WEBVTT 00:00:00.799 --> 00:00:02.419 All right, hip pain in young adults, 00:00:03.299 --> 00:00:04.841 it's one of those problems that can linger 00:00:04.881 --> 00:00:05.360 for years. 00:00:05.421 --> 00:00:07.081 Patients balance between providers. 00:00:07.161 --> 00:00:08.962 Imaging looks confusing. 00:00:09.122 --> 00:00:11.364 Symptoms don't quite match what the 00:00:11.403 --> 00:00:12.765 textbooks actually say. 00:00:13.144 --> 00:00:14.666 And sometimes what looks like a simple 00:00:14.726 --> 00:00:16.466 orthopedic issue turns out to be something 00:00:16.545 --> 00:00:18.126 much more complex, 00:00:18.507 --> 00:00:20.187 a structural problem in the hip that was 00:00:20.207 --> 00:00:21.568 never recognized in the first place. 00:00:22.574 --> 00:00:24.274 Our guest today has been studying exactly 00:00:24.315 --> 00:00:24.675 that. 00:00:24.695 --> 00:00:26.256 She's a physical therapist, researcher, 00:00:26.295 --> 00:00:28.097 and educator who's been digging into 00:00:28.137 --> 00:00:29.917 whether the things we measure every day, 00:00:30.437 --> 00:00:31.478 strength, range of motion, 00:00:31.919 --> 00:00:33.079 even hypermobility scores, 00:00:34.744 --> 00:00:37.085 might help clinicians spot hidden hip 00:00:37.267 --> 00:00:38.987 instability earlier. 00:00:40.027 --> 00:00:41.487 Because when hip dysplasia goes 00:00:41.527 --> 00:00:42.109 undetected, 00:00:42.429 --> 00:00:45.689 patients can spend years in pain before 00:00:45.710 --> 00:00:47.871 they finally get the right diagnosis and 00:00:47.890 --> 00:00:48.472 then treatment. 00:00:49.112 --> 00:00:51.012 She presented this research at CSM. 00:00:51.393 --> 00:00:52.213 Her goal was simple, 00:00:52.493 --> 00:00:54.334 give clinicians better clues to recognize 00:00:54.353 --> 00:00:55.354 the problem sooner. 00:00:56.034 --> 00:00:57.735 Our guest today, Libby Burton. 00:00:58.115 --> 00:01:00.156 Libby, welcome to the show. 00:01:00.176 --> 00:01:00.697 Thanks, Jimmy. 00:01:00.837 --> 00:01:02.298 I really appreciate that introduction. 00:01:02.357 --> 00:01:02.857 That was awesome. 00:01:03.564 --> 00:01:04.265 Big fancy intro. 00:01:04.305 --> 00:01:06.066 That's the peak. 00:01:06.186 --> 00:01:07.307 I do nothing well for the rest of 00:01:07.326 --> 00:01:07.647 the show. 00:01:07.667 --> 00:01:08.908 It's all on me, so no pressure. 00:01:09.507 --> 00:01:11.109 So you're spreading hip dysplasia and 00:01:11.129 --> 00:01:12.430 instability in young adults. 00:01:12.531 --> 00:01:15.012 A diagnosis that I said in the intro 00:01:15.313 --> 00:01:17.213 often gets missed. 00:01:18.055 --> 00:01:19.075 So we'll just go with it. 00:01:19.114 --> 00:01:20.656 Let's do the value for a million-dollar 00:01:20.697 --> 00:01:21.436 question first. 00:01:21.977 --> 00:01:23.197 Why does this happen so frequently? 00:01:23.257 --> 00:01:25.000 Why are we bad at this? 00:01:25.159 --> 00:01:25.659 What happens? 00:01:25.799 --> 00:01:26.240 Gosh. 00:01:27.063 --> 00:01:28.463 That's such a complex question. 00:01:28.703 --> 00:01:30.644 And I think your summary in the first 00:01:30.805 --> 00:01:32.965 minute of introducing this topic, I mean, 00:01:33.006 --> 00:01:34.447 if everyone just knew what you said in 00:01:34.466 --> 00:01:35.968 the minute, I'd be stoked, right? 00:01:36.628 --> 00:01:37.447 That's a starting point. 00:01:37.768 --> 00:01:37.968 I mean, 00:01:38.049 --> 00:01:40.530 I think our knowledge about what hip 00:01:40.549 --> 00:01:43.771 dysplasia is, is so far behind the times. 00:01:43.850 --> 00:01:45.492 You know, when I went to PT school, 00:01:45.572 --> 00:01:46.453 I'm going to do one of those that 00:01:46.492 --> 00:01:46.832 dates me. 00:01:47.212 --> 00:01:48.954 When I went to PT school over twenty 00:01:48.974 --> 00:01:49.715 years ago now, 00:01:50.195 --> 00:01:51.897 I was told that the hip can't be 00:01:51.998 --> 00:01:52.457 unstable. 00:01:52.617 --> 00:01:53.338 It's just impossible. 00:01:53.498 --> 00:01:55.301 It cannot have a hypermobility there. 