Hello, everyone, my name is Ryan McGovern, and I'm a clinical researcher here at Texas health in the Dallas Fort worth area. I want to take a 2nd to thank Anna and see for having me specifically. I want to thank John Chris Freddie and now stops for hosting this event. And although I can only attend virtually, I'm excited that in person learning is back and I hope you all are enjoying your time up there in Chicago today. I'll be talking to you all about the validated single squat tests for doctor and rehab team. So, 1st, and foremost, you know, as we're going through this process, I really want to talk about pre arthritic hip pain. And while I'm very aware of the setting, and what you all are studying as a rehab specialist, and kind of the way that we're defining femoral acetabular impingement syndrome. Now, this is a key topic for us. And as we expand our, you know, other providers in the rehabilitation world, whether that's physical therapy, athletic trainers, chiropractors, other ones that are performing this really differentiating between the structural deformities and these painful pathologies. Now, you know, this is kind of the way that we want to teach it here. And I wanted to share this prior to going into the talk. And really, you know, this started many years ago, probably in 2016, during my doctoral studies, and really trying to define what I wanted to do. And really, it came down to evaluation of patients with pre arthritic hip pain. And, you know, 3 things specifically came to mind, but also were extremely important to us, as I work through this with, you know, Dr. Chris Freddie and Rob Roy Martin up at Duquesne University, and was identify impairments associated with intraarticular structures, identify the severity of the specific pathology, which is very much indicative of what is normally done in the clinical setting by practitioners, orthopedic surgeons, primary care, sports medicine, and the one that I wanted to focus on, with the unique role that I have, being present in an orthopedic surgeon's office, but also being an athletic trainer, as we kind of can take people through these testings. And number three was where we focused, and this was to identify associated neuromuscular deficiencies and functional limitations. And really, as we started this process, we were very aware that there was absolutely no standardized functional performance tests that had been established as valid, reliable, or responsive. Obviously, clinicians and orthopedic surgeons specifically were evaluating their patients in office, and everybody was doing it, but there was no, in the literature, a valid or reliable test to do that. So really, we wanted to focus on that. So, you know, it kind of all started with, what is the effect of pre-arthritic hip pain? You know, as we dove into the literature, we really found that individuals with these pre-arthritic hip pains in the joint really had abnormal functional movement patterns, which is not reinventing the wheel, it's what everybody already knew. However, it was particularly present in single leg activities. So we honed in on, you know, what would individuals be able to improve on, and how could we actually evaluate them and their functional movement patterns in office and make it reliable and valid. So from there, we did a lit review, really into a systematic and literature review to kind of get the best procedures from the single leg squat and the step-down test. I won't be talking about the step-down test today, but truthfully, for an all-inclusive test, I really think the single leg squat is the preferred test in our clinic and our center down here in Dallas, but also should be, I thought, taught all over for assessment of pretty much any functional movement pattern issues throughout the kinetic chain. So really what we focused on and came up to was a set of performance tests. And, you know, this is deeply ingrained in the knee and ankle literature taken from ACL and chronic ankle instability, but kind of modified to really accentuate the hip. I think the biggest thing you can see right here in our model is the placement of the non-affected or the non-evaluated knee or leg, and really with a bent knee at 90 degrees facing backwards. A lot of functional performance testing with the single leg squat is based with the foot in front or at a 90 degree hip flexion with 90 degrees of knee flexion. You know, in the literature, we kind of found taking the individual with hip pain and putting them into an interior tilt of the pelvis actually puts them in the impingement zone and then exacerbates that. So we really kind of wanted to put them in the toughest position and evaluate them at that point. So if we could see improvements or we could see anything like that, that's where we would go. So really it was focusing on the hip and knee flexion with the anterior pelvic tilt, flexion of the trunk, and then hip abduction with the knee internally rotating and abducting. So that was the thought process by us kind of standardizing that. Really what we came to is this evaluation chart, which obviously we're not going to take the time clinically to do it in an everyday office. Normally you're going to look at that as normal or abnormal. However, for this standard evaluation, we took across the top row three repetitions. So one, two, three. This gave the patient the ability to perform the test several times at their own pace. And really what I was looking at as we were going through this would be trunk movement, the posture of the pelvis, posture of the hip, posture of the knee, the depth of the squat, and then my overall or the evaluator's overall impression of this. So were they throwing their hands? Were they falling over? Did they actually have the ability to perform the test? Which if you have all done this in your own office, most of the time a lot of people off the street without any kind of hip pain would fail these tests. And by most, I would say almost all. So really when we evaluated it, this is just a breakdown of what it would look like. Repetition one, repetition two, repetition three. And really what it came down to is zero or one positive deviations. And positive deviations are marked by a number one on this chart. Zero is negative, so no presence of. If you were at zero out of six or one out of six, that was a passing score. And if you only passed once in the example that I have here, that was a pass for the