Podcast
Questions and Answers
When performing an anteroposterior progression (posterior glide) mobilization of the hip, which patient position and technique application would MOST effectively target the posterolateral hip capsule?
When performing an anteroposterior progression (posterior glide) mobilization of the hip, which patient position and technique application would MOST effectively target the posterolateral hip capsule?
- Prone with hip in 10-15 degrees of abduction and applying caudally directed oscillations, potentially adding 3-6 thrusts at the beginning of the first set.
- Side-lying with the hip in neutral, applying a lateral distraction force to the femur while stabilizing the pelvis.
- Prone with the knee bent, applying pressure inferior and medial to the greater trochanter in a posterior to anterior direction while varying hip flexion and extension.
- Supine with the hip in flexion and adduction, using body weight to impart passive oscillations through the long axis of the femur, adding more flexion, adduction, or internal rotation to progress. (correct)
A physical therapist is treating a patient with hip dysfunction and decides to perform a posteroanterior progression (anterior glide). What modification to the standard technique would BEST target the sacrum while still addressing the hip joint?
A physical therapist is treating a patient with hip dysfunction and decides to perform a posteroanterior progression (anterior glide). What modification to the standard technique would BEST target the sacrum while still addressing the hip joint?
- Performing the technique in side-lying with the hip adducted and internally rotated.
- Applying pressure directly over the greater trochanter with the hip in maximal external rotation.
- Increasing the speed of the oscillations while maintaining a consistent posterior to anterior force.
- Using a figure-4 position and applying pressure through the sacrum. (correct)
Which dosage parameter is consistently recommended across all the listed hip mobilization and soft tissue techniques to optimize therapeutic outcomes without exacerbating symptoms?
Which dosage parameter is consistently recommended across all the listed hip mobilization and soft tissue techniques to optimize therapeutic outcomes without exacerbating symptoms?
- Limiting treatment duration to a single set to minimize risk of adverse reactions.
- Applying maximal force during manual techniques to stimulate aggressive tissue remodeling.
- Performing interventions daily to promote cumulative tissue adaptation.
- Using 3-6 sets of 30-second intervals for joint mobilizations. (correct)
What is the PRIMARY biomechanical goal of applying long-axis distraction to the hip in a prone position with 10-15 degrees of abduction, utilizing caudally directed oscillations?
What is the PRIMARY biomechanical goal of applying long-axis distraction to the hip in a prone position with 10-15 degrees of abduction, utilizing caudally directed oscillations?
A therapist is preparing to administer soft tissue massage to a patient with limited hip internal rotation. Considering the interconnectedness of hip musculature, which muscle group's release would MOST directly facilitate improved internal rotation range of motion?
A therapist is preparing to administer soft tissue massage to a patient with limited hip internal rotation. Considering the interconnectedness of hip musculature, which muscle group's release would MOST directly facilitate improved internal rotation range of motion?
When applying a hold-relax PNF stretching technique, what is the most critical element that differentiates it from static stretching?
When applying a hold-relax PNF stretching technique, what is the most critical element that differentiates it from static stretching?
A physical therapist is treating a patient with chronic hamstring tightness using trigger point therapy and stretching. Considering the information provided, what is the most appropriate duration for sustained compression on a trigger point within the hamstring?
A physical therapist is treating a patient with chronic hamstring tightness using trigger point therapy and stretching. Considering the information provided, what is the most appropriate duration for sustained compression on a trigger point within the hamstring?
When assessing a patient with suspected muscle dysfunction, how does the identification of familiar versus unfamiliar pain during trigger point palpation most directly influence the subsequent treatment approach?
When assessing a patient with suspected muscle dysfunction, how does the identification of familiar versus unfamiliar pain during trigger point palpation most directly influence the subsequent treatment approach?
In which scenario would ballistic stretching be most appropriate?
In which scenario would ballistic stretching be most appropriate?
A therapist decides to use soft tissue mobilization on a patient's adductors. What is the most important step to take before applying the technique?
A therapist decides to use soft tissue mobilization on a patient's adductors. What is the most important step to take before applying the technique?
When comparing static progressive stretching to traditional static stretching, what is the key differentiating factor in how the stretch is applied?
When comparing static progressive stretching to traditional static stretching, what is the key differentiating factor in how the stretch is applied?
In clinical practice, what is the primary rationale for utilizing pincer palpation over flat palpation when assessing specific muscle groups?
In clinical practice, what is the primary rationale for utilizing pincer palpation over flat palpation when assessing specific muscle groups?
What is the most important factor when determining whether to use flat palpation versus pincer grip palpation?
What is the most important factor when determining whether to use flat palpation versus pincer grip palpation?
In the context of trigger point therapy, what is the primary purpose of incorporating a submaximal contraction of the affected muscle during treatment?
In the context of trigger point therapy, what is the primary purpose of incorporating a submaximal contraction of the affected muscle during treatment?
When integrating soft tissue mobilization techniques into a comprehensive intervention approach for hip dysfunction, what is the most critical initial step following a thorough patient examination?
When integrating soft tissue mobilization techniques into a comprehensive intervention approach for hip dysfunction, what is the most critical initial step following a thorough patient examination?
When performing a hip inferior glide, also known as a 'distraction,' which of the following patient presentations would make this technique preferable to a long axis distraction?
When performing a hip inferior glide, also known as a 'distraction,' which of the following patient presentations would make this technique preferable to a long axis distraction?
A physical therapist is treating a patient with limited hip abduction. During a mobilization with movement technique, which principle MOST accurately guides the therapist in selecting the appropriate glide direction?
A physical therapist is treating a patient with limited hip abduction. During a mobilization with movement technique, which principle MOST accurately guides the therapist in selecting the appropriate glide direction?
Which of the following describes the correct hand placement for applying a posterior-to-anterior (PA) mobilization to improve hip extension?
Which of the following describes the correct hand placement for applying a posterior-to-anterior (PA) mobilization to improve hip extension?
When performing mobilization with movement (MWM) to improve hip flexion, what is the MOST effective way to incorporate active patient participation?
When performing mobilization with movement (MWM) to improve hip flexion, what is the MOST effective way to incorporate active patient participation?
A therapist aims to improve a patient's hip flexion by applying an anterior-to-posterior (A/P) mobilization through the knee. What is the PRIMARY goal of this intervention?
A therapist aims to improve a patient's hip flexion by applying an anterior-to-posterior (A/P) mobilization through the knee. What is the PRIMARY goal of this intervention?
During palpation, a physical therapist notes increased warmth in a patient's hip region. While this finding warrants further investigation, which of the following conditions is MOST likely indicated by increased warmth?
During palpation, a physical therapist notes increased warmth in a patient's hip region. While this finding warrants further investigation, which of the following conditions is MOST likely indicated by increased warmth?
