Conservative management of ischiofemoral impingement: Strengths and opportunities for future research

Abstract

This commentary evaluates the case report by Mohammed et al on conservative management of ischiofemoral impingement through a multimodal physical therapy program integrating in-person sessions, telerehabilitation, dry needling, and kinesiology taping. The study demonstrated significant pain reduction and functional improvement, highlighting the feasibility of hybrid care models. However, limitations include short-term follow-up, lack of post-treatment imaging, and single-case design restricting generalizability. Future research should prioritize longitudinal studies, anatomical correlation via imaging, and randomized trials to validate efficacy across diverse populations. While the framework offers promising clinical utility, further investigation is critical to optimize protocols and elucidate biomechanical mechanisms underlying symptom resolution.

Key Words: Ischiofemoral impingement; Conservative management; Telerehabilitation; Multimodal therapy; Case report

Core Tip: This letter highlights the clinical significance of a structured, multimodal physical therapy program for ischiofemoral impingement syndrome as reported by Mohammed et al. The case study shows positive outcomes, but further research is needed to validate long-term efficacy, optimize telerehabilitation protocols, and explore the biomechanical mechanisms underlying symptom resolution.

TO THE EDITOR

We read with great interest the case report by Mohammed et al[1] on the successful management of ischiofemoral impingement (IFI) using a tailored multimodal physical therapy program. The authors’ innovative integration of in-person and telerehabilitation sessions, combined with dry needling and kinesiology taping, underscores the potential of conservative approaches in treating this underrecognized condition. However, although this study provides valuable insights, we want to emphasize its strengths and highlight areas for future exploration.

STRENGTHS OF THE STUDY

Mohammed et al[1] demonstrated a notable advancement in the conservative management of IFI using a multimodal approach. The integration of stretching, strengthening, kinesiology taping, and dry needling addresses both biomechanical deficits and neuromuscular imbalances in line with contemporary recommendations for IFI management[2]. A particularly innovative aspect is the hybrid delivery model that combines in-person and telerehabilitation sessions, which not only underscores the feasibility of remote monitoring in musculoskeletal care but also highlights its potential applicability in resource-limited settings[3]. The use of validated outcome measures such as the numerical pain rating scale (NPRS) and the Musculoskeletal Health Questionnaire (MSK-HQ) further strengthened the clinical relevance of the findings. The decrease in pain scores from 9 to 3 on the NPRS, along with the significant improvement in MSK-HQ scores from 12 to 48, highlights the effectiveness of the program and provides robust evidence for its clinical usefulness.

OPPORTUNITIES FOR FURTHER RESEARCH

Although this study offers valuable insights, there are several areas that require further investigation. The absence of long-term follow-up data extending beyond 2 months limits the ability to draw definitive conclusions about the long-lasting therapeutic benefits. Therefore, future research should prioritize longitudinal assessments to evaluate relapse rates and sustained functional improvements at intervals of 6–12 months postintervention. Multicenter randomized controlled trials or longitudinal cohort studies also could be employed to rigorously examine long-term outcomes. Additionally, the absence of posttreatment imaging to reassess ischiofemoral space dimensions represents a missed opportunity to correlate clinical improvements with anatomical changes. Such data could help elucidate the mechanisms underlying symptom resolution and refine targeted interventions. Furthermore, the single-case design inherently limits generalizability, necessitating randomized controlled trials to compare the effectiveness of this multimodal approach with standard care protocols across diverse patient populations and explore the feasibility of integrating telerehabilitation into routine healthcare delivery systems. Addressing these gaps would not only validate the current findings but also enhance the translational impact of the proposed rehabilitation framework.

CLINICAL IMPLICATIONS

This case reinforces the importance of personalized rehabilitation for IFI. Hip abductor/external rotator strengthening directly address biomechanical deficits, whereas dry needling may mitigate quadratus femoris hyperactivity, a main source of pain[4]. However, clinicians should be cautious when applying these results without additional validation.

CONCLUSION

Mohammed et al[1] presented a compelling framework for conservative IFI management. Their work prompts further investigation of the optimal duration of intervention, integration of telehealth, and mechanisms underlying recovery.