Hip Intervention Flashcards
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?
- Ther ex to inc strength/endurance of hip mm & enhance trunk/core stability
- Use of footwear w/ cushioned outsoles & insole materials to dec perceived forces acting on LE
- Addressing biomech contributors from LQ
- Use of AD (cane, crutches, walker)
- Correct LLD
A key principle for managing Hip OA is decreasing pain and joint stiffness. In what ways can this be accomplished?
- warm bath or moist heat to region (esp in AM, aquatic therapy should ALWAYS be considered!)
- Daily hip ROM by pt
- weight loss
- MT (to reduce intra-articular pressure by inc mobility of jt capsule & surrounding soft tissue structures)
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?
- Unilat vs bilat hip pain
- Age </= 58
- Pain >/= 6/10
- 40m SPWT* of < or = 25.9 sec
- Sxs < 1 yr
*SPWT = self paced walk test
*** >/= 3 factors present is predictive of good outcomes
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?
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)
T or F: there is evidence that DN can be beneficial for pts with hip OA
T
What are key domains for THA rehab?
- progressive resistive exercsies for entire LE (knee flexors/ext =typically weakest), initiate strength training early
- balance training
- correction of faulty mvmt patterns
- restoration of ROM
- reintegration into previous sports/activities
T or F: Quadratus femoris becomes dysfunctional with FAIS
T
T or F: obturator internus can be over-active in those with FAIS, leading to inefficiency with deep motor synergies of hip
T
A form of GTPS managment is to correct modifiable risk factors. What are 7 modifiable risk factors for GTPS?
- obesity
- core instability
- glute med weakness
- ITB tightness
- LLD
- abnormal LE biomech (excessive pronation)
- excessive or asymmetric shoe wear
Besides correcting modifiable risk factors, what are other GTPS management options?
- relative rest (cane)
- avoid lying on involved side or hyper adduction
- STM to gluteal trigger points
- optimize ROM/flexibility around hip
- lumbopelvic strength training
- regional interdependece
- ice + acetaminophen (pain relief)
T or F: cortisone injections/NSAIDS should be avoided in chronic cases
T
T or F: extracorpeal shock wave therapy (ESWT) has been shown to improve pain and function for pts with GTPS
T
T or F: DN has been shown to be beneficial for GTPS
T
T or F: pts with GTPS have inc hip flexor and abductor demands
T (bc the pelvis is trying to drive laterally)
T or F: pts with Hip OA have more trunk flexion compensation
T
What are the 2 type of pt presentations that have been described for piriformis syndrome?
- Shortened/hypertonic pirifrmis muscle leading to compression on sciatic n
- chronic ecc overuse of piriformis secondary to weakness in glute max/med
How long does it take for a grade I HS strain to recover?
3 weeks
Grade I: sxs post activity, tightness but no loss of length
How long does it take for a grade II HS strain to recover?
6 weeks
Grade II: partial tear, loss some flexibility amd strength, limping with twinges of pn
How long does it take for a grade III HS strain to recover?
3 months (up to 12 mo if at tendon)
Grade III: lump of tissue palable, cannot walk w/o pn, may require surgical repair
T or F: HS mid-substance tears can have accelerated recovery (2-4 weeks)
T
T or F: HS injury is very often a sciatic neurodynamic issue too
T
When prescribing exercise interventions for a pt post-HS strain that is a grade I or 2, how would you dose considering their pain?
Interventions can be UP TO the point of pain (should be a little uncomfortable, NOT painfree)
T or F: you should add ECC training to rehab for HS?
T
What is a HS proximal avulsion?
Complete tear away from ischial tub
Does a HS proximal avulsion separation of <2cm need to be surgically repaired or can it be conservatively managed?
Conservatively managed
How long does recovery of a HS proximal avulsion fx take?
up to 12 mo (typically more than 6 mo)
Is it more ideal to have a HS strain proximal, distal, or in the middle?
Middle!
More prox or distal take longer to heal!
What are MT techniques to improve hip Flexion?
- AP glide (below 90 deg, above 90 deg)
- Other techniques (additional hip abd focus):
- lateral distraction
- long axis distraction manip
What are MT techniques to improve hip ext?
- PA glide progression
- Figure 4 (military crawl)
Other techniques:- Long axis distraction manip