00:01:55.801 --> 00:01:57.382 And that just didn't make sense to me. 00:01:57.421 --> 00:01:59.665 And so I think a few things. 00:01:59.944 --> 00:02:00.745 One, 00:02:00.766 --> 00:02:02.626 there's a misunderstanding about hip 00:02:02.647 --> 00:02:03.888 dysplasia and instability, 00:02:03.987 --> 00:02:07.051 and that's that dysplasia only occurs 00:02:07.070 --> 00:02:08.573 between birth and age two. 00:02:09.539 --> 00:02:10.921 And so we think about this as something 00:02:10.942 --> 00:02:12.163 we learned in pediatrics. 00:02:12.243 --> 00:02:13.786 We think about a screen for the hip, 00:02:14.347 --> 00:02:15.487 but that's just not true. 00:02:15.548 --> 00:02:17.411 As we're starting to really learn about 00:02:17.570 --> 00:02:19.532 growth and development and growth plates, 00:02:19.693 --> 00:02:21.616 it turns out that dysplasia, 00:02:21.675 --> 00:02:24.240 when it occurs in adolescents and adults, 00:02:24.280 --> 00:02:25.281 particularly athletes, 00:02:27.182 --> 00:02:28.824 It does not mean that it was necessarily 00:02:28.943 --> 00:02:30.044 missed at birth. 00:02:30.283 --> 00:02:31.864 It actually is something that can develop 00:02:32.084 --> 00:02:33.525 as a result of loading in the way 00:02:33.544 --> 00:02:35.284 the growth plates are loaded during growth 00:02:35.305 --> 00:02:35.884 and development. 00:02:36.406 --> 00:02:37.526 And that's kind of why we've changed the 00:02:37.545 --> 00:02:39.265 terminology in hip dysplasia to 00:02:39.346 --> 00:02:41.046 developmental dysplasia of the hips. 00:02:41.067 --> 00:02:42.447 So this is not just a condition that 00:02:42.486 --> 00:02:43.987 occurs between zero and two, 00:02:44.587 --> 00:02:46.348 but it can develop at any time in 00:02:46.367 --> 00:02:48.628 the growth span of human development. 00:02:48.649 --> 00:02:50.248 So as long as that skeleton is open, 00:02:50.689 --> 00:02:51.949 someone can develop hip dysplasia. 00:02:52.957 --> 00:02:53.418 Understood. 00:02:53.638 --> 00:02:53.878 Okay. 00:02:54.079 --> 00:02:55.079 So we've gotten the million dollar 00:02:55.098 --> 00:02:55.879 question out of the way. 00:02:56.020 --> 00:02:56.740 Let's get some other ones. 00:02:57.580 --> 00:02:59.401 Your specific research looks at whether 00:02:59.782 --> 00:03:01.143 standardized clinical tests, 00:03:01.203 --> 00:03:02.302 I mentioned this in the intro too, 00:03:02.562 --> 00:03:03.563 range of motion, strength, 00:03:03.584 --> 00:03:05.865 hypermobility scores might actually help 00:03:05.925 --> 00:03:07.725 predict hip dysplasia. 00:03:08.106 --> 00:03:10.728 So what early signs should clinicians 00:03:10.747 --> 00:03:12.829 start paying closer attention to? 00:03:12.968 --> 00:03:14.330 Where should they be looking? 00:03:14.370 --> 00:03:15.691 What is the canary in the coal mine? 00:03:16.860 --> 00:03:18.161 Yeah, I think, first of all, history. 00:03:18.360 --> 00:03:18.540 You know, 00:03:18.580 --> 00:03:20.201 if you've got someone with unexplained hip 00:03:20.222 --> 00:03:21.644 pain and they come from a sporting 00:03:21.663 --> 00:03:23.344 background with kind of more of a 00:03:23.405 --> 00:03:24.645 hypermobile bias. 00:03:24.725 --> 00:03:26.007 So our ballet dancers, 00:03:26.447 --> 00:03:27.768 we know in performing arts, 00:03:28.187 --> 00:03:28.889 particularly ballet, 00:03:28.908 --> 00:03:30.229 the incidence of hip dysplasia is 00:03:30.270 --> 00:03:31.411 somewhere between eighty and ninety 00:03:31.431 --> 00:03:31.830 percent. 00:03:32.431 --> 00:03:34.272 And so if you have an athlete that's 00:03:34.293 --> 00:03:35.633 kind of living on that hypermobile 00:03:35.713 --> 00:03:37.935 spectrum with unexplained hip dysfunction, 00:03:38.074 --> 00:03:39.597 you can probably bet there's some hip 00:03:39.616 --> 00:03:41.437 instability and possibly dysplasia there. 00:03:42.289 --> 00:03:44.012 That'd be similar even with running, 00:03:44.072 --> 00:03:45.372 breaststroke and swimming. 00:03:45.513 --> 00:03:47.235 And so sports that were done at a 00:03:47.375 --> 00:03:47.975 high level. 