Exam 3: The Hip Flashcards
What are possible pathomechanics found in the hip region
decreased flexibility
asymmetrical leg length
hip muscle imbalances and their effects
What are possible causes of asymmetrical leg lengths
unilateral short leg
coxa valga and coxa vara
anteversion and retroversion
A person with a unilateral short leg will cause a pelvic ____ and sends the (thoracic/lumbar) spine into a side bend
tilt; lumbar
If a person has an anterior pelvic tilt, what muscles could be tight?
hip flexors and low back extensors
If a person has an anterior pelvic tilt, what muscles could be over stretched?
Abs and hamstrings
If a person has a posterior pelvic tilt, what muscle could be tight
abs and hamstrings
If a person has a posterior pelvic tilt, what muscles could be over stretched
hip flexors and low back extensors
Which muscle groups of the hip are important to function during gait
flexors, extensors, and abductors
Which muscle group is important to function during initial contact to limit hip extension
hip flexors
Why do the hip flexors need to function during gait
They are needed for IC to limit hip extension
Which muscle group is important to function during stance phase and initial contact to control the hip as we load
hip extensors
Why do the hip extensors need to function during gait
They are needed for initial contact and stance phase to control the hip as we load
Which muscle group is important to function during gait, especially during single limb stance to keep the pelvis neutral instead of dropping to one side
Hip abductors
Why do the hip abductors need to function during gait
They are needed in single limb stance to keep the pelvis neutral instead of dropping to one side
If a patient’s pelvis drops to onside during single limb stance instead of remaining in a neutral position (Trendelenburg’s) which muscle group is probably at fault
hip abductors
Which 3 nerves of the hip are subject to injury or entrapment
sciatic nerve
femoral nerve
obturator nerve
The sciatic nerve will be entrapped from the _____ muscle, causing pain to go down most of the leg
piriformis
Which nerve runs through the piriformis, often getting entrapped by this muscle and causing pain to run through the leg
sciatic
The femoral nerve runs (anterior/posterior) to the hip and is often injured from a femoral or pelvis fracture.
anterior
How is the femoral nerve commonly injured? Remember that it runs anterior to the hip
A femur or pelvis fracture
Which nerve runs anterior to the hip and can be injured if a femoral or pelvis fracture occurs
femoral
How is the obturator nerve usually injured?
In females that are giving birth
Which nerve is most likely to get injured in females that are giving birth
obturator nerve
What are the common sources of referred paid in the hip and buttock region
nerve roots L1-L3, S1-S2
Lumbar intervertebral and SI joints
What are some pathologies that could be related to joint hypomobility of the hip that do no need surgical management
osteoarthritis
degenerative changes
post immobilization
What are some examples of degenerative changes in the hip that would cause joint hypomobility
aseptic necrosis
slipped epiphysis
dislocations
congenital deformities
What is aseptic necrosis
bone death of the femoral head
When would a patient have a slipped epiphysis
adolescents and young males during times of accelerated growth
What is slipped epiphysis
the femoral head slips in and out of place at the growth plate
What are some common impairments of body structure and function at the hip relating to hypomobility (Hint: There’s 6 possible reasons)
pain in groin and anterior thigh to knee stiffness after rest limited motion with a firm end feel antalgic gait limited hip extension impaired balance and postural control
Which common impairment of body structure and function relates to true hip joint pain
pain in groin and anterior thigh to knee
Which common impairment of body structure and function relates to patients with arthritis
stiffness after rest
what is antalgic gait
painful gait
Common activity/functional limitations and participation restrictions in patients with joint hypomobility include pain with WB activities, cleaning, shopping - especially at the end of the day. Would this be considered during the early or progressive stage of degeneration
early
Common activity/functional limitations and participation restrictions in patients with joint hypomobility include difficulty rising from a chair, climbing stairs, squatting, bathing, and dressing. Would this be considered during the early or progressive stage of degeneration
progressive
What are common activity/functional limitations and participation restrictions of a patient with hip joint hypomobility in the early stage of degeneration
pain with WB activities, cleaning, shopping - especially at the end of the day.
What are common activity/functional limitations and participation restrictions of a patient with hip joint hypomobility in the progressive stage of degeneration
difficulty rising from a chair, climbing stairs, squatting, bathing, and dressing.
During the protection phase, what are three goals that a clinician would have for their patient in treating joint hypomobility in the hip
decrease pain at rest
decrease pain during weight bearing activities
decrease effects of stiffness and maintain available motion
During the protection phase, how would a clinician decrease hip pain at rest
low grade joint mobilizations
During the protection phase, how would a clinician decrease pain during weight bearing activities
use assisted devices
adapt seating surfaces
During the protection phase, how would a clinician decrease effects of stiffness and maintain available motion
ROM exercise
aquatic therapy and non impact activities
During the controlled motion and return to function phases, how would a patient improve joint tracking and pain free motion
increase IR, flexion, extension and increase extension during WB activities
During the controlled motion and return to function phases, how would a patient improve muscle performance in supporting muscles
neuromuscular facilitation with muscle setting, and strengthening exercises progressing to functional activities and balance then low impact exercise program
What are examples of painful hip syndromes and overuse syndromes that do not require operative management
tendonitis/muscle strain
trochanteric bursitis
psoas bursitis
ischiogluteal bursitis
____ bursitis occurs with excessive flexion and can be paired with a popping or clicking sound
psoas
psoas bursitis occurs with excessive (flexion/extension)
flexion
What is another name for ischiogluteal bursitis
tailor’s or weaver’s bottom
Tailor’s or weaver’s bottom is another name for ______ ____
ischogluteal bursitis
What are some common body structure and function impairments and activity limitations and participation restrictions related to painful hip syndromes and overuse syndromes
pain
gait deviations
imbalance in muscle flexibility and strength
decreased muscular endurance
How would a clinician manage painful hip syndromes and overuse syndromes in the protection phase
By controlling inflammation and promoting healing as well as developing support in related areas
Which phase of managing painful hip syndromes and overuse syndromes would a clinician develop balance in length and strength of muscles, develop stability of closed chain function, and develop muscle and cardiopulmonary endurance
controlled motion
How would a clinician manage painful hip syndromes and overuse syndromes in the return to function phase
progress strength and functional control
return to full function
Which phase of managing painful hip syndromes and overuse syndromes would a clinician have a patient perform accelerating and decelerating sprints to practice quick starts and slowing down
return to function
What are a patient’s limitations after a total hip replacement performed from a posterolateral approach
Patient cannot exceed hip flexion greater than 90
patient cannot exceed adduction and IR greater than neutral
What is the number one initial goal for the clinician when treating a post-op patient
protect healing of soft tissues surrounding surgical procedure
A patient will fall under a (hypermobility/hypomobility) classification for slow progression of exercise within the restraints of WB and motion precautions after operation
hypomobility