A patient presents with dry and cracked skin around the hip. What underlying condition should the therapist be MOST concerned about?
A patient presents with dry and cracked skin around the hip. What underlying condition should the therapist be MOST concerned about?
A physical therapist is evaluating a patient with suspected arterial insufficiency in the lower extremity. During palpation, which finding would be MOST indicative of this condition?
A physical therapist is evaluating a patient with suspected arterial insufficiency in the lower extremity. During palpation, which finding would be MOST indicative of this condition?
When palpating a patient's hip region, a physical therapist notes the absence of a pulse. What is the MOST appropriate immediate course of action?
When palpating a patient's hip region, a physical therapist notes the absence of a pulse. What is the MOST appropriate immediate course of action?
When incorporating a post-facilitatory stretch to address a tight iliopsoas, what is the MOST important stabilization point to ensure the stretch is isolated to the hip flexors?
When incorporating a post-facilitatory stretch to address a tight iliopsoas, what is the MOST important stabilization point to ensure the stretch is isolated to the hip flexors?
A physical therapist is preparing to perform a prone internal rotation mobilization to improve a patient's hip internal rotation. Which anatomical landmark should the therapist palpate to assess end range of motion?
A physical therapist is preparing to perform a prone internal rotation mobilization to improve a patient's hip internal rotation. Which anatomical landmark should the therapist palpate to assess end range of motion?
A patient exhibits limitations in hip internal rotation. Which mobilization technique combines active patient movement with therapist-applied joint mobilization to address this restriction effectively?
A patient exhibits limitations in hip internal rotation. Which mobilization technique combines active patient movement with therapist-applied joint mobilization to address this restriction effectively?
Following a thorough evaluation, a physical therapist determines that a patient's limited hip extension is primarily due to a tight iliopsoas muscle. Which intervention strategy would be MOST appropriate to address this specific impairment?
Following a thorough evaluation, a physical therapist determines that a patient's limited hip extension is primarily due to a tight iliopsoas muscle. Which intervention strategy would be MOST appropriate to address this specific impairment?
During soft tissue palpation, a physical therapist identifies trophic changes in the skin and underlying tissues of a patient's hip. Which findings would MOST strongly suggest a potential vascular compromise?
During soft tissue palpation, a physical therapist identifies trophic changes in the skin and underlying tissues of a patient's hip. Which findings would MOST strongly suggest a potential vascular compromise?
A patient reports hip pain that increases significantly with passive internal rotation. Which mobilization technique would be MOST appropriate to address this specific presentation?
A patient reports hip pain that increases significantly with passive internal rotation. Which mobilization technique would be MOST appropriate to address this specific presentation?
When applying sustained pressure on a trigger point, what observation would suggest proceeding with caution due to potential inflammation?
When applying sustained pressure on a trigger point, what observation would suggest proceeding with caution due to potential inflammation?
In the context of trigger point therapy, how does the duration of compression differ between active and chronic trigger points?
In the context of trigger point therapy, how does the duration of compression differ between active and chronic trigger points?
A physical therapist is designing a resistance training program for a patient recovering from a hip injury. If the primary goal is to enhance muscular endurance, which of the following loading parameters would be MOST appropriate?
A physical therapist is designing a resistance training program for a patient recovering from a hip injury. If the primary goal is to enhance muscular endurance, which of the following loading parameters would be MOST appropriate?
When prescribing flexibility exercises, what is the MOST crucial instruction to ensure effectiveness and safety?
When prescribing flexibility exercises, what is the MOST crucial instruction to ensure effectiveness and safety?
Which of the following exercise parameters is MOST appropriate for achieving hypertrophy?
Which of the following exercise parameters is MOST appropriate for achieving hypertrophy?
What is the MOST important consideration when prescribing therapeutic exercises for patients with hip intra-articular pathologies?
What is the MOST important consideration when prescribing therapeutic exercises for patients with hip intra-articular pathologies?
In the early rehabilitation phase following a hip injury, what is the primary purpose of incorporating muscle setting and isometric exercises?
In the early rehabilitation phase following a hip injury, what is the primary purpose of incorporating muscle setting and isometric exercises?
For a patient with hip osteoarthritis (OA), what is the MOST appropriate initial step in their management?
For a patient with hip osteoarthritis (OA), what is the MOST appropriate initial step in their management?
For a patient with hip osteoarthritis experiencing joint mobility limitations, which manual therapy technique would be MOST appropriate to begin with?
For a patient with hip osteoarthritis experiencing joint mobility limitations, which manual therapy technique would be MOST appropriate to begin with?
What is the recommended dosage for performing long-axis distraction with thrust manual therapy technique?
What is the recommended dosage for performing long-axis distraction with thrust manual therapy technique?
In the management of hip osteoarthritis (OA), when is it MOST appropriate to refer a patient to a nutritionist or dietitian?
In the management of hip osteoarthritis (OA), when is it MOST appropriate to refer a patient to a nutritionist or dietitian?
What is the recommended frequency and duration for manual therapy interventions in patients with mild to moderate hip osteoarthritis?
What is the recommended frequency and duration for manual therapy interventions in patients with mild to moderate hip osteoarthritis?
For a patient in the early-stage muscle activation phase of hip rehabilitation, what is the recommended Rating of Perceived Exertion (RPE) during exercise?
For a patient in the early-stage muscle activation phase of hip rehabilitation, what is the recommended Rating of Perceived Exertion (RPE) during exercise?
During hip rehabilitation, what is the MOST important consideration when progressing from single-joint to multi-joint motor control exercises?
During hip rehabilitation, what is the MOST important consideration when progressing from single-joint to multi-joint motor control exercises?
Following the acute phase of a hip flexor strain, which of the following exercises would be MOST appropriate to initiate tendon reloading?
Following the acute phase of a hip flexor strain, which of the following exercises would be MOST appropriate to initiate tendon reloading?
In the context of lumbar spine mobilization, which of the following mobilizations would MOST directly address limitations in extension?
In the context of lumbar spine mobilization, which of the following mobilizations would MOST directly address limitations in extension?
A patient presents with restricted hip internal rotation (IR). After performing a long axis distraction thrust, which of the following manual therapy techniques would be MOST appropriate to directly address the soft tissue restrictions contributing to this limitation?
A patient presents with restricted hip internal rotation (IR). After performing a long axis distraction thrust, which of the following manual therapy techniques would be MOST appropriate to directly address the soft tissue restrictions contributing to this limitation?
A patient is being treated for restricted hip extension. Which sequence of interventions would be MOST appropriate to address this impairment, progressing from initial mobility work to functional integration?
A patient is being treated for restricted hip extension. Which sequence of interventions would be MOST appropriate to address this impairment, progressing from initial mobility work to functional integration?