00:03:48.015 --> 00:03:49.396 So I'm not talking about occasional 00:03:49.437 --> 00:03:50.057 performance, 00:03:50.117 --> 00:03:51.879 but these high level athletes that are 00:03:51.919 --> 00:03:53.562 exposed to many, 00:03:53.581 --> 00:03:55.663 many hours of loading in these end range 00:03:55.704 --> 00:03:57.645 positions during adolescence are 00:03:57.686 --> 00:03:58.627 definitely more at risk. 00:03:59.328 --> 00:04:01.310 We know women as predominantly females 00:04:01.370 --> 00:04:02.050 more than males. 00:04:02.911 --> 00:04:03.510 And then, you know, 00:04:03.550 --> 00:04:04.632 generally as a clinician, 00:04:04.651 --> 00:04:06.352 what I see so often is just there's 00:04:06.391 --> 00:04:07.112 increased motion. 00:04:07.272 --> 00:04:09.354 So I think our target and what I 00:04:09.394 --> 00:04:10.334 hope to see eventually, 00:04:10.373 --> 00:04:11.775 and we're starting to see in the research 00:04:11.794 --> 00:04:12.555 that I'm working on, 00:04:13.115 --> 00:04:15.235 is that when we look at the arc 00:04:15.276 --> 00:04:17.637 of rotation, particularly in hip flexion, 00:04:17.836 --> 00:04:18.737 so in hip flexion, 00:04:18.776 --> 00:04:20.798 when we look from external to internal 00:04:20.838 --> 00:04:23.559 rotation, seeing just a global increase, 00:04:23.759 --> 00:04:23.939 you know, 00:04:23.959 --> 00:04:25.259 greater than what you would expect. 00:04:26.120 --> 00:04:26.199 Yeah, 00:04:26.220 --> 00:04:27.600 I've got someone in the clinic right now, 00:04:27.661 --> 00:04:28.600 and he's in his seventies, 00:04:28.641 --> 00:04:30.362 has had multiple back surgeries. 00:04:31.122 --> 00:04:32.423 And the guy's got somewhere between eighty 00:04:32.444 --> 00:04:33.964 and ninety degrees of external rotation of 00:04:34.004 --> 00:04:35.305 his hip. 00:04:35.365 --> 00:04:36.346 And you got to look at that in 00:04:36.387 --> 00:04:37.569 an otherwise kind of stiff, 00:04:37.588 --> 00:04:39.209 not super mobile guy and say, you know, 00:04:39.230 --> 00:04:39.930 that doesn't add up. 00:04:39.971 --> 00:04:41.512 That's more than I would expect. 00:04:42.153 --> 00:04:42.713 So, you know, 00:04:42.733 --> 00:04:44.134 hopefully someday we're going to be able 00:04:44.154 --> 00:04:44.654 to say, well, 00:04:44.694 --> 00:04:46.396 beyond this range of motion cutoff, 00:04:46.437 --> 00:04:48.538 if we look at an extreme of external 00:04:48.559 --> 00:04:50.540 to internal range of motion in the hip, 00:04:50.920 --> 00:04:52.362 that maybe there's something along this 00:04:52.442 --> 00:04:54.043 instability or dysplasia spectrum 00:04:54.084 --> 00:04:54.404 occurring. 00:04:55.060 --> 00:04:56.240 Great, as a former breaststroker, 00:04:56.360 --> 00:04:57.420 I am very in tuned with this. 00:04:57.500 --> 00:04:58.781 And yes, I understand a lot of this. 00:04:58.800 --> 00:04:59.821 Me too. 00:04:59.980 --> 00:05:01.661 Yeah, that's how I got into this research, 00:05:01.701 --> 00:05:02.161 likewise. 00:05:02.182 --> 00:05:02.581 I bet, right? 00:05:02.601 --> 00:05:02.922 I mean, 00:05:02.942 --> 00:05:04.603 that's how we get our research interest a 00:05:04.642 --> 00:05:07.103 lot of times, is personal experience. 00:05:07.702 --> 00:05:08.783 It was the only stroke I could do 00:05:08.824 --> 00:05:11.884 where my mediocrity was an advantage. 00:05:11.985 --> 00:05:13.745 Nobody wanted to do breaststroke. 00:05:13.824 --> 00:05:16.565 Yeah, and actually, for me, 00:05:16.786 --> 00:05:17.906 I couldn't do breaststroke. 00:05:17.946 --> 00:05:19.406 And so my parents doubled down and said, 00:05:19.447 --> 00:05:20.187 well, if you can't do it, 00:05:20.206 --> 00:05:21.307 we're going to get you extra lessons. 00:05:21.326 --> 00:05:23.007 So I went through special lessons to be 00:05:23.048 --> 00:05:24.127 able to do that motion. 