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Our training has taught us how to diagnose many conditions. Those structural diagnoses are the “WHAT”- otherwise known as an ICD code. To be reimbursed by insurance, we need to know how to recognize what tissue is causing or contributing to the patient’s pain.

Insurance companies assume that once an injured “whatever” has healed, there is no future need for care. However, great clinicians use their ability to recognize the “WHY”- i.e. the causative factors that led to a specific diagnosis, including posture, repetitive stress, developmental abnormalities, and/or trauma. Astute clinicians set their treatment goals directed at the why, not just the what. This leads to improved outcomes and lower re-injury rates. Read our prior blog to further understand the what and the why.

After reading tens of thousands of articles we’ve identified several functional deficits (“why’s”) that seem to be co-conspirators of many structural problems (“what’s”). Hip abductor weakness is one of the most common functional contributors to lumbar and lower extremity structural pathology. For example, a recent article by Khavambashi et al. correlated noncontact anterior cruciate ligament injury to hip abductor strength. In a cohort of 501 athletes, they measured preseason isometric hip abduction and external rotation strength. Athletes with weaker hip external rotators and abductors independently predicted future noncontact ACL injury. The study data suggest that screening procedures to assess ACL injury risk should include an assessment of isometric hip abduction and/or external rotation strength. (2) Review this quick 45-second functional evaluation for hip stabilizers.

Knowing that diminished hip strength may increase the risk of noncontact ACL injury is powerful information for patients, parents, and payors.

Merging functional and orthopedic diagnoses is a difficult task to perform in a time efficient manner. Use the ChiroUp exam forms as a clinical predictor for specific orthopedic conditions, then combine that information with the appropriate functional exam to answer the “WHY” for every patient. And to learn more about hip abductor weakness, check out this 15-minute webinar.


  1. Boberg J, Dauphinee D. Plantar Heel. In: Banks AM, Downey D, Martin S, Miller. McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery. 1. 3. Philadelphia: Lippincott Williams & Wilkins; 2001:471.
  1. Khayambashi K, et al. Hip Muscle Strength Predicts Noncontact Anterior Cruciate Ligament Injury in Male and Female Athletes: A Prospective Study. Am J Sports Med. 2016.


About the Author

Dr. Tim Bertelsman

Dr. Tim Bertelsman


Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board.

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