A patient presents with restricted hip abduction. After performing a long axis distraction thrust and soft tissue mobilization to the adductors, which of the following home exercise progressions would be MOST effective in regaining functional hip abduction strength and control?
A patient presents with restricted hip abduction. After performing a long axis distraction thrust and soft tissue mobilization to the adductors, which of the following home exercise progressions would be MOST effective in regaining functional hip abduction strength and control?
In managing FAI with mobility exercises, which intervention is MOST appropriate for directly addressing restrictions in hip flexion and internal rotation?
In managing FAI with mobility exercises, which intervention is MOST appropriate for directly addressing restrictions in hip flexion and internal rotation?
A patient post hip arthroscopy is 10 days post-op. They are WBAT with crutches. Which of the following exercises should be AVOIDED due to the risk of exacerbating hip flexor pain and potential complications?
A patient post hip arthroscopy is 10 days post-op. They are WBAT with crutches. Which of the following exercises should be AVOIDED due to the risk of exacerbating hip flexor pain and potential complications?
Following hip arthroscopy for FAI, a patient is in the 22-48 day post-operative phase and is now FWB. What exercise should be carefully progressed or potentially avoided due to its higher demand on hip flexor control and potential to exacerbate symptoms?
Following hip arthroscopy for FAI, a patient is in the 22-48 day post-operative phase and is now FWB. What exercise should be carefully progressed or potentially avoided due to its higher demand on hip flexor control and potential to exacerbate symptoms?
For a patient 50 days post-op following hip arthroscopy for FAI, who has progressed to full weight-bearing (FWB), which exercise would be MOST appropriate to introduce cautiously, monitoring for any signs of joint overload or pain exacerbation?
For a patient 50 days post-op following hip arthroscopy for FAI, who has progressed to full weight-bearing (FWB), which exercise would be MOST appropriate to introduce cautiously, monitoring for any signs of joint overload or pain exacerbation?
A patient with gluteal tendinopathy is being educated on load management. Which activity should be MOST emphasized as one to minimize due to its potential to compress the gluteal tendons against the greater trochanter?
A patient with gluteal tendinopathy is being educated on load management. Which activity should be MOST emphasized as one to minimize due to its potential to compress the gluteal tendons against the greater trochanter?
When initiating restorative loading exercises for gluteal tendinopathy, which exercise should be prioritized to gently activate the trochanteric abductors while minimizing tension on the iliotibial band?
When initiating restorative loading exercises for gluteal tendinopathy, which exercise should be prioritized to gently activate the trochanteric abductors while minimizing tension on the iliotibial band?
In the context of piriformis syndrome rehabilitation, at what point is it MOST appropriate to introduce weight-bearing strengthening exercises, such as squats and side steps with a theraband, following a period of isolated muscle recruitment?
In the context of piriformis syndrome rehabilitation, at what point is it MOST appropriate to introduce weight-bearing strengthening exercises, such as squats and side steps with a theraband, following a period of isolated muscle recruitment?
For a proximal hamstring strain, early-phase isometric exercises are recommended. Which positioning strategy is MOST crucial to minimize compression on the injured tendon and facilitate effective loading?
For a proximal hamstring strain, early-phase isometric exercises are recommended. Which positioning strategy is MOST crucial to minimize compression on the injured tendon and facilitate effective loading?
In Phase 2 of hamstring strain rehabilitation, which focuses on isotonic hamstring loading with minimal hip flexion, what is the PRIMARY rationale for incorporating heavy slow resistance training with both concentric and eccentric components?
In Phase 2 of hamstring strain rehabilitation, which focuses on isotonic hamstring loading with minimal hip flexion, what is the PRIMARY rationale for incorporating heavy slow resistance training with both concentric and eccentric components?
During Phase 4 of hamstring strain rehabilitation, which involves energy storage loading, what clinical sign indicates readiness for reintroduction of power and elastic stimulus to the myotendinous unit?
During Phase 4 of hamstring strain rehabilitation, which involves energy storage loading, what clinical sign indicates readiness for reintroduction of power and elastic stimulus to the myotendinous unit?
What is the MOST critical factor to consider when progressing a patient through post-operative rehabilitation following a total hip replacement?
What is the MOST critical factor to consider when progressing a patient through post-operative rehabilitation following a total hip replacement?
A patient is 7 weeks post-op following a hip arthroscopy. They exhibit a slight Trendelenburg sign during prolonged single-leg stance but otherwise demonstrate symmetrical range of motion and strength. According to the typical rehabilitation timeline, which phase should the patient be in and what is the MOST appropriate course of action?
A patient is 7 weeks post-op following a hip arthroscopy. They exhibit a slight Trendelenburg sign during prolonged single-leg stance but otherwise demonstrate symmetrical range of motion and strength. According to the typical rehabilitation timeline, which phase should the patient be in and what is the MOST appropriate course of action?
A patient who underwent a posterior approach total hip arthroplasty (THA) 3 weeks ago is being discharged from inpatient rehabilitation. Which of the following home exercise modifications is MOST crucial to prevent hip dislocation?
A patient who underwent a posterior approach total hip arthroplasty (THA) 3 weeks ago is being discharged from inpatient rehabilitation. Which of the following home exercise modifications is MOST crucial to prevent hip dislocation?
A patient is being treated following hip arthroscopy, which of the following signs or symptoms would MOST strongly suggest the patient is ready to progress from Phase 1 to Phase 2 of their rehabilitation program?
A patient is being treated following hip arthroscopy, which of the following signs or symptoms would MOST strongly suggest the patient is ready to progress from Phase 1 to Phase 2 of their rehabilitation program?
Which of the following signs or symptoms during functional activities would MOST strongly indicate the need to regress a patient from Phase 3 back to Phase 2 of hip arthroscopy rehabilitation?
Which of the following signs or symptoms during functional activities would MOST strongly indicate the need to regress a patient from Phase 3 back to Phase 2 of hip arthroscopy rehabilitation?
In the context of total hip arthroplasty (THA) rehabilitation with a posterior approach, which activity presents the HIGHEST risk of hip dislocation during Phase 1 (protection phase)?
In the context of total hip arthroplasty (THA) rehabilitation with a posterior approach, which activity presents the HIGHEST risk of hip dislocation during Phase 1 (protection phase)?
A patient is being treated following a hip arthroscopy and is in Week 6 of rehabilitation. They are demonstrating a normal gait pattern with no Trendelenburg sign during level walking. However, when performing single-leg squats, a mild Trendelenburg is observed on the surgical side. According to the typical hip arthroscopy rehabilitation protocol, what is the MOST appropriate course of action?