00:05:24.687 --> 00:05:26.509 that guess what my hip couldn't do and 00:05:26.528 --> 00:05:28.329 then i wound up being almost a collegiate 00:05:28.370 --> 00:05:30.071 breaststroker doing a breaststroke was my 00:05:30.130 --> 00:05:32.232 specialty so you can imagine what that 00:05:32.271 --> 00:05:33.752 caused in a hip that couldn't do that 00:05:33.791 --> 00:05:36.853 motion over the years so yeah yeah so 00:05:36.874 --> 00:05:39.355 you've trained pts across an entire health 00:05:39.375 --> 00:05:41.336 system to use a standardized measurement 00:05:41.475 --> 00:05:43.456 protocol what would that look like talk us 00:05:43.476 --> 00:05:45.877 through that and why was that important 00:05:46.098 --> 00:05:47.538 for your your research 00:05:48.536 --> 00:05:49.156 Yeah, yeah. 00:05:49.216 --> 00:05:51.177 So I'm very fortunate to work with a 00:05:51.519 --> 00:05:53.721 phenomenal hip preservation specialist. 00:05:54.521 --> 00:05:56.062 These surgeons can be difficult to find 00:05:56.083 --> 00:05:57.463 and there's a small network of them. 00:05:57.483 --> 00:05:58.485 I work with Dr. 00:05:58.564 --> 00:06:00.627 Joel Wells in the Dallas metro area. 00:06:01.127 --> 00:06:03.069 He is a phenomenal human being and an 00:06:03.129 --> 00:06:04.029 exceptional surgeon. 00:06:05.250 --> 00:06:08.271 So when you look at trying to find 00:06:08.351 --> 00:06:09.132 clinical measures, 00:06:09.172 --> 00:06:10.031 so if we're going to look at, 00:06:10.112 --> 00:06:10.271 you know, 00:06:10.291 --> 00:06:11.892 what do PTs look at and how do 00:06:11.913 --> 00:06:13.973 we start to develop a screen or any 00:06:14.012 --> 00:06:15.913 sort of clinical utility of tests that we 00:06:15.934 --> 00:06:16.194 do? 00:06:16.774 --> 00:06:18.314 What we really wanted to do was create 00:06:18.334 --> 00:06:20.415 a pragmatic trial where we're able to kind 00:06:20.454 --> 00:06:22.596 of look at tests that PTs do every 00:06:22.615 --> 00:06:22.815 day. 00:06:23.596 --> 00:06:24.297 And thankfully, 00:06:24.336 --> 00:06:25.738 like a lot of hip preservation 00:06:25.778 --> 00:06:26.499 specialists, 00:06:26.519 --> 00:06:27.701 he'd already kind of had a system of 00:06:27.740 --> 00:06:29.682 data collection and he had PTs that he 00:06:29.702 --> 00:06:30.242 referred to. 00:06:30.723 --> 00:06:31.785 And so we just had to ask the 00:06:31.824 --> 00:06:34.007 question of how can we standardize how 00:06:34.047 --> 00:06:35.588 these measurements are done, 00:06:36.209 --> 00:06:38.012 get some decent reliability data, 00:06:38.151 --> 00:06:40.074 and so that we can use this information 00:06:40.093 --> 00:06:42.175 that's basically passing by every day and 00:06:42.196 --> 00:06:42.956 start to capture it. 00:06:43.819 --> 00:06:45.040 so that was kind of the overall goal 00:06:45.100 --> 00:06:46.701 is you know initially we trained over 00:06:46.762 --> 00:06:48.783 fifty clinicians across a hundred clinics 00:06:49.264 --> 00:06:50.283 and then for the study we had to 00:06:50.303 --> 00:06:51.524 kind of pare it down with the ones 00:06:51.545 --> 00:06:53.286 that were really interested in continuing 00:06:53.386 --> 00:06:55.487 on in this work and so um it 00:06:55.507 --> 00:06:57.428 took a few trials um in looking at 00:06:57.468 --> 00:06:59.009 reliability we have some of our 00:06:59.050 --> 00:07:00.031 measurements were a little more 00:07:00.091 --> 00:07:02.291 problematic than others but you know we 00:07:02.312 --> 00:07:04.894 came up with a good mix between something 00:07:04.913 --> 00:07:06.634 that's more research based and something 00:07:06.654 --> 00:07:08.336 that's more pragmatic that clinicians do 00:07:08.375 --> 00:07:10.697 every day so we can get good information 00:07:10.737 --> 00:07:11.137 and data 00:07:11.718 --> 00:07:13.199 again on things that pts would measure 00:07:13.259 --> 00:07:15.298 every day anyways right and that's the 00:07:15.338 --> 00:07:16.600 sweet spot right you don't want to make 00:07:16.639 --> 00:07:18.680 it so specific that someone couldn't do it 00:07:18.961 --> 00:07:22.422 quickly consistently clearly and you don't 00:07:22.442 --> 00:07:23.682 want to make it so loose and so 00:07:23.762 --> 00:07:25.062 easy it doesn't give you any good data 00:07:25.103 --> 00:07:26.483 you sort of have to have that that 00:07:26.543 --> 00:07:28.444 sweet spot between clinician and 00:07:28.485 --> 00:07:30.524 researcher that understands what the 00:07:30.564 --> 00:07:33.906 constraints are for both absolutely yeah 00:07:34.107 --> 00:07:35.007 now do i have this right you just 00:07:35.047 --> 00:07:37.028 presented at csm right as we record in 00:07:37.067 --> 00:07:39.209 march correct i did i did i just 00:07:39.228 --> 00:07:39.709 had a poster 00:07:40.478 --> 00:07:40.757 Perfect. 