Movement Pattern Training in People With Intra-articular, Prearthritic Hip Disorders

Significance: Intra-articular, prearthritic hip disorders (PAHD) result in substantial
dysfunction in young adults and are proposed precursors to hip osteoarthritis. The number of
surgical procedures to treat PAHD has grown exponentially in the past decade, despite the
lack of high level evidence to guide treatment decisions. The potential exists for surgery to
become standard treatment before rigorous investigation of treatment options has been
completed. This trend may be partially due to a lack of evidence related to rehabilitation.
Although some authors believe rehabilitation can improve function in people with PAHD, others
state that rehabilitation is contra-indicated and recommend surgery as the best option. There
are no published clinical trials to support or refute either opinion, therefore little is
known about the comparative effectiveness of rehabilitation.

Innovation: The investigators' long term goal is to develop effective treatment strategies
for people with PAHD that will improve function and prevent or delay the onset of OA.
Movement pattern training is an innovative rehabilitation approach designed to reduce
stresses on the hip joint by optimizing the biomechanics of functional tasks through
task-specific instruction. Preliminary work suggests that abnormal movement patterns may be
associated with PAHD and that movement pattern training may be an effective treatment
approach, however comparison to standard rehabilitation has not been completed.

Purpose: This study was designed to assess the feasibility of conducting a multicenter
randomized clinical trial (RCT) to determine the efficacy of movement pattern training
compared to standard rehabilitation for people with PAHD. Participants enrolled at Washington
University and University of Pittsburgh will be randomized into one of two treatment groups,
movement pattern training or standard rehabilitation. In addition to assessing feasibility of
the trial, preliminary estimates of effect sizes for treatment outcomes will be obtain in
preparation for the future definitive trial. Post-treatment improvements in patient-reported
function as measured by the Hip disability and Osteoarthritis Outcome Score and hip adduction
motion during functional tasks, a proposed mechanistic factor associated with PAHD will be
assessed. Upon completion of this study, the investigators will be positioned to implement a
multicenter RCT to definitively assess the efficacy of movement pattern training.

Impact: Ultimately, if movement pattern training is determined to be effective, it will
provide a relatively inexpensive alternative to surgical intervention. Further, the
theoretical concepts of movement pattern training could be used to possibly serve a role in
injury prevention, as well as optimize post-surgical outcomes in those who do require
surgery.

Inclusion Criteria:

- be 15-40 years old

- report deep hip joint or anterior groin pain, confirmed upon physical exam

- report pain > 3/10 and present > 3 months

- demonstrate functional limitation with modified Harris Hip Score <90.

Exclusion Criteria:

- previous hip surgery, fracture, pelvic/hip infection

- pain due to high impact trauma

- inflammatory disease, e.g. rheumatoid arthritis, gout

- neurological involvement affecting balance

- age <15 or >40

- Slipped Capital Femoral Epiphysis (SCFE) or Legg-Calve-Perthes Disease (LCP)

- pain, numbness or tingling that radiates into the thigh

- known pregnancy