A patient is being treated following a hip arthroscopy and is in Week 6 of rehabilitation. They are demonstrating a normal gait pattern with no Trendelenburg sign during level walking. However, when performing single-leg squats, a mild Trendelenburg is observed on the surgical side. According to the typical hip arthroscopy rehabilitation protocol, what is the MOST appropriate course of action?
Which of the following scenarios BEST exemplifies the application of sensorimotor training principles during Phase 3 of hip arthroscopy rehabilitation?
Which of the following scenarios BEST exemplifies the application of sensorimotor training principles during Phase 3 of hip arthroscopy rehabilitation?
A patient is 4 weeks post-operative following a total hip arthroplasty (THA) via an anterior approach. They are progressing well with their rehabilitation but report feeling tension and discomfort in their hip during specific exercises. Which of the following movements should be approached with the MOST caution during this phase?
A patient is 4 weeks post-operative following a total hip arthroplasty (THA) via an anterior approach. They are progressing well with their rehabilitation but report feeling tension and discomfort in their hip during specific exercises. Which of the following movements should be approached with the MOST caution during this phase?
A high-level athlete is undergoing rehabilitation following a hip arthroscopy for a labral repair. They are currently in Phase 4 of their rehabilitation program. Which of the following is MOST important to consider when determining their readiness to return to sport?
A high-level athlete is undergoing rehabilitation following a hip arthroscopy for a labral repair. They are currently in Phase 4 of their rehabilitation program. Which of the following is MOST important to consider when determining their readiness to return to sport?
A patient who underwent a total hip arthroplasty (THA) 8 weeks ago is complaining of persistent groin pain and clicking in the hip joint during ambulation and certain movements. Radiographs rule out implant loosening or malalignment. Which of the following conditions should be considered as a potential cause of their symptoms?
A patient who underwent a total hip arthroplasty (THA) 8 weeks ago is complaining of persistent groin pain and clicking in the hip joint during ambulation and certain movements. Radiographs rule out implant loosening or malalignment. Which of the following conditions should be considered as a potential cause of their symptoms?
Which outcome would be LEAST expected following outpatient Total Hip Arthroplasty (THA) in patients with no significant comorbidities?
Which outcome would be LEAST expected following outpatient Total Hip Arthroplasty (THA) in patients with no significant comorbidities?
A patient who is 2 weeks post-op following a hip arthroscopy is limited to 50% weight bearing. What is the PRIMARY rationale for this weight-bearing restriction during this phase of rehabilitation?
A patient who is 2 weeks post-op following a hip arthroscopy is limited to 50% weight bearing. What is the PRIMARY rationale for this weight-bearing restriction during this phase of rehabilitation?
What is the MOST important distinction between the rehabilitation protocols for total hip arthroplasty (THA) and hip arthroscopy?
What is the MOST important distinction between the rehabilitation protocols for total hip arthroplasty (THA) and hip arthroscopy?
Following hip arthroscopy, a patient reports feeling a pinching sensation in their hip joint during certain movements. What is the MOST likely cause of this sensation?
Following hip arthroscopy, a patient reports feeling a pinching sensation in their hip joint during certain movements. What is the MOST likely cause of this sensation?
A patient is in Phase 2 of rehabilitation following a hip arthroscopy. The patient is progressing well, but the therapist notices she is compensating during gait. What is the MOST appropriate way for the therapist to cue the patient to improve her gait mechanics?
A patient is in Phase 2 of rehabilitation following a hip arthroscopy. The patient is progressing well, but the therapist notices she is compensating during gait. What is the MOST appropriate way for the therapist to cue the patient to improve her gait mechanics?
Flashcards
Flat Palpation
Flat Palpation
Using the flat pads of fingers to touch and assess tissue, best for broader muscles.
Pincer Palpation
Pincer Palpation
Using thumb and index finger to grip and assess tissue, best for rounder muscles.
Active Trigger Point
Active Trigger Point
A point within a taut band of muscle that produces familiar pain upon palpation.
Latent Trigger Point
Latent Trigger Point
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Submaximal Contraction for Trigger Points
Submaximal Contraction for Trigger Points
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Static Stretching
Static Stretching
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Cyclic Stretching
Cyclic Stretching
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Ballistic Stretching
Ballistic Stretching
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Hold-Relax (PNF)
Hold-Relax (PNF)
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Agonist Contraction
Agonist Contraction
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Hip Longitudinal Distraction
Hip Longitudinal Distraction
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Hip Inferior Glide
Hip Inferior Glide
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Hip Joint Mobilization
Hip Joint Mobilization
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Mobilization with Movement (Abduction)
Mobilization with Movement (Abduction)
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Mobilization with Movement (Flexion)
Mobilization with Movement (Flexion)
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Mobilization with Movement (Internal Rotation)
Mobilization with Movement (Internal Rotation)
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Improving Hip Extension
Improving Hip Extension
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Improving Hip Flexion
Improving Hip Flexion
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Improving Hip Internal Rotation
Improving Hip Internal Rotation
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Increased Warmth (Palpation)
Increased Warmth (Palpation)
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Decreased Warmth (Palpation)
Decreased Warmth (Palpation)
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Increased Moisture (Palpation)
Increased Moisture (Palpation)
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Loss of Moisture (Palpation)
Loss of Moisture (Palpation)
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Trophic Changes (Palpation)
Trophic Changes (Palpation)
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Pulse Evaluation (Palpation)
Pulse Evaluation (Palpation)
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Pelvic Oscillation Technique
Pelvic Oscillation Technique
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Soft Tissue Massage for Hip
Soft Tissue Massage for Hip
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Long-Axis Hip Distraction
Long-Axis Hip Distraction
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Anteroposterior Hip Glide
Anteroposterior Hip Glide
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Posteroanterior Hip Glide
Posteroanterior Hip Glide
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Active vs. Latent Trigger Point
Active vs. Latent Trigger Point
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Submaximal Contraction
Submaximal Contraction
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Trigger Point Treatment Duration
Trigger Point Treatment Duration
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Flexibility Training Frequency