00:07:40.817 --> 00:07:42.821 So your poster presentation at CSM, 00:07:44.201 --> 00:07:45.444 what trends are starting to show up in 00:07:45.463 --> 00:07:45.744 the data? 00:07:45.783 --> 00:07:47.706 Like give us the movie trailer version of 00:07:47.725 --> 00:07:48.226 the poster, 00:07:48.326 --> 00:07:49.908 which I think is how we should look 00:07:49.949 --> 00:07:52.591 at posters in terms of movie trailers, 00:07:52.992 --> 00:07:54.334 because who doesn't love a movie trailer? 00:07:55.103 --> 00:07:57.244 Yeah, I love that. 00:07:57.324 --> 00:07:59.245 It's a good synopsis of what we're 00:07:59.285 --> 00:08:00.084 starting to see. 00:08:01.386 --> 00:08:02.766 We've screened over a hundred and fifty 00:08:02.786 --> 00:08:03.086 people. 00:08:03.607 --> 00:08:05.326 We have about sixty that we included. 00:08:05.826 --> 00:08:07.648 At the time that I published the poster, 00:08:07.687 --> 00:08:09.348 we only had about twenty five that had 00:08:09.389 --> 00:08:09.988 dysplasia. 00:08:10.009 --> 00:08:11.769 We only had nine with FAI. 00:08:11.810 --> 00:08:13.370 And so with this study, 00:08:13.411 --> 00:08:14.891 we're really looking at those hips that 00:08:14.930 --> 00:08:15.911 are not arthritic. 00:08:16.192 --> 00:08:18.593 And we're seeing that when we catch FAI, 00:08:19.033 --> 00:08:20.452 they tend to be people that are already 00:08:20.512 --> 00:08:21.053 arthritic. 00:08:21.113 --> 00:08:22.233 And so we're having a harder time 00:08:22.274 --> 00:08:23.754 capturing those FAI hips. 00:08:24.454 --> 00:08:26.156 But with that early data where we had 00:08:26.538 --> 00:08:29.420 about twenty to thirty dysplasia cases and 00:08:29.440 --> 00:08:31.283 about nine FAI cases, 00:08:31.642 --> 00:08:33.644 we actually did find some cool things. 00:08:33.706 --> 00:08:36.408 And the take home is that there's two 00:08:36.448 --> 00:08:38.009 things that are starting to show up as 00:08:38.070 --> 00:08:38.650 predictors. 00:08:39.532 --> 00:08:39.751 One, 00:08:40.153 --> 00:08:42.855 generally range of motion being greater in 00:08:43.015 --> 00:08:44.336 acetabular dysplasia group. 00:08:44.957 --> 00:08:46.399 Because of the type of prediction modeling 00:08:46.438 --> 00:08:47.419 that we were doing, 00:08:47.480 --> 00:08:49.341 we weren't able to really come down to 00:08:49.441 --> 00:08:50.581 which one just yet, 00:08:50.621 --> 00:08:52.182 but it's already starting to pop up that 00:08:52.222 --> 00:08:53.403 we think that there's going to be one 00:08:53.423 --> 00:08:54.485 or more of these range of motion 00:08:54.524 --> 00:08:56.785 measurements that is showing some 00:08:56.846 --> 00:08:58.607 relationship to what we see on imaging 00:08:58.648 --> 00:08:59.067 studies. 00:08:59.567 --> 00:09:00.028 And again, 00:09:00.288 --> 00:09:01.669 it is kind of probably that flexion 00:09:01.730 --> 00:09:03.230 rotation arc of motion. 00:09:03.770 --> 00:09:04.871 And as we get more numbers, 00:09:04.892 --> 00:09:06.832 we'll be able to now really kind of 00:09:06.873 --> 00:09:08.595 dive in and figure out which motion 00:09:08.634 --> 00:09:10.395 measurement is the one that's triggering 00:09:10.436 --> 00:09:11.216 the significance. 00:09:12.256 --> 00:09:13.797 The second thing that we noticed is that 00:09:13.976 --> 00:09:15.217 adduction strength. 00:09:15.817 --> 00:09:17.477 And so patients with hip dysplasia had 00:09:17.518 --> 00:09:19.918 significantly weaker hip adduction, 00:09:20.418 --> 00:09:22.938 and that was actually able to predict what 00:09:22.979 --> 00:09:25.259 we see on imaging studies. 00:09:25.299 --> 00:09:26.659 So the two of those things together. 