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.

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

Public transport

Tube

All stations are a 15–20 minute walk.

Fulham Broadway—District Line Earls Court—Piccadilly and District Lines South Kensington—Piccadilly, District and Circle Lines Gloucester Road—Piccadilly, District and Circle Lines Rail

Imperial Wharf (15 minutes walk) West Brompton (15 minutes walk)

Bus

Local bus routes

Fulham Road:

• 14—from South Kensington or Fulham Broadway
• 414—from South Kensington or Fulham Broadway
• 211—from Hammersmith, Fulham Broadway or King’s Road

King’s Road:

• 11—from Fulham Broadway
• 22—from Putney Common Redcliffe Gardens (southbound)/Finborough Road (northbound):
• 328—from Earls Court
• C3—from Earls Court or Clapham Junction

Personal Transport

Car

The hospital has an underground car park which is accessed via Nightingale Place—spaces are limited. The car park is not run as a commercial operation and all the money goes directly to support the work of the hospital and the care of its patients.

Please note height restriction of 1.9m.

On arrival at the entrance to the car park, take a ticket at the barrier. Before returning to the car park when leaving the hospital please pay by cash or card (not American Express or Diner’s Club) at the machines located on the ground floor of the hospital by main reception. Cash payments can also be made at the main reception desk.

The car park becomes very busy during the day and spaces are not guaranteed. Therefore, please allow additional time if you intend to drive. There are also Pay and Display spaces on the streets near the hospital.

Car parking charges

The minimum charge of £3.00 for up to 1 hour applies daily from 8am–7pm. This charge is reduced to £1.00 for up to 1 hour from 7pm–8am. There is also a maximum stay of 24 hours which incurs a charge of £40. Lost tickets will incur a charge of £40. The Trust cannot accept liability for loss or damage caused to vehicles or contents while parked within the car park.

8am–6pm (Sun–Fri):

• up to 1 hour—£3.00
  
• 1–2 hours—£7.00
• 2–3 hours—£9.00
• 3–4 hours—£12.00
• 4–5 hours—£15.00
• 5–6 hours—£18.00
• 6–7 hours—£21.00
• 7–8 hours—£24.00
• 8–9 hours—£26.00
• 9–10 hours—£28.00
• 10–24 hours—£40.00

8am–6pm (Saturdays):

• up to 1 hour—£3.00
  
• 1–2 hours—£7.00
• 2–3 hours—£12.00
• 3–4 hours—£15.00
• 4–5 hours—£18.00
• 5–6 hours—£21.00
• 6–7 hours—£24.00
• 7–8 hours—£27.00
• 8–9 hours—£30.00
• 9–10 hours—£33.00
• 10–24 hours—£40.00

From 6pm–8am the car park rate is £1 per hour (daily).

Motorbike

Free parking available in a designated area of the hospital car park for motorbikes and scooters which can fit past the barriers (ie not those with sidecars).

Bicycle

Free parking in designated areas and in the hospital car park.