Many of you know that I have spent the last few years looking more and more at hips, the pain they produce and the uncontrolled movement that seems to be an epidemic in the patients I see.

It is very important for me in diagnosis to link exactly the site of the uncontrolled movement to the symptoms, other wise it just looks like everything hurts and everything is moving. The most important thing is relating the direction of the movement to the painful structure, being able to dissociate the movements of the hip from the movements of the trunk is key.

These movements recently have been described by Mark Comerford as either segmental translators uncontrolled movements or as Global range-specific uncontrolled movements.  Knowing which one you are dealing with can help a great deal.

Segmental translatory uncontrolled movements occurs when the femoral head appears to glide forwards (anterior translation), when in flexion, extension or lateral rotation/abduction movements.

A Global range specific uncontrolled movement demonstrates uncontrolled motion- i.e. hyper mobile range not under control into hip flexion or hip extension or medial/lateral rotation, at either end of the ROM.  These group are often seen to have problems in sustained positions- i.e. with hip flexion- sitting leaning forward at a desk, bending forwards, driving, squatting and climbing stairs .

There are 18 tests which can help you decide which of directions has the least control, and are laid out in great detail by Mark Comerford. Along side this are the corrections to the diagnosis, and treatment ideas- but for a lot of them you need to use your knowledge base.

For me the biggest loss of control of movement I regularly see is into rotation, with little ability to control and dissociate between hip and trunk when turning the trunk away. Seen a lot in people who kick or turn for sport- and should (but do not) have good control and dissociation of the trunk from the standing leg.  Uncontrolled medial rotation, such as this is often linked to an inefficiency of the stabilisers of the gluteal lateral rotators- glut med and deep glut max, not being able to control eccentric motion whilst loaded. This allows both segmental and global range specific problems to develop.

So ask a lot of questions about when the pain comes on exactly what their sport is, so you at least have a point to start from, 18 tests is a lot if you do them all- and that is not the point- the point is you- as a clever clinician will analyse what the movement problems may be before you even get started testing.

I saw a kick boxer the other day- I made him show me how he kicked, in lots of positions, and at what speeds, as I had no idea how he was getting the pain and why- as soon as he showed me I knew when he got the uncontrolled movement- in a position I would never have tested him in if I had not asked!

So start  asking, listening and testing!