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Ther Ex 2 - LQ > Hip > Flashcards

Hip Flashcards

1
Q

what are the most common mobility impairments in hip pts

A

flexion/IR/abd

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2
Q

common flexibility impairments

A

tight hip flexors (stress on spine/knee)
tight ADD and hamstrings

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3
Q

what causes medial collapse?

A

decreased strength of hip ABD/EXT/ER

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4
Q

Common M imbalance impairments related to hip

A

short tfl
dominance of TFL over glute med
dom. of TFL over iliopsoas
dom of hamstrings over glute max

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5
Q

Common M control impairments related to hip

A

poor hip control in WB position (squat or unilateral squat)
hyperext/swayback posture and ANT hip
movement training is KEY

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6
Q

most common hip pain in older adults

A

hip pain associated with OA

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7
Q

RF for hip OA

A

age, developmental disorders, previous hip injury, reduced ROM (IR), osteophytes, lower socioeconomic status, higher bone mass and BMI

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8
Q

describe the natural hx of OA

A

-Decrease in joint space
-Shortening of capsule
-Flattening of femoral head
-Osteophytic growth

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9
Q

common impairments/clinical presentation hip OA

A

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)

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10
Q

Clinical criteria for OA dx
(adults > 50)

A

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

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11
Q

Hip school

A

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

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12
Q

most common hamstring strain

A

long head biceps femoris

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13
Q

hamstring strain RF

A

modifiable: fascicle length/stiffness
non-modifiable: >23 yrs, previous HIS, ACL injury, calf strains, other knee/ankle lig injuries

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14
Q

common impairments with ham strain

A

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

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15
Q

what does evidence say about pain free vs pain threshold rehab

A

-Did not accelerate RTP
-Strength = greater knee flexor strength in pain-threshold group
-BFLH fascicle length = greater in pain-threshold group

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16
Q

what does evidence say about adding eccentric exercise to strengthening program (hamstring)

A
  • 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
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17
Q

what does evidence say about progressive agility and trunk stabilization (hamstring)

A
  • Reinjury rates lower for PATS (hamstring is important as a hip stabilizer in all trunk stabilization exsc)
  • RTP no diff
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18
Q

what helps RTP for hamstring injuries?

A

eccentrics

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19
Q

what helps reduce reinjury for hamstring injury?

A

PATS: progressive agility and trunk stabilization

20
Q

pt education recommendation for FAI

A

avoid positions that create impingment (end range flexion, IR, sometimes ABD)

21
Q

pt education recommendation for instability

A

avoid activities that place repetitive strain on passive restorations of hip (forced ext and rot loading)

22
Q

pt education activity modification

A

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

23
Q

common pattern in FAI

A

decreased IR and increased ER
decreased flexion and abduction

24
Q

clinical presentation of FAI

A

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

25
Q

prognosis FAI with/without treatment

A

better with treatment worsens without

26
Q

2 common themes in non-arthritic pain

A

abnormal movment pattern (medial collapse, associated with articular cartilage damage, can lead to early OA, PTF pain, ACL)
and
weakness

27
Q

Impact of swayback posture on hip

A

demonstrated higher peak hip ext angle, hip flexor moment, hip flexion angular impulse –> results in increased forces required on anterior hip structures

28
Q

movement pattern training–standing

A

stand with equal weight on legs, avoid locking of knees, avoid hips in front of shoulders (swayback)

29
Q

movement pattern training–walking

A

heel to toe, avoid completely straightening leg, lift heel and push off with toes

30
Q

movement pattern training–sitting

A

knees in line with feet, feet supported on floor, don’t cross legs

31
Q

movement pattern training–sleeping

A

– SL –pillow b/w knees, avoid hip flexion pr rotation

32
Q

movement pattern training–ascending stairs (and single leg squat)

A

lean forward, don’t let knee roll in or pelvis tilt

33
Q

Goals for post op hip

A

pain free hip
stable joint for LE for WB
adequate ROM and strength of LE for function

34
Q

RF for fracture

A

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

35
Q

RF for functional and mortality outcomes

A

increasing age, comorbidities, lower pre-fx functional mobility, confusion, cognitive impairments/dementia

36
Q

considerations for hip fracture

A

WBAT as early as possible after surgery
hip m function (w fracture or fixation)

37
Q

what muscles should you think about with…
greater trochanter
lesser trochanter
subtrochanteric region
lateral incision

A

glute med/min
iliopsoas
glute max
TFL, glut med, vastus lateralis

38
Q

outcome measures for hip fracture

A

should assess pain, knee extension, across all care
(knee strength correlates with hip strength, cant assess hip strength right out of surgery)

39
Q

outcome measures in early post op in pt settings

A

VRS, knee extension

CAS, TUG, NMS, gait speed, falls efficacy scale

40
Q

outcome measures in postactute period in pt setting

A

VRS, knee extension
CAS, TUG, NMS, gait speed, 5tSTS, 6MWT, falls efficacy scale

41
Q

post acute period community settings outcome measures

A

VRS, knee extension, hip muscles

CAS, TUG, NMS, GAIT SPEED, 6MWT, FALLS EFFICACY

42
Q

across entire episode of care post op

A

-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

43
Q

early post op in pt setting treatment

A

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

44
Q

post acute period home care/community settings treatment

A

extended exercise opportunities

recommendations to maximize safe PA

may provide aerobic training in addition to PRE, balance, mobility training in community

45
Q

(post op)
what does resistance training program look like

A
  • Intensity = 8RM –allows us to progress and overload!
  • Volume 3x8
  • Frequency = 20 visits over 12 wks
  • Hip ext and ABD
46
Q

results of HIGH INT training (post op)

6-8 wks post hip fx (3x/wk x 12 wks)

A

(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

Ther Ex 2 - LQ (3 decks)

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