Flexibility Training Frequency
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Static Stretch Duration
Static Stretch Duration
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Strength Training Parameters
Strength Training Parameters
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Hypertrophy Training Parameters
Hypertrophy Training Parameters
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Muscular Endurance Training Parameters
Muscular Endurance Training Parameters
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Early Rehab: Muscle Setting/Isometrics
Early Rehab: Muscle Setting/Isometrics
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Early Rehab: AROM
Early Rehab: AROM
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Treatment of Hip OA
Treatment of Hip OA
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Flexibility for Hip OA
Flexibility for Hip OA
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Hip OA Management
Hip OA Management
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Hip OA: Long-Axis Distraction
Hip OA: Long-Axis Distraction
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Early-Stage Muscle Activation
Early-Stage Muscle Activation
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Manual Stretch Dosage
Manual Stretch Dosage
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Lumbar Unilateral PA Glides
Lumbar Unilateral PA Glides
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Passive Lumbar Rotation
Passive Lumbar Rotation
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Long Axis Distraction Thrust
Long Axis Distraction Thrust
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Adductor STM for Abduction
Adductor STM for Abduction
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STM for Hip Extension
STM for Hip Extension
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STM Gluteals for IR
STM Gluteals for IR
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Exercises for Restricted Hip ER
Exercises for Restricted Hip ER
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Exercises for Restricted Abd
Exercises for Restricted Abd
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Exercises for Strengthening Knee Extensors
Exercises for Strengthening Knee Extensors
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Exercises for Functional Balance
Exercises for Functional Balance
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Exercises for Lumbar Spine Mobility
Exercises for Lumbar Spine Mobility
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Total Hip Replacement
Total Hip Replacement
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Gluteal Tendinopathy Treatment
Gluteal Tendinopathy Treatment
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Hamstring Phase 1: Isometrics
Hamstring Phase 1: Isometrics
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Total Hip Replacement (THR)
Total Hip Replacement (THR)
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Posterior THR Precautions
Posterior THR Precautions
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Anterior THR Precautions
Anterior THR Precautions
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Abduction Pillow
Abduction Pillow
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Hip Arthroscopy
Hip Arthroscopy
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Flexion Limit (Post-Arthroscopy)
Flexion Limit (Post-Arthroscopy)
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Weight-Bearing Status (Post-Arthroscopy)
Weight-Bearing Status (Post-Arthroscopy)
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Pinching (Hip)
Pinching (Hip)
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Trendelenburg Sign
Trendelenburg Sign
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Phase 3 Goals (Hip Rehab)
Phase 3 Goals (Hip Rehab)
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Phase 4 Goals (Hip Rehab)
Phase 4 Goals (Hip Rehab)
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Independent ADL's (Phase 2)
Independent ADL's (Phase 2)
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Phase 2 THR Goals
Phase 2 THR Goals
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Labrum Repairs
Labrum Repairs
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Pre-operative Phase
Pre-operative Phase
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Study Notes
Hip Manual Therapy
- Manual therapy techniques can be integrated into the intervention approach
- Examination findings guide the selection of manual therapy techniques
Hip Longitudinal Distraction
- This is used primarily for pain relief
- Can be performed with a sustained contraction or a grade one or two mobilization
Inferior Glide
- This is also called a “distraction”
- Can be performed with the hip and knee at 90 degrees
- Isolates movement at the hip, avoiding movement through the ankle and knee
- It is important for patients with comorbidities at the knee or ankle
Hip Joint Mobility
- Place the patient’s limb in open packed position, which is flexion, abduction, and external rotation
- Add lateral traction before applying anterior-posterior mobilization
- Posterior-anterior mobilization involves stabilizing hand on the distal femur and moving arm inferior to the gluteal fold with the leg in extension
Mobilization with Movement for Abduction
- This aims to increase abduction range of motion
- The therapist applies a glide in the direction that decreases the patient’s pain most
- The therapist needs to figure out which direction of glide helps to decrease that pain most and then mobilizes back and forth or sustains the mobilization
Mobilization with Movement for Flexion
- This exercise aims to increase flexion range of motion
- Therapist controls motion of the limb (passive flexion ROM) while performing the inferior glide using a belt
- Combines active contraction, allowing the patient to flex the hip while therapist applies the inferior glide with the belt
Mobilization with Movement for Internal Rotation
- Includes an active therapist, does not control the motion, so it is active from the patient
- Internal rotation with an inferior or an inferior lateral glide
Improving Hip Extension
- Theee techniques used
- Hip includes long distraction mobilization and manipulation
- Hip extension with overpressure
- Apply posterior to anterior glide at the inferior gluteal fold
- Post facilitatory stretch iliopsoas
- Use contract relax method to lengthen the iliopsoas
- Stabilize at Anterior Superior Iliac Crest, patient will contract against your resistance for 5 seconds then follow up with the patient relaxing, and you stretching the iliopsoas
Improving Hip Flexion
- Hip long Distraction Mobilization and Manipulation
- Hip Flexion Mobilization with Movement
- Can incorporate an active hip flexion or passive hip flexion
- Hip A/P Mobilization through the Knee
- Therapist uses sternum to provide an anterior posterior force through the knee to the hip.
- Intended to improve hip posterior capsule mobility and restore proper arthrokinematics at the acetabulo-femoral joint
Improving Hip Internal Rotation
- Use hip Long Distraction Mobilization and Manipulation
- This helps with pain relief
- Use prone Internal Rotation Mobilization
- Passively internally rotate the affected hip while feeling at the posterior superior iliac spine for the end range of motion (ROM)
- Hold the leg at end range of internal rotation and apply a posterior to anterior force at the PSIS
- Hip Internal Rotation with Mobilization
- Therapist can mobilize with an inferior or inferior lateral motion through the hip using the belt
Introduction to Soft Tissue Mobilization
Objectives
- Understand the fundamentals of soft tissue palpation for pathology
- Understand when soft tissue mobilization is necessary
- Apply these concepts to physical therapy examination
- Apply these concepts to physical therapy
Palpation for Pathology
What are we looking for?
