Hip Interventions Flashcards
Hip fx -strong evidence of? (2 obvious)
-prevent and identify delirium
-assess and manage fall risks (must assess and document rfs for falls)
-PT must provide exercise (progressive high-intensity resistive strength, balance and WB, functional mobility training)
Hip fx -expert opinion
-MUST asses pain at rest and during activity, try to minimize pt during session
-MUST screen for pressure ulcers
-Secondary fx prevention (osteoporosis pts)
-Determine and communicate functional assistance required
-Identify individual goals (get to PLOF, return to residence, indepen.)
-Transition of care from inpatient setting
Rfs for pressure ulcers
-sig. limited mobility
-sig. loss sensation
-previous or current ulcers
-nutritional deficiency
-inability to reposition selves
-incontinence
-sig. cog. impairment
Hip fx inpatient guidelines
-MUST transfer pt OOB and ambulate ASAP (A)
-High frequency PT following sx (B)
-Provide UE aerobic training (C)
-E-stim for quad strengthening (C)
-E-stim for pain (C)
Hip fx -postacute period
PTs offer strength, balance, gait, and functional therapy if there are still limitations. OP therapy and HEPs (A)
Provide recs to maximize safety (A)
PTs can do aerobic training along with resistive, balance, and mobility training (C)
Improve mobility P1
-activation/coordination exercise
-mobility exercises
-inhibitory exercises
-STM
-joint mobs, manips.
Improve mobility P2
-progression to strength/endurance training (retrain/strengthen motion with new range)
Improve mobility P3
increase challenge of exercises (progress toward activity limitations)
OA -pt education and interventions
edu: patient empowerment / progression to indepen. and activity mods.
Manual therapy
Strengthening/endurance exercise
Diet/weight loss
Walking/gait training
Pain control modalities
OA CP guidelines
-Functional, gait, balance training with ADs (C)
-Flexibility, strengthening, and endurance exercises- address ROM, weakness, limited flexibility (1-5x week over 6-12wks)(A)
-Patient education (mods., exercise, weight reduction, unloading joints)(B)
-Manual therapy (3x week over 6-12wks)(A)
-Modalities (US, exercise and hot packs)(B)
-Weight loss (collab with other drs to support weight loss)(C)
Improve stability P1
-exercises: physiologic effects
-activation/coordination exercises
-joint mobs, manips.
Improve stability P2
progression to strength/endurance training of stabilizers
Improve stability P3
increase challenge of exercises (progress toward activity limitations)
Non-arthritic hip pain
Multimodal interventions:
-activity mods
-exercise for strengthening (hip muscles, trunk, LE in general)
-manual therapy
-postural movement correction
-stretching
-balance exercises
-movement pattern training
-education (weak)
-ther ex and activities (weak)
Non-arthritic hip pain -conflicting and expert opinions
bracing is conflicting evidence when used alone
manual therapy- with pain, STM with impaired mobility good
NM re-ed good
Mechanical loading (3 things that matter)
duration, intensity, frequency (if we can cut down on duration with pillow between legs, this can take out a large part of loading)
FAI guidelines
-avoidance of impingement position (especially end range IR)
-pt education
-muscle performance (eccentric ERs)
-some pt dependent interventions
Acetabular labral tear (conservative P1)
P1: activity mod/ pt edu
gait training maybe with AD
oscillation mobs/ ST mobs
mobility/ pain mng exercises
Acetabular labral tear (conservative P2)
-lumbopelvic coordination/strengthening exercises (improve hip stability w/ ADDs, IRs, ERs)
-LE strengthening
-balance/coordination exercises
Acetabular labral tear (conservative P3)
increase challenge of exercises (toward activity limitations)
Acetabular Labral tear (operative restrictions)
no flex >90, ABD/ER/IR >30, ext >0 for first 3 weeks
Acetabular labral tear (operative P1)
days (1-7)
w/b to tolerance with crutches
isometric quad and glut
AROM all planes
closed chain- bridge, weight shift, balance exercises
open chain- hip flex, ext, ADD, ABD
*AVOID SLR
Acetabular labral tear (operative P2)
weeks 1-3
progress off crutches- normalize gait
progress ROM, stretch at end range w/in tol
stationary bike
light open chain above knee RT (pulley or t band)
Acetabular labral tear (operative P3)
weeks 4-6
progress flexibility exercises
progress resisted strengthening (lumbopelvic stability, strength imbalances, biomechan control)
functional exercises introduced
Tendinopathy
pain and inflamm. mx w/ acute
address impairments (guarding, hypomobility)
protection vs. mod stressing/facilitating healing
-eccentrics! (and concentrics)
address contributing factors
- repet. microtrauma
-capsule hypomobility
-hip, lumbopelvic discoordination
-l-spine hypomob.
-muscle tendon unit tightness
Eccentric loading
promotes collagen fiver cross-linkage within tendon, facilitates remodeling
improved tensile loading capacity, tissue strength
GTPS
-decreased loading
-thermotherapy
-exercise interventions (tendinopathy)
-concentration on ABD and ER
-manual therapy (hip joint mobs, STM)
-activity mods (avoid sleep on side, avoid hip ADD, avoid crossing legs, use of handrail on non-symp side when using stairs)
ITB stretching ILL ADVISED
Muscle strain (POLICE)
Protection (limit excess loading on injured side)
Optimum Loading (guide collagen fiber formation, just right amount of exercise)
Ice (limits ECF and hematoma to be reabsorbed)
Compression (limits swelling)
Elevation (limits swelling)
Hamstring strain injury (reinjury risk and return to play)
-Already having a hamstring injury, higher risk for future reinjury (B)
-Use caution in RTP for pts that did not complete exercise program with eccentrics (B)
-Use hamstring strength, pain, days from injury, area of tenderness on IE to estimate time to RTP
Hamstring strain (dx)
Presents with sudden onset of P. thigh pain, with pain reproduced when hamstring stretched or activated, tenderness with palp, and loss of func (B)
HSI (examin)
-Quantify knee flexor strength using handheld or isokinetic dynamometer (A)
-Assess hamstring length by measuring knee ext deficit with hip at 90, using inclinometer (A)
-Length of muscle tenderness and prox to ischial tub to predict timing of RTP (C)
-Assessing trunk and pelvic posture during func. movements (F)
HSI interventions
-Include Nordic hamstring exercise as HSI prevention program, along with warm-up, stretching, stability training, strengthening, func. movements (A)
!!!HSI (interventions after injury)
Nerve entrapments -Mobs
attempt to retore dynamic balance between movement of neural tissues and surrounding mechan interfaces
N. entraps (types, mechanisms)
Types: gentle stretching, nerve mobs (active or passive, gliders or tensioners)
-decrease adhesions and improved movement of peripheral ns., increase neural vascularity (increase O2 decreases ischemic pain), dispersion of noxious fluids, improve axoplasmic flow
