Nancy J. Bloom

Context: Surrounding the predictive value of clinical measurements and assessments for future athletic injury, most researchers have not differentiated between contact and noncontact injuries. Objectives: We assessed the association between clinical measures and questionnaire data collected before sport participation and the incidence of noncontact lower extremity (LE) injuries among Division III collegiate athletes. Design: Prospective cohort study. Setting: University setting, National Collegiate Athletic Association Division III. Patients or Other Participants: Here, 488 Division III freshmen athletes were recruited to participate in the study during their preseason physical examinations. Main Outcome Measure(s): Prospective incidence of noncontact LE injury. Athletes completed questionnaires to collect demographics and musculoskeletal pain history. Clinical tests, performed by trained examiners, included hip provocative tests, visual appraisal of a single-leg squat to identify dynamic knee valgus, and hip range of motion. Injury surveillance for each athlete’s collegiate career was performed. The athletic training department documented each athlete-reported new onset injury and documented the injury location, type, and outcome (days lost, surgery performed). Univariable generalized estimating equation models were used to analyze the relationship between each clinical measure and the first occurrence of noncontact LE injury. An exchangeable correlation structure was used to account for repeated measurements within athletes (right and left limbs). Results: Of the 488 athletes, 369 athletes (75%) were included in the final analysis. Sixty-nine noncontact LE injuries were reported. Responding yes to, “Have you ever had pain or an injury to your low back?” was associated with an increased risk of noncontact LE, odds ratio = 1.59 (95% confidence interval = 1.03, 2.45; P = .04). No other clinical measures were associated with an increased injury risk. Conclusions: A history of prior low back pain or injury was associated with an increased risk of sustaining a noncontact LE injury while participating in National Collegiate Athletic Association Division III athletics.

The evaluation and treatment of adolescents and young adults with hip pain has seen tremendous growth over the past 20 years. Labral tears are well established as a common cause of hip pain but often occur because of underlying bony abnormalities. Femoroacetabular impingement (FAI) and acetabular dysplasia are now well-established causes of hip osteoarthritis and are increasingly treated in the prearthritic stage in hopes of improving symptoms and prolonging the longevity of the native hip. Beyond FAI and acetabular dysplasia, this patient population can present with a complex and variable group of underlying conditions that need to be taken into account. Expertise in the conservative management of this population, including physical therapy, is valuable to maximize the success. Preoperative, surgical, and postoperative decision-making and care in this population is complex and evolving. A comprehensive, multidisciplinary approach to the care of this patient population has been used for over 20 years by our institution with great success. The purpose of this article is to review the “team-based approach” necessary for successful management of the spectrum of adolescent and young adult hip disorders.

Objective: To investigate the effect of hip joint position on hip rotator muscle strength of healthy young adults by using a hand‐held dynamometer.Design: A cross‐sectional cohort study.Setting: A university medical center.Participants: Thirty‐four healthy (19 women, 15 men; mean [standard deviation] age, 25 ± 2.3 years) participated in this study.Methods: A hand‐held dynamometer was used to measure the strength of hip internal rotators and external rotators in 2 positions: hip flexion in sitting and hip extension in supine. The hip was tested in a neutral position with respect to rotation, abduction, and adduction. Isometric force in pounds was measured as the subject pushed against the device.Main Outcome Measurements: For each subject, hip rotator muscle strength measurements were taken during a single session. Hypotheses were developed before data collection.Results: Hip internal rotators were significantly stronger in hip flexion compared with hip extension (P < .01). There was no significant difference found in the hip external rotators between the 2 positions.Conclusions: Hip internal rotators and external rotators behave differently when comparing strength measurements between the positions of hip flexion and hip extension. A hand‐held dynamometer provided an objective measurement of strength that was clinically feasible to use. Both muscle length and moment arms influence force production of the hip rotators as the hip position changes. Understanding these relationships may help clinicians interpret strength findings and direct intervention toward strengthening the appropriate muscles by using the most advantageous position.