Temperature
- Light superficial touch
- Increased warmth could indicate infection or DVT
- Decreased warmth could indicate decreased blood flow (obstruction)
Moisture
- Light touch
- Increased moisture could indicate: Infection Open wound (e.g. chronic venous insufficiency leads to ulceration)
- Loss of moisture on the skin could indicate Arterial insufficiency
- Dry and cracked skin could indicate a risk of diabetes
Texture
- Starts with light touch on surface of skin, but deeper into the skin allows for examination of the muscles to feel trophic changes
- Trophic changes include texture and tone
- Skin changes include hair raised, hair loss, “goosebumps” which may indicate there not enough blood flow to the area
- Hypertrophy and Atrophy should always be compared to the other side
Pulses
- Check if they are absent or present
- If present then there is blood flow to the area
- Palpation for decreased pulses helps you look at what other testing needs to be done such as a Doppler ultrasound
- Refer out because there may be some blockage
- Pulse evaluation scale should be used to give more information on the type of pulse being felt, is it bounding or is it weak
Types of Palpation
Flat palpation
- Use pads of fingers touching the tissue
- This is used for flat muscles like quads and hamstrings
Pincer palpation
- Similar to a lumbrical grip between the index and thumb finger and holding the tissue between them
- This is used for rounder muscles like biceps or SCM Muscles
Palpation for Pathology – Trigger Points
- For trigger point effective technique for treatment is soft tissue palpation to find the trigger point and feel for a taut band (point of patient’s pain)
- Flat palpation versus pincer grip palpation
- Ask the patient to identify if the pain is familiar or unfamiliar
- Familiar means it is an active trigger point
- Unfamiliar means it is a latent trigger point
- Treat by starting at submaximal contraction by applying 2-4 lbs light pressure
- Ask patient to meet the pressure you are applying
- Patient contracts their muscles against your resistance simultaneously, and applying compression for the analgesic effect
- Try to stop blood flow to the area
- Sink deeper into trigger point for a further 30 seconds
- Treat acute pain for one minute and chronic pain for 3-5 minutes
Types of Stretching
Static
- Constant external force
- Static progressive stretching incorporates moving into newly gained range as the muscle relaxes
Cyclic (intermittent) stretching
- Low velocity stretch, then release, then stretch again in cyclic manner (minimal evidence that cyclic stretching causes muscles to yield more readily in young healthy individuals)
Ballistic
- Rapid forceful intermittent stretch
- Effective in young, healthy individuals
- Can only be utilized when it is specific to a sport or task that requires high velocity movements into tissue stretch
PNF (proprioceptive Neuromuscular Facilitation)
- This is is the Integration of active muscle contractions into stretching
- Provides Greater gains than static stretching
Hold-relax/contract-relax
- Target muscle is activated isometrically (5-6 seconds) at its end-range and then passively stretched (~10 seconds); this is repeated for several cycles
- More effective than static stretching
Agonist contraction
- Activation of the muscle opposite the shortened muscle (i.e., quads if hamstrings are short); concentrically activate muscle and hold for several seconds for several cycles (picture popliteal angle position hamstring stretch using quads to create the stretch)
- Mixed evidence when compared to static stretching
Hold-relax with agonist contraction
- Hold-relax technique followed by agonist contraction
Hip Manual Therapy
Objectives
- Describe indications for integrating soft tissue mobilization techniques into the intervention approach
- Analyze patient findings from the examination to select soft tissue mobilization techniques
Soft Tissue Mobilization
4 examples of soft tissue mobilization
- Adductor
- Hamstring
- Iliopsoas
- Tensor fasciae latae
- Techniques can be applied to any muscle that has some sort of hypertrophy, trigger points, or spasms
Concepts to take into account
- Confirm that you’re on the muscle so the patient can perform submaximal contraction of the muscle so you know you are on the correct tissue
- Soft tissue mobilization can then be applied parallel to the muscle or perpendicular to the muscle
- Palpate to find the trigger point, which feels like a taut band under your hand
- Can perform a flat palpation, which is all five fingers flat or four fingers flat
- Looking for flatter muscles such as hamstrings or adductors
- Palpate using a pincer grip which is good for muscles that are rounder such as and SCM muscles
- First ask the patient if the pain they feel when you get the top band and you palpate is familiar, If familiar, it indicates it is an active trigger point
- One of the activating reasons for the pains they’re feeling actively at this time If unfamiliar, it is a latent trigger point, which is something that is dormant but if activated or palpated, it causes them pain
- Ask patient to contract for treatment by administering very little pressure of about 2-4 lbs and for 5-6 seconds then release
- If trigger point is active, perform technique for one minute because it can feel inflammatory to the pain at the beginning and if the trigger point is chronic, do technique for three to five minutes
Hip Therapeutic Exercise
Objectives
- Identify and apply therapeutic exercises for hip impairments
Flexibility Training Guidelines
- Perform 2-4 repetitions per muscle group
- Perform these 2-3 days per week with greater gains with higher frequency
- Static stretches should be taken to point of mild discomfort for at least 10-30 seconds
- Each muscle group should be stretched for at least 60 seconds
Resistance Exercise Dosing
Training Goal Strength
- Load greater than 85%
- Goal repetitions should be less than 6
- Goal sets between 2-6
- Rest interval between 2-5 min
- Power: Single Event
- Load 80-90%
- Goal repetitions between 1-2
- Goal sets between 3-5
- Rest interval between 2-5 min
- Power: Multiple Events
- Load 75-85%
- Goal repetitions between 3-5
- Goal sets between 3-6
- Rest interval between 2-5 min
- Hypertrophy
- Load 67-85
- Goal repetitions 6-12
- Goals sets 3-6
- Rest interval between 30-90 seconds
- Muscular Endurance
- Load less than 67%
- Goal Repetitions should be greater than 6-12 repetitions
- Goal sets should be between 2-3 sets
- Rest interval should be less than 30 seconds
Exercise Dosing for Early Rehab
- Muscle setting, isometrics, should be held for 6 seconds each
- Perform AROM for 30 seconds
- Perform early-stage muscle activation at > 12 reps or Motor control at > 12 reps
- Muscle setting and isometrics should be done for 1 set, AROM for 2 sets, and Early-stage muscle activation for 1-3 sets
- Load for Muscle setting is none, for isometrics, can vary
- The load for AROM is none, the load for Early-stage muscle activation is up to 45-50% of 1RM RPE 2-4 (easy/moderate) and for Motor control NegligibleRPE < 3 (easy)
- Rest between sets for Muscle setting and Isometrics should be 10s rest between reps, AROM is not applicable, and Early-stage muscle activation should be 1 minute
- Purpose of Muscle setting and isometrics is muscle recruitment to maintain fiber mobility and stability
- The purpose of AROM is Active mobility for edema management including facilitating muscle fiber mobility
- The purpose of Early-stage muscle activation is to promote tissue healing
- The purpose of Motor control is to activate muscles for appropriate movement patterns
- Complexity of Muscle setting and isometrics involves a single muscle/joint
