Retraining in a Female Elite Rower with Persistent Symptoms Post-Arthroscopy for Femoroacetabular Impingement Syndrome: A Proof-of-Concept Case Report

Abstract

Athletes with femoroacetabular impingement syndrome (FAIS) managed arthroscopically do not always return to sport. Inability to control back/pelvis, hip and lower limb movements may contribute to the onset and recurrence of symptoms. Our hypothesis is that results from a battery of cognitive movement control tests can inform a cognitive movement control (neuromuscular) retraining programme for improving the clinical presentation and quality of life in an athlete with FAIS. This case report presents a female elite rower with persistent left-sided anterior hip pain, four years post-arthroscopic surgery for FAIS, whose symptoms failed to respond to conventional physical therapy. Hip and groin outcome score (HAGOS), passive and active hip flexion range of motion (ROM) workload (time training on water), hip and pelvic kinematics (3-D motion analysis) and electromyography during a seated hip flexion movement control test, and a movement control test battery to identify movement control impairments (The Foundation Matrix), were assessed pre-intervention (week 0) and immediately post-intervention (week 16). Impaired movement control was targeted in a tailored 16-week cognitive movement control retraining exercise program. All measures improved: HAGOS (all 6 sub-scales); symptoms (61/100 pre-training to 96/100 post-training); physical activities participation (13/100 to 75/100); and active hip flexion ROM increased (78 to 116 and 98 to 118 degrees, respectively); workload increased from 4 to 18 h/week; and movement control impairment reduced (25/50 to 9/50). Pelvic motion on kinematic analysis were altered, and delayed activation onset of tensor fascia latae and rectus femoris muscles reduced. This proof-of-concept case report supports the hypothesis that cognitive movement control tests can inform a targeted cognitive movement control retraining program to improve symptoms, function and quality of life, in an elite rower with persistent hip pain. This training offers an alternative approach to conventional physical therapy, which has failed to restore function in FAIS, and the present study illustrates how specific cognitive movement control assessment can direct individual training programmes.