Hip Intervention

Question 1

A key principle for managing Hip OA is decreasing pain by reducing mech stresses/forces acting on the hip joint. In what ways can this be accomplished?

Answer 1

1. Ther ex to inc strength/endurance of hip mm & enhance trunk/core stability
2. Use of footwear w/ cushioned outsoles & insole materials to dec perceived forces acting on LE
3. Addressing biomech contributors from LQ
4. Use of AD (cane, crutches, walker)
5. Correct LLD

Question 2

A key principle for managing Hip OA is decreasing pain and joint stiffness. In what ways can this be accomplished?

Answer 2

1. warm bath or moist heat to region (esp in AM, aquatic therapy should ALWAYS be considered!)
2. Daily hip ROM by pt
3. weight loss
4. MT (to reduce intra-articular pressure by inc mobility of jt capsule & surrounding soft tissue structures)

Question 3

A 2011 prognostic study identified factors that predict which pts with Hip OA will have good outcomes with MT and exercise intervention. What was the 5 factors?

Answer 3

1. Unilat vs bilat hip pain
2. Age </= 58
3. Pain >/= 6/10
4. 40m SPWT* of < or = 25.9 sec
5. Sxs < 1 yr

*SPWT = self paced walk test

*** >/= 3 factors present is predictive of good outcomes

Question 4

According to the CPG 2017 revision, it is recommended that PTs should use MT for pts w/ mild-mod hip OA and impairements of joint mob, flexibility, and/or pain?

Answer 4

True.

MT may incl: thrust, non-thrust, STM

*As hip motion improves, add exercsies (stretching, strengthening) to augment and sustain gains in ROM, flexibility, strength)

Question 5

T or F: there is evidence that DN can be beneficial for pts with hip OA

Answer 5

T

Question 6

What are key domains for THA rehab?

Answer 6

1. progressive resistive exercsies for entire LE (knee flexors/ext =typically weakest), initiate strength training early
2. balance training
3. correction of faulty mvmt patterns
4. restoration of ROM
5. reintegration into previous sports/activities

Question 7

T or F: Quadratus femoris becomes dysfunctional with FAIS

Answer 7

T

Question 8

T or F: obturator internus can be over-active in those with FAIS, leading to inefficiency with deep motor synergies of hip

Answer 8

T

Question 9

A form of GTPS managment is to correct modifiable risk factors. What are 7 modifiable risk factors for GTPS?

Answer 9

1. obesity
2. core instability
3. glute med weakness
4. ITB tightness
5. LLD
6. abnormal LE biomech (excessive pronation)
7. excessive or asymmetric shoe wear

Question 10

Besides correcting modifiable risk factors, what are other GTPS management options?

Answer 10

1. relative rest (cane)
2. avoid lying on involved side or hyper adduction
3. STM to gluteal trigger points
4. optimize ROM/flexibility around hip
5. lumbopelvic strength training
6. regional interdependece
7. ice + acetaminophen (pain relief)

Question 11

T or F: cortisone injections/NSAIDS should be avoided in chronic cases

Answer 11

T

Question 12

T or F: extracorpeal shock wave therapy (ESWT) has been shown to improve pain and function for pts with GTPS

Answer 12

T

Question 13

T or F: DN has been shown to be beneficial for GTPS

Answer 13

T

Question 14

T or F: pts with GTPS have inc hip flexor and abductor demands

Answer 14

T (bc the pelvis is trying to drive laterally)

Question 15

T or F: pts with Hip OA have more trunk flexion compensation

Answer 15

T

Question 16

What are the 2 type of pt presentations that have been described for piriformis syndrome?

Answer 16

1. Shortened/hypertonic pirifrmis muscle leading to compression on sciatic n
2. chronic ecc overuse of piriformis secondary to weakness in glute max/med

Question 17

How long does it take for a grade I HS strain to recover?

Answer 17

3 weeks

Grade I: sxs post activity, tightness but no loss of length

Question 18

How long does it take for a grade II HS strain to recover?

Answer 18

6 weeks

Grade II: partial tear, loss some flexibility amd strength, limping with twinges of pn

Question 19

How long does it take for a grade III HS strain to recover?

Answer 19

3 months (up to 12 mo if at tendon)

Grade III: lump of tissue palable, cannot walk w/o pn, may require surgical repair

Question 20

T or F: HS mid-substance tears can have accelerated recovery (2-4 weeks)

Answer 20

T

Question 21

T or F: HS injury is very often a sciatic neurodynamic issue too

Answer 21

T

Question 22

When prescribing exercise interventions for a pt post-HS strain that is a grade I or 2, how would you dose considering their pain?

Answer 22

Interventions can be UP TO the point of pain (should be a little uncomfortable, NOT painfree)

Question 23

T or F: you should add ECC training to rehab for HS?

Answer 23

T

Question 24

What is a HS proximal avulsion?

Answer 24

Complete tear away from ischial tub

Question 25

Does a HS proximal avulsion separation of <2cm need to be surgically repaired or can it be conservatively managed?

Answer 25

Conservatively managed

Question 26

How long does recovery of a HS proximal avulsion fx take?

Answer 26

up to 12 mo (typically more than 6 mo)

Question 27

Is it more ideal to have a HS strain proximal, distal, or in the middle?

Answer 27

Middle!

More prox or distal take longer to heal!

Question 28

What are MT techniques to improve hip Flexion?

Answer 28

1. AP glide (below 90 deg, above 90 deg)
2. Other techniques (additional hip abd focus):
   • lateral distraction
   • long axis distraction manip

Question 29

What are MT techniques to improve hip ext?

Answer 29

1. PA glide progression
2. Figure 4 (military crawl)
   Other techniques:
   
   • Long axis distraction manip