Pelvis and Hip - Hypermobility through IPI Flashcards
What is hypermobility in the hip?
excessive arthrokinematics/ joint play (guiding motion)
What are the traumatic etiologies of hypermobility of hip?
- fx and ligamentous tear
- labral
What are the atraumatic etiologies of hypermobility of the hip?
- extreme motions in sports
- labral tear with FAIS/IPI
-systemic connective tissue disorder
What are bone abnormalities for hypermobilities?
- shallow acetabulum
- inferior acetabular insufficiency
- excessive femoral version or torsion
- excessive femoral neck angle
What are some femoral torsions in the transverse plane?
- the angle between the femoral condyles and femoral head and neck
What is excessive ante version?
Toeing in
What is excessive retroversion?
Toeing out
What are the frontal plane angles that we should be concerned with?
The angle between the shaft of the femur and the neck
What is coxa valga?
-larger angle of inclination
- leads to gene vara or bow-legged position
What is coxa vara?
- smaller angle of inclincation
- leads to gene valga or knock-kneed position
What is the prevalence of hip hypermobility?
- inconsistent biological sex differences
- 5-35% of those with hip joint pain
What are risk factors for hypermobilitY??
- genetics
- injury
- nature of pt’s activites
What are some activities that can cause or contribute to hip hypermobliity?
- running
- ballet
- golf
- hockey
- soccer
- excessive rotation, flexion, hyperextension
What are symptoms of hypermobility?
like impingement due to hypermobility plus:
- anterior groin or lateral hip pain
- popping, locking or snapping present
- feeling of instability, especially when squatting
What are some signs of hypermobility in the hip?
like impingement due to hypermobility plus:
- ROM: Hip IR> 30˚ at 90˚ flexion
- combined motion: possible inconsistent block
What special tests are there for hip hypermobility?
- Hip apprehension
- ligaments teres test possibly postitive
- specific ligament tests likely positive
- abnormal femoral version or torsion
What is the hip apprehension test?
in prone move hip into ext with ER and ABD while applying antinf force on femur (specific to pubofemoral ligament test)
What is the PT rx focus for hip hypermobility?
- primary focus is on cartilage integrity and stabilization
What is regional interdependence?
- theory that differing body regions are biomechanically and neurophysiologically interdependent and impairment into one region can contribute to impairment in another, particularly if persistent
What may play a role in regional interdependence?
central mechanisms such as the motor cortex
What is the predominant innervation to the L4-S1 Z joints?
L4 dorsal rami
What is the predominant and MOST consistent innervation to the L4-S1 discs?
The L1, 2 dorsal root ganglia and L4 and L5 sinuvertebral nerves
What are the iliolumbar ligaments at L5 innervated by?
L1-4 spinal nerves
What happens if any of the L4-S1 joints are persistently hypermobile/unstable?
The L1-4 nerves are more likely to become sensitized and excessively recruit the hip flexors
What are the primary hip flexors?
- Iliopsoas
- Rectus Femoris
- TFL
- Iliocapsularis
What innervates the iliopsoas?
L1-4
What does the iliopsoas do?
- primarily a hip flexor and trunk stabilizer
- attaches to iliocapsularis
What does the iliocapsularis do?
- primarily a dynamic stabilizer for capsule
- also a hip flexor
What is the innervation of the iliocapsularis?
- L2-4
What does the iliocapsularis attach to?
- the ilipsoas, anteromedial capsule and rectus femoris
What is the innervation to the rectus femoris?
- L2-4
What does the rectus femoris attach to?
- attaches to the capsule
- capsule attaches to the labrum
What o’clock is the IPI on the right hip?
3 o’clock
What o’clock is the IPI on the left hip?
9 o’clock
What is the etiology of the L4-S1 regional interdependence?
- L4-S1 hypermobility/instability
- MOST common segments
What is the imbalance of muscles that lead to L4-S1 regional interdependence?
- excessively recruited hip flexors that share innervation of L1-4
- inhibition of hip extensors and abductors
What happens to excessively recruit hip flexors that share innervation of L1-4?
- attach to capsule and labrum
- excessive traction on antmed portion (3 or 9 o’clock position depending on hip)
- may lead to capsulitis and labral attrition without bony changes like with FAIS
Why is the L4-S1 regional interdependence self perpetuating without addressing the lumbar stabilization?
- iliopsoas is a stabilizer of the lordosis in standing
- Maintain size or even hypertrophies in those with LBP indicating continued and excessive recruitment
What happens with an excessively recruited Ilipsoas?
an further add to the anterior shearing MOST often occurring with lumbar hypermobility/instability
What is ilipsoas impingement?
- impingement without dysplasia or bony changes
What is the etiology of IPI?
- not fully clear
- conditions that lead to excessive hip flexor recruitment
- lumbar hypermobility / instability with regional interdependence
What are symptoms of Iliopsoas impingement?
- like FAIS with labral involvement
- possible lumbar hypermobility/instability symptoms if LB is also aggravated
What are signs of Iliopsoas impingement?
like FAIS with the following additions
- Passive ROM
* IR limitation at 90 degrees of flexion
* hip maltracking at 90 degrees
Why is there IR limitation at 90 degrees of flexion with IPI?
- due to inhibition and hypertonicity of extensors or primarily Glut max which is also the main external rotator at 90 degrees of flexion
- light resistance during IR PROM that is NOT speed dependent
What is hip maltracking due to?
- inhibition and hypertonicity of piriformis that is an abductor at 90 degrees of flexion
- light resistance into flexion PROM if deviation NOT allowed that is not speed dependent
What will we find in resisted testing with IPI?
- possible hip ER inhibition at 90˚ of flexion due to glut max inhibition bc it is the MAIN ER at 90˚ of flexion
What can happen to the hip extensors with IPI?
- possible inhibition of hip extensors, including quad dominant squatting pattern (hip ext inhibited knee ext excessively recruiting)
What can happen to the abductors with IPI resisted testing?
inhibited abductors
What will we find with palpation with IPI?
- TTP over anterior hip region at 3 or 9 o’clock position depending on hip
- inhibited muscles develop protective hypertonicity and tightness at rest
What will we find in our thoracolumbar scan and biomechanics exam findings for IPI?
- possible lumbar hypermobility/instability
What is the PT rx for IPI?
- tissue/cartilage integrity
- address inhibited muscles
What is culprit rx for IPI?
- for lumbar hypermobility/instability
What is victim rx for IPI?
- like FAIS rx
What is MD rx for IPI?
partial iliopsoas surgical release