entire test. So this is where we kind of standardized it. And I want to take you guys through this video and showing our model. Now, when we're testing this, before I run the model through, we always tested them first and had them demonstrate first three repetitions on the unaffected leg. So in this evaluation or in this mock evaluation, my model's affected limb will be on the left side. So we're going to take them through the first three repetitions on the right and then through the left. And I'll go ahead and play this video now. And each time, as you see, I have them gain their balance back. So just putting the foot down as they go through the three repetitions to really take a look and seeing where they are. So now I feel that the model is comfortable to go to the affected side and work through three rotations. All right. So and as you can see, and I'm going to kind of break it down here, is repetition one, repetition two, and repetition three. And I'll go back. This is repetition one. And, you know, I want to kind of demonstrate the difference between the three and really kind of focus in on the patient being fully aware of how they're performing. Now, here, if you're seeing, Cody, you're seeing a little bit, and this is standstill. So you're not seeing the full functional evaluation. But this is pretty much the point where the model was getting down to the depth that we wanted them at and then back up. And usually it's about a 45 degree angle of knee flexion just to see what the response is. And, you know, with example one here, seeing that contralateral, so the right side kind of rotating out and getting a little bit of trunk rotation with a little bit of a valgus collapse. Number two, I like to isolate. This isn't the bottom portion. It's just when he realized that he was about to fall over as he was descending and started to smile and fully aware that this was an awful attempt. So he basically scrapped that and we move on. This is, you know, I joke because this is one of our athletic trainers that works with us that I tortured and took through this modeling. But for me personally, this is a common response I saw with my athletes or the student athletes or the adult athletes that came through the office when Dr. Chris Freddie and I were evaluating these patients. It was quite entertaining because most of them would know which one it was and it became a competition. They really wanted to execute it. Now, this is number three. And while it's not 100% passing from what I would say, it's most definitely the cleanest single leg squat that he had throughout the three repetitions. And you can see the breakdown of why I enjoy doing three. Now, obviously, you're not going to go through clinically and grade them zero to six for three repetitions, but I would encourage you give them a little bit of a soft warm up on the right side or non-affected side and then test them on the effective side with three tests just to get them comfortable with that. Now, what we came through and, you know, we took the test in this group, especially as I mentioned previously, we took the test of single leg squat. We took the standardization through a literature review of that specifically to evaluate the hip, taking it from the knee and the ankle literature and putting it into a manuscript where we showed that both Dr. Chris Freddie and I specifically and were the ones evaluating, we were reliable with moderate to excellent reliability. So, and that was the difference between a certified athletic trainer and an orthopedic surgeon in evaluation of the single leg squat test. The reason, first, you know, the reliability of two different specialists within their own area is important because it isn't just an orthopedic surgeon, orthopedic surgeon. I think having an athletic trainer, a physical therapist, chiropractor, and an orthopedic surgeon really evaluating it because we both look at these tests from a different perspective. And then number two really is important to me is in comparison to the step down test, the single leg squat was correlated and it was significantly different between individuals who passed and failed the single leg squat for evaluation of pain, physical function during their activities of daily life. Daily living and sports related activities. So, not only does this evaluate everyday life, but it also evaluates sports specific motion. And to even go further, I think that's important because the variability of, you know, patients that we see in a center for the hip, where you can have 18 year old athletic, you know, division one football players, and you can also have 50 year old overweight sedentary lifestyle individuals who work at a computer lab. Computer desk, 40 to 60 hours a week, suffering from the same condition and the same injury. I think it's important that the single leg squat test was good in evaluating all of those. Now, I told our athletic trainer that I would take him through this, but I also have to show a little embarrassment for myself, taking you through some of these tests and really what I wanted to show here. With the first, these to me are the two most common depths or two most common tests that you will see. First, very common in what I would term as our femoracetabular impingement patients, really the cam deformity style. This is the deviations that I will see the most of. And you're seeing me go down with a valgus collapse and really that forward trunk flexion with a little bit of loss of mobility at the end. I'm seeing that almost as a clearance to get past their bony deformity, but still get to the depth that they need for a functional movement. That is some of the modification and adaptations that I saw. Specifically with this video, this is more of my instability, lack of core control patients that really would just valgus, Trendelenburg, rotate and almost fall over. In the sense of I didn't want to give myself a pivot shift and my knee on this video. I didn't fall over, but that's exactly what I see and what was common in the evaluation of these patients. So really, I want to thank you all as I get to my last slide here. I want to thank you all for having me. It was a quick, short video. I hope you take this and really use it there. Shout out to my sons and I thank you all and I hope you have a great week.

validated single squat test

pre-arthritic hip pain

structural deformities

functional performance tests

hip flexion