- The complexity of AROM involves a single joint. Early-stage muscle activation involves a single muscle/joint
- Complexity of Motor control may be single or multi-joint
Types of Exercise
- Resistive motion
- Mobility
- Motor coordination
- Functional movement
- Tendon reloading
Hip Intra-Articular Therapeutic Exercise
Objectives
- Describe indications for prescribing therapeutic exercises for patients with intraarticular hip pathologies
- Analyze patient findings from the examination to select appropriate therapeutic exercises
- Progress therapeutic exercise based on knowledge of exercise principles and patient response
Hip Osteoarthritis (OA)
Management for Hip OA includes
- Patient education
- Activity modification
- Exercise
- Supporting weight reduction when overweight
- Methods of unloading the arthritic joints
- Functional gait/balance training
- Impairment-based functional, gait and balance training including use of assistive devices
- Manual therapy for patients with mild to moderate hip osteoarthritis and impairments of joint mobility, flexibility and, or pain
- Thrust, non thrust and soft tissue mobilization
- Perform 1-3 time per week over 6 to 12 weeks
- Exercises to improve hip motion with exercises for Flexibility Strengthening
Endurance
- Perform 1-5 times per week over 6-12 weeks
- Weight loss with referrals and collaboration as needed to physicians, nutritionists, or dietitians to support weight management plan
- Modalities such as Ultrasound may be used in addition to exercise for short-term pain and activity limitation management for up to 2 weeks
Hip OA Treatment – Manual Therapy
Manual therapy techniques include mandatory and optional techniques
Mandatory Techniques
- Long-axis distraction with thrust, done in Supine with hip in 15-30 degrees of flexion, 15-30 degrees of abduction, slight external rotation preferring to use a seat belt
- Perform 3-6 thrusts at the beginning of the first set, then perform oscillations in the remaining sets
- The Dosage is 3-6 sets of 30s each
- Seatbelt glide, or distraction mobilizations with hip flexed patient should be supine and using a seatbelt
- Oscillatory passive accessory mobilization forces applied caudally or laterally to the proximal thigh with a Dosage of 3-6 sets of 30s each
- Internal rotation in prone position prone with knee flexed, internally rotate until contralateral pelvis rises, apply oscillatory force downward to contralateral pelvis
- The Dosage is 3-6 sets of 30s each
- Soft tissue or deep tissue massage of quadriceps, adductors, hamstrings, psoas, lateral hip muscles, or posterior hip muscles and associated fascia using a firm effleurage stroke, deep frictions or sustained pressure trigger point release with the muscle on stretch
- The Dosage for these massages is 2-5 min
Optional techniques
- Long-axis distraction in prone position with patient prone and hip in 10-15 degrees of abduction preferring to use a seat belt
- Perform caudally directed oscillations, may perform 3-6 thrusts at the beginning of the first set with Dosage of 3-6 sets of 30s each
- Anteroposterior progression (posterior glide) with patient supine with hip in flexion and adduction using body weight to impart passive oscillations to the posterolateral hip capsule through the long axis of the femur in for 3-6 sets of 30s
- Add more flexion, adduction, or internal rotation to progress mobilization
- Posteroanterior progression (anterior glide) with patient prone with knee bent and leg supported at knee (may use seatbelt) Apply Pressure inferior and medial to greater trochanter in posterior to anterior direction
- Vary the amount of hip flexion and extension, abduction and adduction, and internal and external rotation with applying pressure for 3-6 sets of 30s
- Manual stretches with 6 reps x 20s, 4 reps x 30s, 2 reps x 60s should be felt in target muscle should match the soft or deep tissue massage technique selected
- Lumbar spine mobilization Dosage is 3-6 sets of 30s of Unilateral posteroanterior accessory glides, Passive physiological lumbar spine rotation, Lumbar spine manipulation (supine) and Lumbar spine manipulation (side lying with affected hip up)
Hip Treatment – Impairment Based Treatment
Restricted hip flexion
- Core muscle testing technique Includes a long axis distraction thrust
- Distraction in hip flexion-inferior glide STM hamstrings
- STM TFL/rectus femoris/gluteals
- Core home exercise
- Includes Hamstring stretch Prayer stretch, Single knee to chest, Anterior posterior glide
- Hamstring stretch
Additional MT technique
- Anterior posterior glide
- Hamstring stretch
- Additional home exercise, which includes Hip flexor/quadriceps stretch
Key points
Restricted hip extension:
- Long-axis distraction thrust
- IR in prone position
- STM rectus femoris/quadriceps/TFL
- Core home exercise: Hip flexor/quadriceps stretch; quadriceps strengthening level 3+; functional drill-side stepping
- Additional MT technique: long axis distraction in prone position; posterior anterior (anterior) glide; stretches psoas/TFL; stretches rectus femoris/quadriceps; figure-4 stretches in prone position
- Additional home exercises: Hip flexor/quadriceps stretch; Figure-4 stretch in prone position; Hip extensor strengthening
Restricted hip ER:
- Long axis distraction thrust
- Distraction in hip flexion-lateral glide
- STM adduction
- STM TFL
- Core home exercise: Faber stretch; Figure-4 stretch supine; Figure-4 stretch sitting; 4 point knee IR/ER
Restricted hip IR:
- Long axis distraction thrust
- Distraction in hip flexion-lateral glide
- IR in prone position
- STM gluteal/ER
- Core home exercise: standing IR stretch; prone IR stretch; 4 point knee IR/ER
- Additional MT technique: long axis distraction in prone position; stretch ER
- Additional home exercise: standing IR stretch; prone IR stretch; 4-point knee IR/Er and Hip IR strengthening
Restricted Hip abduction:
- Long axis distraction thrust
- Distraction in hip flexion lateral glide
- STM adduction
- Core home exercises Faber stretch and Figue-4 stretch supine, as well as functional drill side stepping
Restricted hip adduction:
- Long axis distraction thrust
- Distraction in hip flexion
- STM TFL
- AP (posterior) glide
- Strengthening hip abduction
- Core home exercises such as supine hip abduction and standing hip abduction, as well as side lying hip abduction or standings leg wall press
Strengthening knee extensors:
- Leg press or knee extension through range
- Partial squats
- Partial wall squats
- Sit to stand
- Split sit to stand or wall squat
Strengthening hip extensors:
- Quadriceps strengthening exercise – level 2+
- Supine gluteal sets
- Supine bridging
- Supine unilateral bridging
Strengthening hip ER:
- Quadriceps strengthening exercise – level 3+ with ER
- Clamshells
- Clamshells with resistance
- Standing leg wall press
Impaired
- Functional balance/proprioception/gait
- Core home exercises; choose 2 from:
- Standing weight shifts
- Level 1- forward and lateral weight shifts – eyes open
- Level 2- forward and lateral weight shifts – eyes closed
- Level 3- tandem stance weight shifts – eyes open
- Level 4- tandem stance weight shifts – eyes closed
- Level 5- standing hip control
- Level 6- standing eccentric hip abduction or standing ER
- Level 1- double-leg stance on foam
- Level 2- single-leg stance
- Level 3- single leg stance on soft surface side stepping
- Level 1- side stepping
- Level 2- side stepping with obstacles
- Level 3- carioca shuttle walking stairs
Extra home exercises
- Lumbar spine mobility
- Lumbopelvic exercises
Femoracetabular Impingement Syndrome (FAI)
- Both therapy, manual, and exercises or surgery, the outcomes were the same
- No difference in outcome if the patient had surgery or if they had therapy and surgery
