Week 4 Lecture 4A - Phases of Recovery (Hip)

Question 1

Work on GAIT, crutches initially. Try to get them moving again

Answer 1

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Question 2

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Answer 2

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Question 3

Can do these day 1.
Start with knee flexion, knee abduction, log roll – hip IR and ER. Circumduction feels good for the pt = pt likes to move hip after surgery.
Prone – IR/ER hip rotation in 90, RF stretch.

Week and a half – quadruped heel sits – work on flexion in a stable position – provides stability to the joint bc they are WB.

Answer 3

Got it

Question 4

GOTIT

Answer 4

GOT IT

Question 5

Can start sidelying earlier than in supine

Answer 5

got it

Question 6

Delayed – don’t know if delay causes groin pain or vice-versa. Either way have to address it. Have to work on the core regardless.

Answer 6

got it

Question 7

Abdominal
Draw
In
Mover – this is just an isometric contraction of the abs

Answer 7

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Question 8

Don’t want to do a lot of hip (flexion/rotation) early on after surgery – irritating. Position of the hip flexor – 12-3 of the labrum will be irritated if they did some work with the labrum.

Answer 8

flexion;

Question 9

Got it

Answer 9

Gotit

Question 10

Overhead things with weights, therabands, palloff presses, overhead theraband, moving into hip adduction (bent knee fall out)

Answer 10

Go tti

Question 11

Use stabilization on the foam, bosu, challenge their balance. Can do push/pull wit cable columns.

Answer 11

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Question 12

Activate core when doing glute strengthening.

Answer 12

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Question 13

Movement stabilization of the hip for proprioceptive feedback
Clam shells with the ball on the wall

Answer 13

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Question 14

MWM – Mobilization with movement – can move into flexion if they don’t have that motion, or ER/IR as well

Answer 14

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Question 15

If they have surgery, those tissues can stuck together so they have to move early. Have to get them on the bike asap, just don’t want adhesions early on.

Answer 15

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Question 16

G

Answer 16

O

Question 17

Adductors are typically a sore spot

Answer 17

Got it

Question 18

Extend the knee and drop into abduction

Answer 18

GOT

Question 19

Working on step up and step downs – working on NM control .

Want front planks, make sure no hip flexion irritability with that.

Answer 19

Got it`

Question 20

Got it

Answer 20

gi

Question 21

Good for direction change, precursor for change of direction drills

Have band around ankles and then tap each direction for the arrow.

Answer 21

GI

Question 22

Got it

Answer 22

Got it

Question 23

Gi

Answer 23

gi

Question 24

Isometric contra fall out – abducted leg is the nonop leg.

Answer 24

Gi

Question 25

gi

Answer 25

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Question 26

gi

Answer 26

gi

Question 27

Hip Flexor Progressions

Precaution: (early/SLOW) progression to hip flexion activity

Early: Do not create (anterior/posterior) hip pain

(Do/Avoid) active straight leg raise
(including any type of trunk curl with the hip flexion such as a sit up)

Start this week 4-6 if everything is going well. If getting a lot of pinching and it is irritated, bring the hip flexor progression a little bit more slowly.

Answer 27

SLOW; anterior; Avoid

Question 28

Eccentric hip flexion – they are moving the trunk to create engagement of the hip flexors in an eccentric manner. Her hand is on his adductors/hamstrings to make sure they aren’t too activated – want to focus on the hip flexors.

Answer 28

gi

Question 29

This is a progression

Sidelying hip flexion to eliminate gravity.

Ball can assist hip flexion

Answer 29

Got it

Question 30

If the femoral head is misshaped they’ll do it this way.

Answer 30

gi

Question 31

Surgical hip dislocation

TTWB / crutches
Hip dislocation precautions:
No flexion above _
No Excessive (IR/ER / adduction)

Abduction precautions – trochanteric osteotomy
No passive (add/abd)
No active (add/abd)

Flex, IR, pop out the back is how people dislocate their hip.

Answer 31

90; IR/ER; add; abd;

Question 32

Watched video in class

Folds who don’t have enough coverage – shallow hip socket. Center edge angle is small. They can create an overhang with the PAO by cutting out the acetabulum and moving it to where they want it.

Intense surgery and pts do really well.

https://www.hss.edu/no-index/animation-PAO-periacetabular-osteotomy.htm

Answer 32

gi

Question 33

More overhang in the postop pic on the right. Typically done to people in their late 20s early 30s who have had pain. They return back to high level activity.

Answer 33

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Question 34

PAO- Peri Acetabular Osteotomy

TTWB - weeks
No active hip (extension/flexion)
No active hip (adduction/abduction)
(not a contra indication but might be painful early)

After 8 weeks Rehab similar to hip FAI surgery

Won’t do hip flexion and abduction because they are not too stable and weak so it doesn’t feel good.

Slower progression compared to hip FAI.

Answer 34

6-8; flexion; abduction;

Question 35

They cut the femur and turned it. They turned the femoral shaft so it wasn’t so anteverted.

Answer 35

gOT

Question 36

Pincer and cam can lead to hip damage – won’t have a good congruent joint, will wear out quicker.

If the cartilage is too far gone/damaged, can only do so much.

Bony correction – surgeon has to take out the right amount of bone - too little – still impingement – too much – unstable

Answer 36

gOTI

Question 37

Doesn’t fix their strength, core control, etc

Look up and down the kinetic chain to find limitations.

All hip rehab – need a stable core to have success.

Answer 37

Got itq