00:09:27.000 --> 00:09:27.720 So a little surprising, 00:09:27.779 --> 00:09:29.799 not the Baten hypermobility score did not 00:09:29.879 --> 00:09:30.419 pop up, 00:09:30.860 --> 00:09:32.441 but increased range of motion and 00:09:32.480 --> 00:09:35.041 decreased adductor strength. 00:09:35.061 --> 00:09:35.961 And it makes sense, right? 00:09:35.981 --> 00:09:36.902 Go ahead. 00:09:36.922 --> 00:09:38.221 Yeah, keep going. 00:09:39.428 --> 00:09:40.208 It makes sense, right? 00:09:40.229 --> 00:09:41.908 Because the adductors and the rotators are 00:09:41.948 --> 00:09:43.070 really what's helping to create 00:09:43.110 --> 00:09:44.889 compression of the femoral head into the 00:09:44.929 --> 00:09:45.570 socket, right? 00:09:45.669 --> 00:09:47.570 So those patients who have dysplasia, 00:09:47.710 --> 00:09:48.451 and remember, 00:09:48.490 --> 00:09:49.691 these patients are symptomatic, 00:09:49.711 --> 00:09:50.750 they went to see a surgeon. 00:09:51.471 --> 00:09:53.451 And so we think that maybe once the 00:09:53.530 --> 00:09:55.251 adductors get weak enough with dysplasia, 00:09:55.351 --> 00:09:56.511 so say you have an athlete, 00:09:56.751 --> 00:09:58.011 they're performing at a high level, 00:09:58.631 --> 00:09:59.912 they go to college or they become an 00:09:59.952 --> 00:10:01.533 adult, they become less active. 00:10:01.692 --> 00:10:02.793 And now all of a sudden we have 00:10:02.812 --> 00:10:05.293 this situation where the adductors get 00:10:05.332 --> 00:10:06.854 weaker and we have more sloppiness and 00:10:06.913 --> 00:10:08.634 instability and they have symptoms. 00:10:09.889 --> 00:10:10.589 That makes sense. 00:10:12.350 --> 00:10:14.892 For there to be a good story or 00:10:14.951 --> 00:10:16.153 reason for people to change, 00:10:16.173 --> 00:10:18.333 there needs to be tension in the story 00:10:18.394 --> 00:10:20.075 to go along with our movie trailer and 00:10:20.115 --> 00:10:20.835 movie analogy. 00:10:21.535 --> 00:10:24.798 If PTs can identify possible hip dysplasia 00:10:24.977 --> 00:10:27.759 earlier, what changes for the patient? 00:10:27.940 --> 00:10:29.660 Why are we doing all this? 00:10:29.701 --> 00:10:30.480 Tell me the outcome. 00:10:30.500 --> 00:10:31.881 If we can do this, what happens? 00:10:33.899 --> 00:10:34.779 This is the key point. 00:10:35.321 --> 00:10:36.841 As someone and anyone who's listening to 00:10:36.860 --> 00:10:37.041 this, 00:10:37.061 --> 00:10:38.541 who treats patients that have this can 00:10:38.581 --> 00:10:41.022 testify, these patients suffer for many, 00:10:41.042 --> 00:10:43.001 many years with chronic unexplained pain. 00:10:43.481 --> 00:10:44.743 Their pain isn't always in the hip. 00:10:44.802 --> 00:10:45.822 It can be back pain. 00:10:46.202 --> 00:10:48.124 They oftentimes have a history of multiple 00:10:48.163 --> 00:10:48.724 surgeries. 00:10:49.043 --> 00:10:51.183 The average time right now for a patient 00:10:51.203 --> 00:10:53.945 with hip dysplasia from symptom onset or 00:10:54.304 --> 00:10:56.125 entering into the medical system to 00:10:56.184 --> 00:10:58.145 diagnosis is over seven years. 00:10:58.946 --> 00:11:00.686 They see an average of three to five 00:11:00.807 --> 00:11:00.907 years. 00:11:00.927 --> 00:11:01.187 Seven years. 00:11:01.206 --> 00:11:02.326 I was not expecting that. 00:11:03.458 --> 00:11:03.619 Yep. 00:11:03.759 --> 00:11:03.879 Yep. 00:11:03.938 --> 00:11:04.139 Yep. 00:11:04.460 --> 00:11:05.399 Now that study is older. 00:11:05.440 --> 00:11:06.841 That's a twenty eleven study. 00:11:06.880 --> 00:11:08.562 But we're actually looking at those things 00:11:08.581 --> 00:11:09.883 in the current study and we're seeing 00:11:09.923 --> 00:11:10.663 something similar. 00:11:10.883 --> 00:11:13.043 It's about five to seven years before 00:11:13.423 --> 00:11:16.846 someone gets an accurate diagnosis. 00:11:16.905 --> 00:11:17.307 Wow. 00:11:17.366 --> 00:11:18.706 That like took the wind out of my 00:11:18.746 --> 00:11:19.427 sails there. 00:11:20.268 --> 00:11:21.869 Imagine the suffering, not understanding. 