Lab 7: Hip Treatments OSCE

Question 1

Hip Flexion SD MET

How would you perform this treatment?

Answer 1

• *Patient:** lateral recumbent with affected side up
• *Physician:** faces the pt and places cephalad hand on inferior lateral angle to stabilize and monitor.

1. Physician places caudad hand proximal to the pt’s knee cap and extends the pt’s leg at the hip until the restrictive barrier approximated.
2. Pt is instructed to push leg anteriorly against physician’s counterforce for 3 to 5 seconds.
3. Pt instructed to relax; physician repositions pt into new restrictive barrier.
4. Repeat at least 3-5 times or until no new barriers are attained.
5. Reassess for TART.

Question 2

Hip Extension SD MET

Hamstring Hypertonicity

How would you perform this treatment?

Answer 2

Patient: supine

Physician stabilizes at contralateral ASIS with one hand. Other hand grasps pt’s leg above ankle and flexes at hip until barrier is reached.

1. Pt is instructed to push leg downward toward floor against physician’s counterforce for 3 to 5 seconds.
2. Pt instructed to relax; physician repositions pt into new restrictive barrier.
3. Repeat at least 3-5 times or until no new barriers are attained.
4. Reassess for TART.

Question 3

Hip Extension SD MET

Gluteus Hypertonicity

How would you perform this treatment?

Answer 3

Patient: lateral recumbent with affected side up.

Physician stabilizes at ipsilateral PSIS with one hand. Other hand grasps pt’s leg above ankle and flexes at hip until barrier is reached and foot is placed on physician’s thigh.

1. Pt is instructed to push foot downward against physician’s thigh/counterforce for 3 to 5 seconds.
2. Pt instructed to relax; physician repositions pt into new restrictive barrier.
3. Repeat at least 3-5 times or until no new barriers are attained.
4. Reassess for TART.

Question 4

Hip External Rotation Somatic Dysfunction

How do you perform this treatment?

Answer 4

• *Patient:** Supine or prone with hip and knee
• *Physician** internally rotates pt’s hip to restrictive barrier

1. Pt is instructed externally rotate hip against physician’s counterforce for 3 to 5 seconds.
2. Pt instructed to relax; physician repositions pt into new restrictive barrier.
3. Repeat at least 3-5 times or until no new barriers are attained.
4. Reassess for TART.

Question 5

Hip Internal Rotation Somatic Dysfunction

How do you perform this treatment?

Answer 5

• *Patient:** Supine or prone with hip and knee
• *Physician** externally rotates pt’s hip to restrictive barrier

1. Pt is instructed internally rotate hip against physician’s counterforce for 3 to 5 seconds.
2. Pt instructed to relax; physician repositions pt into new restrictive barrier.
3. Repeat at least 3-5 times or until no new barriers are attained.
4. Reassess for TART.

Question 6

Hip Abduction SD MET

Iliotibial Band Restriction

How do you perform this treatment?

Answer 6

Patient: Supine

Physician stabilizes contralateral LE just above the ankle with one hand. Other hand adducts other LE to test for hypertonic abductor.

1. Approximate the restrictive barrier -Pt is instructed to push LE laterally against physician’s counterforce for 3 to 5 seconds.
2. Pt instructed to relax; physician repositions pt into new restrictive barrier.
3. Repeat at least 3-5 times or until no new barriers are attained.
4. Reassess for TART.

Question 7

Hip Adduction SD MET

Hypertonic Long Adductor of Lower Extremity

How do you perform this treatment?

Answer 7

Patient: Supine with both legs straight at the hip and knee Assessment: Physician uses one hand to abduct the leg that being tested and stabilizes just proximal to the pt’s knee using own hip. Physician places other hand on contralateral knee to stabilize the leg.

Physician abducts patient’s leg until restrictive barrier met, as described above.

1. Pt is instructed to gently push the knee of affected leg into physician’s hip for 3-5 seconds.
2. Pt instructed to relax; physician repositions pt into new restrictive barrier.
3. Repeat at least 3-5 times or until no new barriers are attained.
4. Reassess for TART.

Question 8

Hip Adduction SD MET

Hypertonic Short Adductor of Lower Extremity

How do you perform this treatment?

Answer 8

Patient: Supine with non-tested leg straight at the hip and knee

Assessment: The tested leg is externally rotated and flexed at the thigh and knee with the foot resting against the other thigh.

• -For diagnosis, the physician places cephalad hand on the pt’s opposite hip and caudad hand medial to the pt’s knee of the tested leg.*
• *Physician** abducts patient’s leg until restrictive barrier met, as described above.

1. Pt is instructed to gently push the knee of affected leg into physician’s hand for 3-5 seconds.
2. Pt instructed to relax; physician repositions pt into new restrictive barrier.
3. Repeat at least 3-5 times or until no new barriers are attained.
4. Reassess for TART.