Hip Arthroscopy for FAI Rehabilitation
0-7 days post-op
- Must use crutches for stability, do not push through hip flexor pain
- Check wound for wound Check for erythema/abnormal temperature/excessive effusion/drainage
- Stationary bike
- Seated piriformis stretch
- Glute/quad/HS/TRA isometrics
- Passive ROM series to include Circumduction
- Non-affected single leg raise, Circumduction knee bent
- Hip flexFABER, Klong axis abductionPassive supine roll
- Prone Series for IR and ER, as well as Knee flex
- Modalities- Game ready/ice and elevation
- Goals are to protect healing tissue, Restore ROM, Diminish pain/inflammation, Prevent muscular inhibition
8 days to 21 days post-op
- Must use crutches for stability, No ballistic/forced stretching
- Begin scar massage when incision site re-epithelializes
- Exercises include Double leg hip rotations and Quadruped rocking as well as Standing hip IR on stool, heel slides, and hip abduction/adduction isometrics
- Uninvolved knee to chest, IR/ER Begin standing AROM when patient can demonstrate symmetrical WB w/out assistive device includes Double leg romanian deadlift Double leg pelvic circles, and Lateral weight shift with overhead reach
- Clam shell and Hip 3-way should be started on post-op day 15
- Modalities - Game ready/ice and elevation
- Goal is to to protect repaired tissue, Restore ROM/normal gait pattern, and Progressive increase in strength
22 days to 48 days post-op
- Patient now at FWB and and is free from ballistic/forced stretching as well as from treadmill and contact activities
- continue scar massage as well as the the previous exercises and adduction
- Begin standing figure 4 stretch on post-op day 29, as well as Prone FABER position self-mobs and Dyna-disc single leg Side plank and Standing hip IR (stool) Begin Manual long axis distraction with and Single leg on post-op day 36
- By post op dat 42 begin Elliptical as well as Single leg trunk rotation with band Side stepping, and Lateral step-down with heel hover, push-off at ends
- Goals include Restore muscle endurance and strength, Restore cardiovascular fitness, Restore balance/proprioception
49 days post-op
- Patient is FWB and is free from all precautions
- Lunge exercises as well as Hurdles with slow speeed are incorporated, as well as carioca SLOW speed and forward double and lateral hop
- Agilities include plank to push up start and Side step with band
- If patient is good to go by post op dayy 55 the patient may perform Multi directional lunges and medium hurdle
- Goals for patient is Full range of motion as well as sport specific movement
FAI Management - Mobility Exercises
FAI Management - Self Mobs
- Quadruped rock self mobs with lateral direction
- Standing figure-4 stretch
FAI Management - Myofascial Release
- Piriformis and glut min self myofascial release on ball
- Quadriceps soft tissue on foam roll
- Piriformis and glut min self myofascial release on ball
FAI Management - Motor Control Exercises
- Lateral step down with heel hover
- Isolateral romanian deadlift with dowel
- Side plank
- Supine hip flexion with theraband
Extra-Articular Therapeutic Exercise
Extra-Articular Diagnosis Training
Gluteal Tendinopathy (Greater Trochanteric Pain Syndrome)
Goals of Gluteal Tendinopathy Treatment
- Minimize tendon stretch
- Restorative loading for Isometrics and tensile loading
The 2 Main Exercise Types Recommended for Gluteal Treatment
- Low load isometric abduction, and High load low velocity abduction
- The goal is to gently activate and relax trochanteric abductor/iliotibial band
Piriformis Syndrome
Phases as followed:
Piriformis Syndrome Phase 1
- Isolated muscle recruitment Nonweight bearing exercises utilizing Bilateral bridge with theraband and clapshell
Piriformis Syndrome Phase 2
- Weightbearing strengthening at 4-9 weeks
- Squat with theraband
- Side-step with theraband Single-limb sit to stand
- Step down
Piriformis Syndrome Phase 3
- Functional training at 9-14 weeks
- Forward lunge
- Lunge at 45 degrees
- Double limb jumps/lands
- Double limb jump/single limb land
Hamstring Strain Stages
Hamstring Strain Phase 1
- It is recommended that you start with Isometric Exercises in positions that does not allow tendon compression for effective loading
- A good prognostic sign for isometrics is an immediate reduction in pain with hamstring loading test after the exercise
- Perform a Single leg bridge hold, Straight leg pull down Bridge , and Long lever hold
Hamstring Strain Phase 2
- In this phase Isotonic Hamstring Load with can begin with Minimal Hip Flexion, to Aim to restore hamstring Strength ,bulk and capacity in a functional range of motion
- Exercise include a Nordic hamstring exercise and a Bridging Progression as well as supine and prone leg curls
Hamstring Strain Phase 3
- The Goal is to continue hypertrophy annd load functional position training, perform exercise where there is hip flexion
- Training can be commenced when there is minimal pain with Visual analog scale 0-3 with higher loading hip flexion tests
- Exercise includes, Romanian deathlift and step ups as well as single legged deadlift
- Hamstring Strain Phase 4 For those going into high activity to reintroduce elastic stimulus for the Muscotendious unit
Post-Operative Management
- Goals
- Progress rehabilitation with guidelines that address both the healing time frames and patient response
Surgical Procedures
- Total Hip replacement
- Hip arthrocope
Total Hip Replacement
- The surgery involves an implantation or a prosthetic hip joint to replace the degenerative or non-functional joint
Total Hip Replacement rehabilitation is in three phases
Protect, Load and Function
Pre-operative Phase
- Can be up to 2-3 weeks prior to the surgical appointment, during this time the patient should be prepared for the recovery process.
Phase 1
- Goals To Prevent complications such as DVT during week 0-6, increase function as well as to improve weight bearing and mobility as patient is comfortable
- Patient will be asked no to cross the leg
- If any procedure is to happen at the posterior side of a patient, make sure the patient doe NOT surpass hip Flexion range past 90°
- Anterior surgical approach is not as cautionary as with posterior
Phase 2
- Progressive Loading goal week 6-10 is to Normalize gait with least restrictive assistive device for independence
- You also want to increase strength and mobility of surgical leg
Phase 3
- Functional Sensor motor Training goal. week 10-16 aims to create independent with all activities and progressive strengthening and range of motion
Conclusion
- Patient out comes in surgery vary depending on age or comorbidity
- Most patients have positive effect and surgery rate is low
- Hip Arthroscope
Hip Arthroscopy
The process of labrum repair is done through visual incision surgery and has a successful rate
Hip Arthrocope rehabilitation steps or phases
Phase 1 Weeks 1-4 of protection
- Goal to reduce pain and risk of infection
- Restore muscle as patient may start to lose strength
- Exercise as to patient standards
- Caution limit Flexion up to 90° and abduction up to 25, and extension up to 10°
Phase 2 Load Progress
- Week 4-7 goals are to have to have a steady symmetric pattern and to regain balance and ROM also to initiate function
- Be sensitive when testing to pay attention if patient has sudden pain, it indicates that they are pushing to hard and exercise has to stop
Phase 3 Functioning
Week 7-10 goals are to regain a full balanced symmetric range of motion and if there is any pain to follow procedure from Phase 2
Phase 4 Job Specialization
12+ weeks goal is for patient to regain all muscle memory to perform high impact functions and to train on a high rep load for a long duration
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