Treatment of the Hip Flashcards
Quais as quatro classificações de tratamento em que podem ser inseridos os indivíduos com dor na anca?
- Mobilization (correction of mechanical dysfunction)
- Strengthening (stabilization)
- Postural
- Pain.
Classifications do not need to be mutually exclusive.
Que técnicas estão incluídas no grupo de mobilização?
- Movement related treatments
- Manipulation
- Mobilization
- Mobilization with movement
- Stretching
- (complimentary to the postural classification).
Quando utilizamos a strenghtening classification?
- We use this classification when dysfunction is related to weakness or endurance losses.
- If the patient would benefit from a concurrent strengthening program.
- A maioria dos utentes pode beneficiar da combinação de mobilização seguida de fortalecimento.
Quando se aplica a classificação postural?
• When primary dysfunction and secondary symptoms are associated with the postural disorder.
Que tipo de pacientes mais tendem a beneficiar da classificação da dor?
- Pessoas “dominadas” pela dor, com grande irritabilidade.
- Individuals in which pain limits function
- Numeric pain rating scale sup or equal 7/10.
Look at these assessment findings in a hip OA:
• Decrease ROM: hip F (90°), ER (-5°), and IR (5°);
• Reduced lumbar lateral glide and lumbopelvic control;
• Weak hip abductors, extensors and quadriceps;
• Pain.
What type of interventions can we provide?
- Long-axis distraction in supine (3 x 30 s grade 4);
- Distraction in hip flexion (3 x 30 s grade 4 in F 80°, rot 0°, lateral direction);
- Quadriceps and hip abductor strengthening (Level 2, 3 x 10);
- Education about: hip OA - Physical activity/activity/rest cycling; Physical therapy treatment rationale - Joint Protection advice.
Look at these assessment findings in a hip OA:
• Pain not aggravated by treatment;
• Decrease ROM: E (-5°) and IR (5°)
• ROM: E (-5°).
What type of interventions can we provide?
- Long-axis distraction in supine
- Distraction in hip felxion
- IR Stretch in prone
- Soft tissue therapy
- Quadriceps strengthening
- Hip abductor strengthening
- Functional balance/gait drills set
- Physical activity - Joint protection advice.
Look at these assessment findings in a hip OA:
• Pain has decreased along sessions
• Tolerating treatment well
What type of interventions can we provide?
- Long-axis distraction in supine (3 x 45 s)
- Distraction in hip flexion (3 x 45 s)
- IR in Prone (a/a)
- Soft tissue therapy (a/a).
- Exercise bike.
Look at these assessment findings in a hip OA:
• Pain and medication use decreased along sessions;
• By session 10: ROM: hip F (105°), IR (15°), E (5°);
• Reduced lumbar lateral glide and lumbopelvic control;
• Decreased ROM persisted at session 4: E (-5°);
• Good adherence to exercises;
• Reduced lumbar lateral glide and lumbopelvic control.
What type of interventions can we provide?
- Long-axis distraction in supine (increase to 60 s)
- Distraction in hip flexion (increase to 60 s and added IR 10°)
- IR in prone (increase to 45 s)
- Soft tissue therapy (a/a)
- Lumbar spine mobilization (PA glides, L4-S1, grade 4, 3 sets)
- Additional soft tissue therapy (Psoas 5 min)
- Quadriceps strengthening (Progressed to level 5, 4 x 10)
- Hip abductor strengthening (Progressed to level 3, 3 x 10, 2 kg)
- Stretch (Progressed to IR in 4-point kneel, 10 x 5 s)
- Functional balance/gait drills set x 2 (Sideways walking + braiding, 4 x 30 s)
- Additional exercise (Core, level 2 progressed to level 4).
- Exercise bike.
According to Bennell’s study on interventions for patients with hip OA, when are manual therapy techniques integrated into the treatment?
Session 1. Incorporate manual therapy early in the treatment.
The minimal clinically important difference (MCID) is the same as the minimal detectable change?
False. Minimal clinically important differences (MCID) are patient derived scores that reflect changes in a clinical intervention that are meaningful for the patient. The minimal detectable change is based upon statistics and sample distribution.
What are the benefits of thrust and non-thrust manipulation?
– Improve joint kinematics
– Improve capsular elasticity
– Decrease-intra-articular compression forces
– Improve ROM, pain, function.
Quais as precauções relacionadas com as técnicas de mobilização e manipulação?
– VBI artery insufficiency – Rheumatoid arthritis – Osteoarthritis or elderly patients – Radiotherapy – Prolonged corticosteroid use – Aspirin, anti-coagulant medications – Structural instability
Refere as contra-indicações associadas à mobilização e manipulação.
– VBI
– Malignancy of the spine
– No manipulation of the Cspine in patients with RA (reumatoid arthritis)
– Spinal instability
– Fracture
– Positive neurological signs indicating compromise of spinal cord, cauda equina, or spinal nerve roots
– Total ligamentous rupture or acute repair of ligaments or tendons
– Psychological pain
– Not competent in performing the technique
– Source of symptoms cannot be determined.
