The test to determine the diagnostic accuracy for the clinical tests regarding labral tear with meta-analysis had a clear objective of evaluating the current state of the different clinical tests related to labral tear pathology. In the urge to finding the data, there were various methodologies applied. The study by Reiman, Goode, Cook, Hölmich, and Thorborg (2015) involved computer-aided literature search including tools such as MEDLINE, EMBASE as well as CINHAL. There was the employment of guidelines in the search process and as well as the reporting of different phases in the study. The use of Quality Diagnostic Accuracy Studies-2 (QUADAS-2) was fully used. Again there was the use of random effect models in the summary of the sensitivities as well as respective confidence intervals. The result was that there were about 21 articles which were seen as having the potentiality of high quality ( Reiman et al., 2015) . According to meta-analysis, flexion adduction internal rotation and the flexion internal rotation tests can only possess screening accuracy. From the study, it was concluded that the physical examination of all the tests conducted pertaining to labral tear is of certified quality and can be used for the clinical decision-making processes.
Phases of Labral Tear Treatment
There are four phases involved in the treatment of this condition. According to Spencer-Gardner et al. (2014) , the first phase is the initial exercise which primarily entails isometric contraction activity with the focus on the hip abductors, adductors as well as traverse abdominal and extensor muscle. This process is initiated in the first week and runs for the subsequent four weeks. The treatment modalities in this phase include aquatic therapy which is the movement in water to allow the improvement in gait. Another modality is the cryotherapy which is the appropriate pain management therapy.
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The second phase is the intermediate exercise which commences from the fifth week and goes up to the seventh week. Spencer-Gardner et al. (2014) claim that the main aim of this phase is to soften tissues and ROM flexibility. Activities involved in this case include non-competitive swimming as well as two leg bridging. The third phase is also known as advanced exercise. It starts from the eighth week and proceeds to the twelfth week. In this phase, the manual exercise should be performed with regulation and within a specified limit. Exercises involved are ball stabilization as well as golf progression. The last phase is the sport specific training which goes on from the 12 th week to the last period when the patient is seen as recovered. The activities involved in this case are functional testing and specific drills. The patients who undergo this process demonstrate positive satisfactory functional and clinical outcomes which are a validation of this process ( Spencer-Gardner et al., 2014). Therefore, this process should be recommended to all the patients who have undergone the treatment of labral tear.
Precautions in Each Phase of Treatment
In the treatment process, each phase has a precautionary measure which should be taken into consideration before proceeding to the next phase. Wilk, Macrina, Cain, Dugas, and Andrews , (2013) state that in the first phase, the patient should not be exposed to unnecessary hypermobility exercises as this is seen as a hindrance to the progress in subsequent phases. At the second phase, it is recommended that the patient should attain a state of a normal gait pattern. Before proceeding to the third phase, it should be ensured that the patient has a passive ROM measurement and the pain complaints should be checked and minimized. For there to be progress to the fourth stage, it must be ensured that there are flexibility and symmetrical ROM for both the piriformis and psoas. At the last stage, the patient should have the ability to demonstrate a perfect neuromuscular control to the lowest extreme especially during the small sports activities that they undertake. The patients generally should avoid weight-bearing activities and other exercises which can lead to an increase in the load carried ( Wilk et al. , 2013). This is meant to reduce the pitfalls which might arise from one phase of treatment to another. It is a recommendation which should follow the entire phase and rehabilitation process for these patients.
Identified Exercises for the Patients Undergoing the Labral Tear Treatment
In the first phase, there is the physical activity referred to as aquatic therapy where the patient is expected to jog slightly with a slow pace on water. In addition, there is a need for the patient to engage in water walking as well as ankle pumps. I would recommend these exercise activities in the first phase of the treatment exercise. In addition, there are exercises such as joint repositioning tasks as well as axial loading activities such as wall pushups. In phase two again there should be exposure of the patients to slight activities of swimming which should not be competitive. For the third phase, I would recommend exercises such as golf progression as well as core ball stabilization. Out of these, the most important exercise activity I would recommend for the third phase is the walking lunges as well as walking forward and backward. The last phase will involve functional testing and precise exercise drills.
In a study aimed at investigating hip flexor muscle size and patterns to patients suffering from labral pathology, it was learned that a decrease in hip flexor muscles strength may affect the physical functions for the patients with the problem of hip labral pathology ( Mendis, Wilson, Hayes, Watts, & Hides, 2014). This brings to my conclusion in regard to physical therapy. I would recommend that the patients undergo physical therapy in order to prevent any cases of effects on their physical functions. The role of physical therapy is to prevent any resulting defects from the decreased strength in the flexor muscles.
References
Mendis, M. D., Wilson, S. J., Hayes, D. A., Watts, M. C., & Hides, J. A. (2014). Hip flexor muscle size, strength and recruitment pattern in patients with acetabular labral tears compared to healthy controls. Manual therapy , 19 (5), 405-410.
Reiman, M. P., Goode, A. P., Cook, C. E., Hölmich, P., & Thorborg, K. (2015). Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med , 49 (12), 811-811.
Spencer-Gardner, L., Eischen, J. J., Levy, B. A., Sierra, R. J., Engasser, W. M., & Krych, A. J. (2014). A comprehensive five-phase rehabilitation programme after hip arthroscopy for femoroacetabular impingement. Knee Surgery, Sports Traumatology, Arthroscopy , 22 (4), 848-859.
Wilk, K. E., Macrina, L. C., Cain, E. L., Dugas, J. R., & Andrews, J. R. (2013). The recognition and treatment of superior labral (slap) lesions in the overhead athlete. International journal of sports physical therapy , 8 (5), 579.
