Hip Flashcards
what are the most common mobility impairments in hip pts
flexion/IR/abd
common flexibility impairments
tight hip flexors (stress on spine/knee)
tight ADD and hamstrings
what causes medial collapse?
decreased strength of hip ABD/EXT/ER
Common M imbalance impairments related to hip
short tfl
dominance of TFL over glute med
dom. of TFL over iliopsoas
dom of hamstrings over glute max
Common M control impairments related to hip
poor hip control in WB position (squat or unilateral squat)
hyperext/swayback posture and ANT hip
movement training is KEY
most common hip pain in older adults
hip pain associated with OA
RF for hip OA
age, developmental disorders, previous hip injury, reduced ROM (IR), osteophytes, lower socioeconomic status, higher bone mass and BMI
describe the natural hx of OA
-Decrease in joint space
-Shortening of capsule
-Flattening of femoral head
-Osteophytic growth
common impairments/clinical presentation hip OA
Hip pain (anterior or lateral) and stiffness –worse with WB
Impaired mobility (flexion, IR, ABD, extension)
Impaired m performance (ABD, ext, ER)
Impaired balance
Impaired gait pattern
Activity limitations and participation restrictions (STS, prolonged walking)
Clinical criteria for OA dx
(adults > 50)
mod anterior or lat hip pain
morning stiffness ( <1 hr after walking)
Hip IR <24 degrees OR hip IR + flexion 15 degrees less than non-painful side
Increased hip pain with passive IR
Hip school
Hip dysfunction/pain can improve and does not always get worse it is NOT automatic downhill from here
S/S associated with mvmt and physical exam is best way to dx hip OA
Treatment should start with non-pharm interventions
Not too much, not too little activity
Seek help b4 overwhelmed
** Hip school vs control group = greater reduction in pain and activity limitation
most common hamstring strain
long head biceps femoris
hamstring strain RF
modifiable: fascicle length/stiffness
non-modifiable: >23 yrs, previous HIS, ACL injury, calf strains, other knee/ankle lig injuries
common impairments with ham strain
pain and localized tenderness
impaired mob (active knee ext test)
impaired flexibility (pain w stretching)
impaired m performance (pain)
gait deviations (terminal swing, short stride length, and MSW–clear foot) activity limitations
what does evidence say about pain free vs pain threshold rehab
-Did not accelerate RTP
-Strength = greater knee flexor strength in pain-threshold group
-BFLH fascicle length = greater in pain-threshold group
what does evidence say about adding eccentric exercise to strengthening program (hamstring)
- Adding ecc strengthening exsc to a conventional program = sig reduced RTP
- Important for PREVENTION
(Nordic Hamstring exsc reduced HIS by 50% , Depends on exsc compliance, Performed after training and on days b4 rest)
**Lengthening Exsc had quicker return to play than conventional protocol
what does evidence say about progressive agility and trunk stabilization (hamstring)
- Reinjury rates lower for PATS (hamstring is important as a hip stabilizer in all trunk stabilization exsc)
- RTP no diff
what helps RTP for hamstring injuries?
eccentrics
what helps reduce reinjury for hamstring injury?
PATS: progressive agility and trunk stabilization
pt education recommendation for FAI
avoid positions that create impingment (end range flexion, IR, sometimes ABD)
pt education recommendation for instability
avoid activities that place repetitive strain on passive restorations of hip (forced ext and rot loading)
pt education activity modification
movement pattern and hip alignment should be assessed with all activities. other examples include higher seats (avoid excessive hip flexion) and AD with gait to unload
common pattern in FAI
decreased IR and increased ER
decreased flexion and abduction
clinical presentation of FAI
hip groin pain (ant>post)
c/o clicking, locking catching or stiff
slight decrease ROM (flexion and IR)
f>m
avg 2-4 yrs duration
+ hip impingment tests (FADIR)
pain with walking, standing, sitting
prognosis FAI with/without treatment
better with treatment worsens without
2 common themes in non-arthritic pain
abnormal movment pattern (medial collapse, associated with articular cartilage damage, can lead to early OA, PTF pain, ACL)
and
weakness
Impact of swayback posture on hip
demonstrated higher peak hip ext angle, hip flexor moment, hip flexion angular impulse –> results in increased forces required on anterior hip structures
movement pattern training–standing
stand with equal weight on legs, avoid locking of knees, avoid hips in front of shoulders (swayback)
movement pattern training–walking
heel to toe, avoid completely straightening leg, lift heel and push off with toes
movement pattern training–sitting
knees in line with feet, feet supported on floor, don’t cross legs
movement pattern training–sleeping
– SL –pillow b/w knees, avoid hip flexion pr rotation
movement pattern training–ascending stairs (and single leg squat)
lean forward, don’t let knee roll in or pelvis tilt
Goals for post op hip
pain free hip
stable joint for LE for WB
adequate ROM and strength of LE for function
RF for fracture
age, female, low BMI, prev low trauma fx, parental hx of hip fx, current smoker, hx oral glucocorticoid use, confirmed RA, secondary OP, > 3 drinks a day
RF for functional and mortality outcomes
increasing age, comorbidities, lower pre-fx functional mobility, confusion, cognitive impairments/dementia
considerations for hip fracture
WBAT as early as possible after surgery
hip m function (w fracture or fixation)
what muscles should you think about with…
greater trochanter
lesser trochanter
subtrochanteric region
lateral incision
glute med/min
iliopsoas
glute max
TFL, glut med, vastus lateralis
outcome measures for hip fracture
should assess pain, knee extension, across all care
(knee strength correlates with hip strength, cant assess hip strength right out of surgery)
outcome measures in early post op in pt settings
VRS, knee extension
CAS, TUG, NMS, gait speed, falls efficacy scale
outcome measures in postactute period in pt setting
VRS, knee extension
CAS, TUG, NMS, gait speed, 5tSTS, 6MWT, falls efficacy scale
post acute period community settings outcome measures
VRS, knee extension, hip muscles
CAS, TUG, NMS, GAIT SPEED, 6MWT, FALLS EFFICACY
across entire episode of care post op
-PT/Structured exsc including high intensity resistive strength, balance, WB, functional mobility training
-PT/rehab should be similar for those w/ mild to mod dementia
early post op in pt setting treatment
document time from surgery to first transfer out of bed
Multidisciplinary PT and early mobilization
-should be HIGH FREQUENCY
-assisted transfers
-upper body aerobic training
ESTIM quads
ESTIM pain
post acute period home care/community settings treatment
extended exercise opportunities
recommendations to maximize safe PA
may provide aerobic training in addition to PRE, balance, mobility training in community
(post op)
what does resistance training program look like
- Intensity = 8RM –allows us to progress and overload!
- Volume 3x8
- Frequency = 20 visits over 12 wks
- Hip ext and ABD
results of HIGH INT training (post op)
6-8 wks post hip fx (3x/wk x 12 wks)
(Strong evidence that this is safe )
Resistance Exercise – 70-90% max workload, progressive increase
- Hip ABD, EXT, stretching
- 1.5 hr sessions
Functional-Balance Training
Results
- Sig improvement in strength, functional motor performance and PA levels
- Fall related emotional and behavioral restriction were reduced
- more confidence