O que tende a ser mais eficaz no tratamento de osteoartrite da anca: terapia manual ou exercício?
- The effect of manual therapy (including thrust manipulation) is superior to exercise alone in patients with hip OA (RCT - Hoeksma et al, 2004).
- Case series demonstrates a positive outcome observed in a group of patients receiving MT and exercise (McDonald et al, 2006).
Que tipo de tratamento pode ser aplicado na anca, que tende a melhorar a osteoartrose do joelho?
- A study by Currier et al. (2007), patients with Knee Pain and Clinical Evidence of Knee Osteoarthritis demonstrated a Favorable ShortTerm Response to Hip Mobilization (68%).
- Treatment conditions: grade IV, 3 x 30 sec – Caudal glide, A/P, P/A, P/A in FABER position.
Que resultados tende a apresentar a terapia manual e o exercício terapêutico no que diz respeito à osteoartrite da anca e do joelho?
Abbot et al. (2013).
• RCT results – Manual therapy provided greater mean reductions in pain and disability than exercise therapy; Exercise therapy did provide clinically significant gains over usual care alone and physical performance outcomes favored exercise therapy; The combination of exercise and manual therapy did not produce additional benefit.
• Conclusions – Individually, manual therapy and exercise therapy are superior to usual care alone. A combined treatment approach is of no further benefit.
• Treatment conditions: 9 visits, individualized treatment:
– Manual therapy, exercise therapy, or combined;
– Manual therapy: thrust or non-thrust including cycling, strengthening, stretching, balance training.
Que técnicas mandatórias de terapia manual podemos aplicar em osteoartrite da anca?
Abbot et al. (2013).
- Long-axis hip distraction with thrust
- Lateral hip distraction, non-thrust
- Antero-posterior directed force to the proximal femur, non-thrust
- Poster-anterior directed force to the proximal femur, non-thrust
- Medial hip rotation, non-thrust
- Soft tissue manipulation to hip and thigh musculature and fascia
- Manual stretches to connective tissue of hip and thigh.
Que técnicas de terapia manual adicionais poderão ajudar em osteoartrite da anca, tendo em conta determinados achados clínicos?
Abbot et al. (2013).
- Knee flexion, non-thrust
- Proximal tibio-fibular joint manipulation, thrust or non-thrust
- Knee extension, non-thrust
- Patellar gliding force, non-thrust
- Ankle and talo-calcaneal joint distraction, thrust or non-thrust
- Ankle talo-crural antero-posterior directed force, non-thrust
- Antero-posterior directed force to distal fibula, tibio-fibular joint, non-thrust
- Soft tissue manipulation, ankle plantarflexor muscle group
- Lumbopelvic rotation thrust manipulation.
Relativamente à osteoartrose do joelho, que técnicas mandatórias de terapia manual poderão ser aplicadas?
Abbot et al. (2013).
- Knee flexion, non-thrust
- Antero-posterior directed force to the tibia, tibio-femoral joint, non-thrust
- Knee extension, non-thrust
- Postero-anterior directed force to the tibia, tibio-femoral joint, non-thrust
- Patellar gliding force, non-thrust
- Manual stretch to quadriceps, hamstring, triceps surae muscle groups
- Soft tissue manipulation, quadriceps and peripatellar connective tissue, hamstring, hip adductor and triceps surae muscle groups.
Que técnicas adicionais podem ser utilizadas em casos de osteoartrose do joelho, específicas de acordo com os achados clínicos?
Abbot et al. (2013).
- Long-axis hip distraction with thrust
- Lateral hip distraction, non-thrust
- Antero-posterior directed force to proximal femur, non-thrust
- Poster-anterior directed force to proximal femur, non thrust
- Medial hip rotation, non-thrust
- Soft tissue manipulation to hip and thigh musculature and fascia
- Manual stretches to connective tissue of hip and thigh
- Ankle and talo-calcaneal joint distraction, thrust or non-thrust
- Ankle talo-crural antero-posterior directed force, non-thrust
- Antero-posterior directed force to distal fibula, tibio fibular joint, non-thrust
- Soft tissue manipulation, ankle plantarflexor muscle group
- Lumbopelvic rotation thrust manipulation.
Que tipo de exercícios mandatórios podem ser benéficos para a anca e/ou joelho osteoartríticos?
- Aerobic exercise: up to 10 minutes cycle or walk
- Strengthening: 3 sets of 10 repetitions of:
Hip: hip abduction; hip extension; hip lateral rotation; knee extension.
Knee: knee extension; hip extension; knee flexion. Resistance adjusted as appropriate. - Stretching: 60 seconds passive stretch of:
Hip: hip flexors; knee extensors; hip extensors; knee flexors; hip abductors and lateral rotators; ankle plantarflexors.
Knee: knee flexors; knee extensors; ankle plantarflexors; - Neuromuscular coordination control exercises: Hip or knee: 3 sets of 2 minutes of (choose from): standing weight-shifting exercises; standing balance on uneven surfaces; side-stepping, forward-backward and shuttle-walking drills; or stair walking.
Abbot et al. (2013).
