Entries by Dr Alison Grimaldi

Assessing Lateral Stability of the Hip and Pelvis

Adequate function of the hip abductor mechanism has been shown to be integral to ideal lower limb function and musculoskeletal health. Clinical assessment of hip abductor muscle function may include observational assessment of postural habits, muscle bulk, and of the ability to control optimal frontal plane femoropelvic alignment during a variety of single leg tasks. Strength testing using a hand held dynamometer is perhaps our most robust clinical assessment tool but should not be considered a ‘gold standard’ in the assessment of abductor muscle function. Evidence from magnetic resonance imaging (MRI), and electromyography (EMG) studies provides a deeper understanding of specific deficits that occur within the abductor synergy. The assessment of abductor function should not be based on a single test, but a battery of tests. The findings should be interpreted together rather than independently, and in the context of a thorough understanding of function of the lateral stability mechanism. Manner and comprehensiveness of abductor assessment will have important implications for management and particularly therapeutic exercise.

Can local muscles augment stability in the hip? A narrative literature review

This paper was published in Journal of Musculoskeletal and Neuronal Interactions 2013; 13(1):1-12 T.H. Retchford1,2, K.M. Crossley3, A. Grimaldi4, J.L. Kemp3, S.M. Cowan1 1Melbourne Physiotherapy School, University of Melbourne, Melbourne, Victoria, Australia; 2School of Community Health, Charles Sturt University, Albury, New South Wales, Australia; 3Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, […]

EXERCISE AND LOAD MODIFICATION VERSUS CORTICOSTEROID INJECTION VERSUS ‘WAIT AND SEE’ FOR PERSISTENT GLUTEUS MEDIUS/MINIMUS TENDINOPATHY (THE LEAP TRIAL): A PROTOCOL FOR A RANDOMISED CLINICAL TRIAL

Rebecca Mellor1 Alison Grimaldi1,2, Henry Wajswelner3 Paul Hodges4, Haxby Abbott5, Kim Bennell6, Bill Vicenzino1 1 School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072, Australia. 2 Physiotec, 23 Weller Road, Tarragindi, QLD 4121, Australia. 3 Department of Physiotherapy and Lifecare Physiotherapy, LaTrobe University, Bundoora, VIC 3086, Australia. 4 NHMRC Centre […]

Gluteal Tendinopathy: A Review Of Mechanisms, Assessment and Management

Tendinopathy of the gluteus medius and gluteus minimus tendons is now recognized as a primary local source of lateral hip pain. The condition mostly occurs in mid-life both in athletes and in subjects who do not regularly exercise. Females are afflicted more than males. This condition interferes with sleep (side lying) and common weight-bearing tasks, which makes it a debilitating musculoskeletal condition with a significant impact. Mechanical loading drives the biological processes within a tendon and determines its structural form and load-bearing capacity. The combination of excessive compression and high tensile loads within tendons are thought to be most damaging. The available evidence suggests that joint position (particularly excessive hip adduction), together with muscle and bone elements, are key factors in gluteal tendinopathy. These factors provide a basis for a clinical reasoning process in the assessment and management of a patient presenting with localized lateral hip pain from gluteal tendinopathy. Currently, there is a lack of consensus as to which clinical examination tests provide best diagnostic utility. On the basis of the few diagnostic utility studies and the current understanding of the pathomechanics of gluteal tendinopathy, we propose that a battery of clinical tests utilizing a combination of provocative compressive and tensile loads is currently best practice in its assessment. Management of this condition commonly involves corticosteroid injection, exercise or shock wave therapy, with surgery reserved for recalcitrant cases. There is a dearth of evidence for any treatments, so the approach we recommend involves managing the load on the tendons through exercise and education on the underlying pathomechanics.

Gluteal Tendinopathy: Integrating Pathomechanics And Clinical Features In Its Management

 Alison Grimaldi, PhD1,2  ,  Angela Fearon, PhD3-5 1Physiotec Physiotherapy, Tarragindi, Australia. 2School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia. 3Hip Physio, Watson, Australia. 4Trauma and Orthopaedic Research Unit, Australian National University, Canberra City, Australia. 5School of Physiotherapy, University of Canberra, Bruce, Australia.

Lateral Hip Pain: Mechanisms and Management

  This article was published in In Touch magazine, a resource exclusive to members of Musculoskeletal Physiotherapy Australia, a National Group of the Australian Physiotherapy Association. For more information on the exercise apparatus pictured in this article, Physiotec’s TWS Slider, click here History and prevalence Lateral hip pain (LHP) has traditionally been referred to as trochanteric […]

The Association Between Degenerative Hip Joint Pathology and Size of the Gluteus Maximus and Tensor Fascia Lata Muscles

ABSTRACT The aim of this study was to obtain, using Magnetic Resonance Imaging (MRI), muscle volume measurements for the gluteus maximus (upper:UGM and lower:LGM portions) and tensor fascia lata (TFL) muscles in both healthy subjects (n=12) and those with unilateral osteoarthritis of the hip ( mild: n=6, and advanced: n =6). While control group subjects were symmetrical […]

Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain

Alison Grimaldi1,2, Rebecca Mellor2, Phillipa Nicolson3, Paul Hodges4, Kim Bennell3, Bill Vicenzino2,4 1Physiotec Physiotherapy, Tarragindi, QLD, Australia,2School of Health & Rehabilitation Sciences St Lucia, The University of Queensland QLD, Australia, 3Centre for Health and Exercise Science, University of Melbourne, Parkville, VIC, Australia,4NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University […]