00:11:21.889 --> 00:11:21.969 Yeah. 00:11:21.989 --> 00:11:22.068 Yeah. 00:11:22.129 --> 00:11:22.710 Unnecessary. 00:11:22.789 --> 00:11:24.490 Yeah. 00:11:24.510 --> 00:11:25.850 And there's surgical implications for 00:11:25.870 --> 00:11:26.071 that. 00:11:26.091 --> 00:11:27.792 So when you're younger and you have a 00:11:27.892 --> 00:11:28.753 lower BMI, 00:11:28.773 --> 00:11:30.413 there's surgeries that can help. 00:11:31.277 --> 00:11:31.437 You know, 00:11:31.456 --> 00:11:33.317 when we're older and we gain more weight 00:11:33.357 --> 00:11:34.957 and we have more arthritis on board, 00:11:35.077 --> 00:11:37.019 you really don't have as many options. 00:11:37.058 --> 00:11:39.399 And so there's surgical options that 00:11:39.440 --> 00:11:41.120 change when you know earlier. 00:11:41.539 --> 00:11:42.080 And to be honest, 00:11:42.100 --> 00:11:43.520 a lot of people will not opt because 00:11:43.541 --> 00:11:44.581 those surgeries are they're pretty 00:11:44.620 --> 00:11:45.181 invasive. 00:11:45.240 --> 00:11:47.142 So even if you opt not to have 00:11:47.221 --> 00:11:47.822 surgery, 00:11:48.883 --> 00:11:51.964 the power of understanding what is wrong 00:11:51.984 --> 00:11:53.964 with you is life changing, you know, 00:11:53.984 --> 00:11:55.164 and then you have the power to decide 00:11:55.184 --> 00:11:56.125 what you want to do about it. 00:11:56.851 --> 00:11:57.712 Wow. 00:11:57.732 --> 00:11:59.875 Was not expecting that answer. 00:11:59.914 --> 00:11:59.995 Wow. 00:12:00.014 --> 00:12:00.174 Yeah. 00:12:00.195 --> 00:12:02.437 That's very clear now. 00:12:02.677 --> 00:12:02.937 Wow. 00:12:03.437 --> 00:12:04.498 So your work really sits at the 00:12:04.538 --> 00:12:06.240 intersection of research, performance, 00:12:06.279 --> 00:12:07.821 science, clinical care. 00:12:08.522 --> 00:12:10.182 How do we make sure research like this 00:12:10.322 --> 00:12:13.245 actually reaches everyday clinicians 00:12:13.405 --> 00:12:15.447 besides being on a podcast like this? 00:12:15.727 --> 00:12:15.807 Yeah. 00:12:17.235 --> 00:12:18.275 That's a million dollar question. 00:12:18.316 --> 00:12:18.596 As we know, 00:12:18.636 --> 00:12:20.476 the publishing environment is challenging. 00:12:20.537 --> 00:12:23.898 And as a newly minted PhD and researcher, 00:12:23.957 --> 00:12:24.398 obviously, 00:12:24.498 --> 00:12:26.298 I have to work to get this to 00:12:26.317 --> 00:12:27.839 the quality level that it needs to to 00:12:27.879 --> 00:12:29.178 get out in publications. 00:12:29.219 --> 00:12:30.198 But yeah, 00:12:30.239 --> 00:12:32.779 I hope in the common or current media 00:12:32.879 --> 00:12:34.580 environment, things like podcasts, 00:12:34.960 --> 00:12:36.980 social media, understanding, you know, 00:12:37.541 --> 00:12:39.844 really helps to grow the understanding 00:12:39.864 --> 00:12:41.666 about what's happening in hip dysplasia. 00:12:42.567 --> 00:12:44.308 I think the people that treat hips, 00:12:44.349 --> 00:12:45.590 there tends to be kind of a small 00:12:45.649 --> 00:12:47.231 circle of us that are really passionate 00:12:47.251 --> 00:12:48.013 about this stuff. 00:12:48.072 --> 00:12:49.475 And yeah, it's a good question. 00:12:49.514 --> 00:12:51.136 How do we start to disseminate this 00:12:51.197 --> 00:12:51.797 information? 00:12:52.538 --> 00:12:53.918 You know, it starts with good data, right? 00:12:53.958 --> 00:12:55.559 Some of this stuff is at the very 00:12:55.580 --> 00:12:57.020 beginnings of understanding. 00:12:57.061 --> 00:12:58.682 And so when we don't have great data 00:12:58.721 --> 00:12:59.822 just yet, like my posters, 00:12:59.883 --> 00:13:01.464 only twenty or thirty people, right? 00:13:02.085 --> 00:13:03.605 It's important and it's a start, 00:13:03.745 --> 00:13:05.147 but we need to keep going with this 00:13:05.187 --> 00:13:05.527 study. 00:13:05.586 --> 00:13:06.707 So for us, 00:13:06.888 --> 00:13:08.469 we're trying to get almost a thousand 00:13:08.489 --> 00:13:09.970 people through this study. 00:13:10.509 --> 00:13:12.432 And that hopefully in that a thousand 00:13:12.451 --> 00:13:13.932 people, we'll have about four hundred. 