Long Stride Walking Test | Ischiofemoral Hip Impingement (IFI)
Posterior hip pain remains a challenge for clinicians. The following graphic from a paper by Gomez-Hoyos et al. (2018) shows an overview of possible competing diagnoses:
As you can see, differential diagnosis in the posterolateral hip region is not that straightforward.
In 1977 ischiofemoral impingement, abbreviated as IFI, was first described by Johnson and still remains a disputed entity. Unlike femoroacetabular impingement that you know from the CAM and pincer deformity, IFI is an extraarticular form of impingement. Torriani et al. (2009) defined the syndrome as a decrease in ischiofemoral space between the lateral ischium and the minor trochanter and a decreased quadratus femoris space between the minor trochanter and the proximal hamstring tendons.
Patients often complain about long-stride walking pain. The pain is felt lateral to the ischium during the toe-off/preswing phase of gait with the hip in terminal extension in which position the lesser trochanter rubs the lateral border of the ischium or the semimembranosus tendon origin. Some patients also complain about radiating pain down the ipsilateral leg which could be elicited when the sciatic nerve becomes entrapped in the ischiofemoral space.
Gómez-Hoyos et al. (2016) evaluated the accuracy of the Long stride walking test and found a sensitivity of 95% and a specificity of 84% to diagnose ischiofemoral impingement. The gold standard they used was a combination of posterior hip pain, abnormal MRI findings including a reduced ischiofemoral space or quadratus femoris space, as well as at least 60% pain relief after decompression surgery. This is the only study so far and it was done in a retrospective study design which might have missed patients who did not undergo injection or surgery. Additionally, the study did not determine the intra- or interobserver reliability of this test. For this reason, the clinical value of this test remains questionable for now.
To perform the test have the patient walk with longer strides. The long stride is expected to provoke impingement between the lesser trochanter and lateral ischium in terminal hip extension. Afterward, the patient is asked to walk again with shorter strides to avoid maximal hip extension. The findings of this test are considered positive if the posterior pain is reproduced lateral to the ischium during extension with long strides whereas pain is alleviated when walking with short strides.
21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE
What customers have to say about the Assessment E-Book
The Assessment E-Book This book helped me in my studying for my exam and in assessing my first patients. Awesome! Also for beginners!
The Assessment E-Book It’s an amazing Compilation! Congrats to all the work you have put in there. You’ll propably find all the test’s you’ve been looking for with propper explaination and source to doublecheck for you self. definetly a must have for every student, but it will also help an experienced practioner. Im looking forward to the lifelong updates on the topics.
Great work, guys
The Assessment E-Book A must-have for all physiotherapists, osteopaths and manual therapists. The authors conducted an extensive research on assessment tests in manual therapy. I find it very easy to read. The more I read the more I learn. Thank you!
The Assessment E-Book This book is great! It is very structured and detailed. It works extremely well on my Macbook and iPad.
The Assessment E-Book The best way to spend 80euros. Totally worth it. The amount of work you put behind this must have been absolutely huge. Every physical or physiotherapist should own it.
Congrats guys you’ve done an incredible job.
I’ve learnd a lot of new things and my approach to therapy in general have totally changed.
In one word: amazing. Keep going guys ! Best wishes from france.
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.