The Sports Physical Therapy Podcast · Mike Reinold

Nonarthritic Hip Pain with Keelan Enseki - Episode 42

·51 min·3 clips

Enseki defines non-arthritic hip pain as intra-articular conditions, with FAIS, dysplasia, instability, microinstability, and labral tears.

1. The Sports Physical Therapy Podcast episode focuses on non-arthritic hip pain and a recent JOSPT clinical practice guideline from Keelan Enseki. 2. Mike Reinald introduces Enseki as a University of Pittsburgh Medical Center leader who serves as director of clinical practice innovation, administrative director of physical therapy residency programs, and an adjunct professor at the University of Pittsburgh. 3. The episode asks what a clinical practice guideline is for and how clinicians should use one without treating it like a cookbook. 4. Enseki says the guideline process starts with evidence-based recommendations and has evolved toward stronger recommendation grades as more literature appears. 5. He describes systematic reviews on diagnosis, intervention, prognosis, and outcomes, plus scoping reviews and additional statements for less-studied topics. 6. Enseki says the guideline goes through heavy literature review, three editors, and external reviewers who include surgeons, physicians, and other health professionals. 7. Reinald uses a red-light, green-light, yellow-light analogy to explain how clinicians should think about strong evidence, weak evidence, and gray areas. 8. Enseki agrees that yellow-light areas matter most because they dominate day-to-day practice in non-arthritic hip pain. 9. He says clinicians can use the guideline at different depths, from a quick summary in clinic to deeper review for research or writing. 10. Enseki warns that the guideline is not meant to replace clinical decision-making or give exact exercise prescriptions and timelines. 11. Enseki says the 2023 revision captured more studies than the 2014 version, including systematic reviews and trials that strengthened some recommendations. 12. He notes that the earlier 2014 guideline reflected a smaller literature base and included many F-level recommendations. 13. On definition, Enseki says non-arthritic hip pain is mainly an intra-articular condition and not an extra-articular catchall. 14. He says the umbrella includes femoroacetabular impingement syndrome, acetabular dysplasia, instability, microinstability, labral tears, osteochondral lesions, loose bodies, and ligamentum teres tears. 15. Enseki and Reinald discuss how the hip field has learned from shoulder terminology debates and is trying to use definitions that are more clinically useful. 16. Enseki says imaging findings such as cam morphology are common in some sports like hockey and should be interpreted as morphological changes, not automatic pathology. 17. He says athletes with symptoms, impairments, and large alpha angles may have a lower threshold for surgical referral, while others may improve with rehabilitation. 18. Enseki says clinicians should first look for strength, range of motion, movement quality, and symptom impairments before attributing pain to anatomy alone. 19. This episode fits an interview format with a steady educational tone and long back-and-forth explanation from both speakers. 20. Physical therapists, residents, and sports medicine clinicians will likely get the most value, while listeners wanting entertainment or a quick answer may skip it.

As heard by us

A practical hip-pain conversation about imaging, symptoms, and the risk of overreading common changes on scans.

This discussion of a recent JOSPT clinical practice guideline on non-arthritic hip pain stays focused on the clinical problem that matters most: how to tell meaningful hip findings from changes that only appear important on imaging.

Read the full review in PlayNext →

Why you'd press play

If hip imaging keeps muddying your clinical decisions, start here.

Read the full recommendation in PlayNext →

Listen to the show on

Apple Podcasts Spotify

Play clips from this episode More from The Sports Physical Therapy Podcast