00:13:13.993 --> 00:13:15.433 And then we can have at least maybe 00:13:15.794 --> 00:13:17.275 it's looking like we'll get lucky if we 00:13:17.296 --> 00:13:19.557 get two or three hundred with dysplasia 00:13:19.998 --> 00:13:21.178 and a hundred with FAI. 00:13:21.239 --> 00:13:22.580 And that'll give us enough power to really 00:13:22.639 --> 00:13:26.322 understand with better numbers and better 00:13:26.342 --> 00:13:30.166 data and better confidence that we have 00:13:30.206 --> 00:13:31.628 these clinical measures that can predict 00:13:31.668 --> 00:13:32.607 this hip dysplasia. 00:13:33.568 --> 00:13:34.289 And then you have to go on a 00:13:34.330 --> 00:13:34.850 roadshow. 00:13:34.970 --> 00:13:35.650 You got to go on tour. 00:13:36.410 --> 00:13:38.972 I'll do it. 00:13:39.013 --> 00:13:39.332 I'll do it. 00:13:39.352 --> 00:13:39.933 I would love to. 00:13:39.974 --> 00:13:41.154 They call it the poster child for a 00:13:41.215 --> 00:13:43.456 reason because we've got a problem. 00:13:43.736 --> 00:13:44.836 We didn't put a face with it. 00:13:44.918 --> 00:13:46.879 Now that face needs to sort of be 00:13:46.938 --> 00:13:47.359 everywhere. 00:13:48.399 --> 00:13:49.821 We have a segment on the show at 00:13:49.841 --> 00:13:51.322 the end called Words of Wisdom. 00:13:51.842 --> 00:13:53.543 I'll ask you this for our last question. 00:13:53.583 --> 00:13:55.365 If a physical therapist is evaluating a 00:13:55.385 --> 00:13:56.687 young adult with chronic hip pain, 00:13:57.366 --> 00:13:58.788 just hammer it into them. 00:13:58.827 --> 00:14:00.950 What are the one or two signs that 00:14:00.970 --> 00:14:02.850 should make them pause and think this 00:14:02.910 --> 00:14:05.533 might be dysplasia instead of something 00:14:05.894 --> 00:14:06.214 else? 00:14:07.775 --> 00:14:09.277 Hmm. 00:14:09.356 --> 00:14:10.437 Signs or symptoms. 00:14:10.498 --> 00:14:11.759 My mind is going crazy. 00:14:11.818 --> 00:14:15.982 So young female athlete stopped sport has 00:14:16.043 --> 00:14:19.345 chronic unexplained pain in and around the 00:14:19.384 --> 00:14:20.787 hip, low back, down the leg, 00:14:20.886 --> 00:14:22.067 mechanical symptoms. 00:14:23.168 --> 00:14:25.029 And they've probably seen multiple 00:14:25.070 --> 00:14:28.172 providers and they're struggling and 00:14:28.192 --> 00:14:29.432 they're upset about their pain because 00:14:29.474 --> 00:14:30.214 it's very limiting. 00:14:31.075 --> 00:14:31.335 Yeah. 00:14:31.894 --> 00:14:32.316 Well said. 00:14:32.375 --> 00:14:33.937 If someone wants to reach out and find 00:14:33.976 --> 00:14:35.437 out more and connect with you, Libby, 00:14:35.678 --> 00:14:37.139 what's the one spot you want to send 00:14:37.159 --> 00:14:37.279 them? 00:14:38.259 --> 00:14:38.519 Sure. 00:14:39.100 --> 00:14:40.741 Our private practice is Performance 00:14:40.761 --> 00:14:41.682 Science and Rehab. 00:14:41.743 --> 00:14:42.222 So if you go to 00:14:42.243 --> 00:14:44.504 performancesciencerehab.com, 00:14:44.565 --> 00:14:46.225 you can find our clinical practice here in 00:14:46.245 --> 00:14:46.365 St. 00:14:46.405 --> 00:14:47.027 Augustine, Florida. 00:14:47.807 --> 00:14:48.927 It's a very well done website. 00:14:48.988 --> 00:14:49.749 I went there earlier. 00:14:49.908 --> 00:14:50.909 So I want to give you kudos for 00:14:50.950 --> 00:14:53.051 that because I think your science is 00:14:53.071 --> 00:14:53.230 great, 00:14:53.652 --> 00:14:55.452 but people have to want to engage with 00:14:55.493 --> 00:14:55.613 it. 00:14:55.692 --> 00:14:56.854 And you have a very engaging website. 00:14:56.933 --> 00:14:59.015 Well done for whoever did that. 00:14:59.056 --> 00:14:59.456 Thank you. 00:14:59.495 --> 00:15:00.116 It was not me. 00:15:02.158 --> 00:15:02.739 Well, Libby, 00:15:02.759 --> 00:15:04.039 thanks for doing this work and thanks for 00:15:04.059 --> 00:15:05.841 sharing it with us here on AMT. 00:15:06.840 --> 00:15:07.403 Thank you so much, 00:15:07.443 --> 00:15:08.409 I really appreciate your time Jimmy.