Student: Corey Iamonico
Mentor: Professor Gail Samdperil, Professor Jodi Ouellette and Professor Tara Stritch
Major: Athletic Training

Background: A 19 year old female soccer player presented with a one year history of chronic hip pain and a three year history of back pain due to a herniated disc at the L5-S1 level. Athlete was diagnosed with bilateral greater trochanteric bursitis by doctor at home and was seeking treatment for said diagnoses. She was continuing to compete during the regular season, but was limited by pain. ATC performed a biomechanical analysis and gait analysis. Treatment and rehabilitation were performed to improve gait and decrease pain. After continued hip pain, athlete was referred to hip specialist, where an arthrogram was ordered, and left acetabular labrum tear was found. Differential Diagnoses: Bilateral greater trochanteric bursitis, iliopsoas bursitis, distension of the subgluteal bursae, gluteus medius or minimus tendinosis, partial tear of gluteus medium or minimus, adductor strain, iliotibial band syndrome, snapping psoas syndrome, lumbar radicular pain, osteonecrosis, hip stress fracture, inguinal or femoral hernia. Treatment:  Initial MRI taken at home prior to the season found trace amount of fluid in the left iliopsoas bursa, and disc protrusion at L5/S1. ATC did initial evaluation and diagnosed athlete with bilateral greater trochanteric bursitis and iliotibial band tightness. Athlete continued to participate in play while receiving treatment including ultrasound and electrical stimulation, as well as moist heat. Biomechanical evaluation was performed by ATC and several abnormalities were found. Athlete has forward head posture, anterior tilt of pelvis, bilateral internal femoral rotation, bilateral genu recurvatum, internal rotatin of right tibia, left extremity placed behind right, hallux valgus on left foot with external rotation, and flat footed. Video gait training analysis revealed left foot internal rotation, supination with left heel strike, and pronation with right. Positional-release therapy (PRT) was performed to help moderate pain and gait training was implemented. Prophylactic taping was performed to help re-educate muscles during gait training. ATC fit athlete for new orthotics to correct biomechanical problems. Athlete began rehab protocol for core and lower extremity strengthening. Physical therapy was continued during Christmas break at home. Upon continued recommendation athlete met with hip specialist who ordered x-ray and arthrogram of left hip. X-rays were negative, arthrogram was positive for labral tear. MD believes based on symptoms, labral tear exists in right hip as well. Athlete underwent arthroscopic surgery and labrum was removed. Athlete is in process of physical therapy. Uniqueness:  Isolated acetabular labral tears are uncommon, resulting in only 5% of cases. Labral tears tend to take up to two years to diagnose due to misdiagnosis. Athlete experienced a decrease in pain and symptoms through Positional-Release Therapy, and athlete completely changed gait pattern through training and prophylactic taping.