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chapter 24. Hip. Hip. A common site for pain referral Lumbar disc Organ disease Myofascial pain SI dysfunction Knee Force transmitter for upper and lower extremities Stability for upper- and lower-extremity activities
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chapter24 Hip
Hip • A common site for pain referral • Lumbar disc • Organ disease • Myofascial pain • SI dysfunction • Knee • Force transmitter for upper and lower extremities • Stability for upper- and lower-extremity activities • experiences repetitive, microtraumatic injuries more often than acute, macrotraumatic injuries Reassess if no change after 2 weeks of treatment
Hip Alignment Coxa valga (see figure 24.1b) • Angle between neck and shaft = >125° • Femoral head load, femoral neck stress • Lengthens the limb • Hip abductor effectiveness Coxa vara (see figure 24.1c) • Angle between neck and shaft = <125° • Femoral neck stress, femoral head load • Shortens the limb • Hip abductor effectiveness
Transverse Plane Hip Alignment Retroversion (see figure 24.2b) • Femoral neck is rotated in relation to femoral shaft at an angle <12° • External rotation (ER), toe-out gait • Supinated foot, frog-eyed patellae, Q-angle, lumbar lordosis (continued)
Transverse Plane Hip Alignment (continued) Anteversion (see figure 24.2c) • Femoral neck rotated in relation to femoral shaft at an angle >15° • Internal rotation (IR), toe-in gait • Pronated foot, squinting patellae, Q-angle, lumbar lordosis
Neural Considerations • Sciatic nerve • Can run through piriformis • Impingement: posterior leg, calf symptoms • Lateral femoral cutaneous nerve • Goes through psoas major and under inguinal ligament • Impingement: tensor fascia latae, anterolateral thigh ache/burn • Obturator nerve • Enters thigh to provide sensory and motor innervation to medial thigh • Impingement: medial thigh sensory, adductor strength changes
Joint Mobility • Convex on concave rule • Resting position: 30° flexion, 30° abduction, slight lateral rotation • Close-packed position: full extension, abduction, and internal rotation • Capsular pattern: • ER = normal • IR = most restricted • Loss of motion: IR > flexion and abduction > extension
Influence of Pelvis • Pelvis movement influences hip movement • Anterior pelvic tilt • Moves anterior pelvis closer to anterior femur • Hip flexion • Posterior pelvic tilt • Moves posterior pelvis closer to posterior femur • Hip extension
Unilateral Weight Bearing • In one-leg stance: • Rotation stress on hip • Hip abductors prevent contralateral pelvic drop • Necessary abductor force • >BW 2° LAL (lever-arm length) • If weak, hip will drop or patient must lean to BW LAL
Assistive Devices in Ambulation • Assistive devices used to assist weak hip abductors • Cane on opposite side upward counterbalance force • Force through cane is small (~15%): cane LAL = >CoG LAL
Leg-Length Discrepancies • Can be caused by true length or soft-tissue differences • Pelvis drops on shorter side; trunk bends away from the short leg in weight bearing • Uneven shoe wear most obvious indication • Can lead to osteoarthritis of longer leg
Reducing Hip Stress in AcuteLower-Extremity Injuries • Goal post-injury: normal gait • Antalgic gait: requires assistive devices until normal ambulation is possible • Stride length during walking or running • Smaller stride reduces the force and motion demands • Spica wrap
Rehabilitation Considerations • Hip pain can be difficult to interpret since there are several referring sources of pain • Hip: to groin, medial anterior thigh • Spine: to anterior hip, buttock, thigh • Sacrum: buttock, posterior thigh, lateral thigh • Organs and abdomen: to groin • Differential diagnosis may be needed (continued)
Rehabilitation Considerations (continued) • Some hip injuries are self-limiting. • Predisposing factors must be corrected to reduce recurrence. • Inclusion exercises: • Hip stabilization • Knee and ankle weakness • Trunk stabilization
Soft-Tissue Mobilization • If Rx is not effective, reassess: • Soft-tissue techniques • Deep-tissue massage • Scar-tissue massage • Cross-friction mobilization • Myofascial release (i.e., trigger point and ice-and-stretch) • End with active stretches • Home exercise program: Stretches, self-mobilization
Joint Mobilization • Capsular pattern: grades III, IV • Techniques • I and II: oscillating • III and IV: sustained or oscillating • Little need to stabilize hip joint before mobilization; pelvis is sufficient anchor • Self-mobilization: with strap or on step
