinical reasoning, and skills for assessment of nociceptive sources, clinical entities and drivers associated with lateral hip & buttock pain
• Provide a framework for optimally effective, targeted interventions that consider
  • Morphological variants & implications for load management advice, exercise therapy and manual therapy
  • Adverse loading associated with kinematics and neuromotor function
  • Individual goals and functional demands
• Provide opportunity to practice useful exercise therapy and nerve mobilisation techniques

Learning Objectives:

Upon completion of this course, participants should be able to:

Perform diagnostic tests for lateral hip and buttock pain and use that information for differential diagnosis of the most likely source of nociception or a primary clinical entity

• 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 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

The substantial theoretical component of this course is presented in an online learning format for your flexibility and optimal learning experience.

• 6 hours of PowerPoint lectures with printable notes.
• Learn anywhere, at your own pace, in your own time.
• Rewind and revise as many times as you like.
• Online forum for discussion.
• Self-assessment quiz.
• Three months of unlimited access to video content

The online component will:

• Clarify definitions and diagnoses of lateral hip and buttock pain
• Explore factors which may influence loads across the lateral hip & buttock and predispose to intra or extra-articular impingement, such as:
  • morphological variants (e.g. bony structure, soft tissue - neural relationships)
  • 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. Understanding the impact of bony morphology, soft tissue interfaces and postural and movement patterns is critical to optimal management of these conditions.

The one-day practical workshop will include:

Diagnostic tests, management strategies & key exercises for:

• gluteal tendinopathy & associated soft tissue pathologies
• posterior hip joint instability
• extra articular impingements *ischiofemoral impingement
• deep gluteal syndrome/extraspinal sciatica
• proximal hamstring tendinopathy

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

How to get there

Tube

The English National Ballet is just a 2 minute walk from Canning Town station, which is served by the Jubilee and DLR lines - only 15 minutes from Central London and just 5 minutes from Canary Wharf and Stratford.

Bus

The 115 Bus from Cannint Towm every 7-10 minutes with links to a number of other major bus routes and tube stations.