Introduction

The High Performance Hip Masterclass, taught by Dr Jo Kemp and Dr Sue Mayes, provides a complete distillation of the assessment and management of hip pain in the active population. This Executive Summary provides clinically relevant, actionable information that may be useful to health professionals.

Part 1: Assessment of Hip Pain - Diagnosis

A thorough assessment is paramount to accurately diagnose individuals with hip pain. Subjectively, it’s crucial to gather the individual’s age and sex, sporting + training load and history, as well as their pain presentation over a 24-hour period. However, we cannot forget to rule out red flags including cancer, of which a number commonly metastasise to the hip, as well as the involvement of the lumbar spine and pelvis.

• The DOHA agreement provides a comprehensive overview of how to clinically assess five sub-categories of hip pain, including a) hip related, b) hip flexor related, c) adductor related, d) abdominal related and e) pubic related pain.
• The key tools to assist with differential diagnoses are a) pain location, b) palpation and c) special tests.
  

Part 2: Clinical Assessment of Hip Pain

A comprehensive clinical hip assessment allows the clinician to identify impairments in strength, ROM and function which then form the basis of the patient’s management plan. Those with hip pain commonly have impairments in hip strength, and an individualised assessment using handheld dynamometry should always be completed.

• It is crucial to assess hip strength throughout an individual’s rehab journey as it is commonly impaired amongst those with hip pain, especially into hip adduction and extension.
• Trunk control and strength is also impaired in those with hip pain and may influence the extent of hip impingement.
• Hip ROM is no different between those with FAI and controls, however, should be assessed at the start and end of treatment.
  

Part 3: Hip Pathology and Imaging

Imaging can sometimes be perceived by the wider public as a panacea that will provide the answers as to why they are experiencing pain. Whilst the presence of findings such as labral tears, cartilage defects and ligamentum teres tears may differ between dancers, athletes, and the general population, these findings don’t usually correlate well with symptoms. It is also paramount to respect these anatomical and structural variances when treating the individual in front of you.

• Findings, and their progressions, on a hip scan don’t often correlate well with pain or symptoms.
• Imaging should never be used in isolation, and describing results as ‘imaging findings’ rather than ‘pathology’ or ‘abnormality’ is crucial.
• Dancing and regular exercise may have a preventative effect on hip pain, especially in the presence of imaging findings
  

Part 4: Physiotherapy Management of Hip Pain

Exercise is a cornerstone of hip pain rehabilitation and should encompass a gradually loaded program that is challenging and specific to the individual. However, knowing which exercises to choose and when can be tricky. Certain muscle groups are important to target for certain subgroups, such as adduction being important for all patients and hip flexion being especially important for women with pathologies. Specific return to sport criteria should be created and tested on the individual, depending on what sport and level they are returning to.

• The goal of exercise rehabilitation should be to optimise hip joint function by targeting known impairments identified during assessment.
• Exercise is paramount for hip rehabilitation, and should focus on at least 3 months of lower extremity strength, core strength, motor control exercises and ROM exercises.
• Exercise should start with low load, safe positions then move to higher load, more challenging movements.