Anatomy
The pelvis is made up of which 3 bones?
Illium, Ischium and Pubis
If your patient has weak glute max, how would you expect them to compensate during gait?
increased trunk extension (lean back) secondary to decreased hip extension
What am I?
Compression of nerve root L4-5 + paresthesia in glutes/back of thigh/lower leg/foot + no back pain
Sciatica
Your patient, complaining of R SI jt pain presents to therapy - ANTERIORLY ROTATED on the R. You decide to do a MET (muscle energy technique) to attempt to correct her pelvic alignment. Describe the position and action of you/your patient as you perform this MET.
to correct anterior rotation: pt supine, R hip and knee flexed, instructed to resist hip extension (can instruct them to resist hip flexion on contralateral side)
REVIEW: manual techniques for correction - anterior/posterior rotations, shotgun,
What are the 3 most common precautions following THA/TRA?
No hip flexion past 90, adduction past neutral, IR past neutral
Which strongest ligament of the hip is also known as the "Y ligament"?
The iliofemoral ligament
If your patient has weak iliopsoas, how would you expect them to compensate during gait?
increased hip ER/circumduction secondary to decreased hip flexion during swing phase
Patients with SI jt dysfunctions oftentimes present with a leg length discrepancy. Name 2 reasons why their legs may appear to be different in length?
1. structural: actual length difference (upper leg/lower leg)*pronated or supinated foot to compensate
2. Functional: unilateral pelvic rotation (anterior, posterior, lateral)
Your patient has been diagnosed with osteoarthritis (OA) of the hip. Name general interventions appropriate for this diagnosis.
-maintain jt mobility/ jt mobs and stretching
-strengthen muscles surrounding the hip
-active rest from irritating activities
Name 2 interventions (manuals or exercises) appropriate for a patient who is 2 weeks s/p R THA?
-AROM in supine, moving to standing with allowed WBing
-isometric exercises for operative side (hip/knee/ankle/core), conditioning exercises for non-operative side
-prevention of hip flexion contracture
-prevent pulmonary and vascular issues
-prevent dislocation/subluxation
-independence with ADLs and mobility
Name 2 hip muscles that are prone to being tight
hip flexors (iliopsoas), piriformis, hamstrings, TFL/ITB, rectus femoris
In unilateral weight bearing, increased firing of this muscle on the stance side prevents pelvic drop
increased firing of the glute med on the stance side prevents pelvic drop
Which muscle group is usually weak in patients diagnosed with patellofemoral impairments and/or ACL issues?
hip ABDs are weak (leading to increased valgus/ shear forces)
Name a hip/spine pathology for which nerve gliding/flossing would be appropriate for?
Sciatica and other nerve related diagnoses
Name 2 interventions (manual or exercise) appropriate to implement for a patient 6 weeks s/p THA?
-restore full ROM/AROM
-improve cardiopulmonary endurance (stationary bike, swimming and aquatic exercise if incision healed)
-increased WBing, progressing to unilateral WBing
-regain strength and endurance (especially hip ABD and extensors)
-progress balance, gait, postural stability
Name 2 hip external rotation muscles
hip ERs (gemellus superior and inferior, obturator internus and externus, quadratus femoris, gluteus maximus, medius, and minimus, psoas major and minor, sartorius)
If your patient presents with a posterior pelvic tilt which muscles would you expect to be tight and which would you expect to be weak?
tight: hamstrings, glutes, and abdominals
weak: hip flexors and back extensors
In patients with hip bursitis (lateral or anterior), to address the muscular imbalances, the PTA would want to stretch the ____ and strengthen the _____.
Stretch the ITB ("stretch") and the hip flexors
Strengthen the hip ABDs
In patients with piriformis syndrome, weak ______/________ are usually present
Weak hip abductors and extensors
What criteria must a patient meet in order to be able to progress from the second phase/ protection phase to the 3rd phase/moderate protection phase following a THR?
-3/5 MMT
-FWB
-AROM=within functional limits (WFL)
-independent ambulator
Tight hip flexors and weak glutes could cause _______ rotation of the pelvis on that side.
Anterior rotation
Review: pelvic rotation, what is tight/weak for each, how to correct (manually and or with exercise)
If your patient has increased IR of the femur on the tibia at the knee, you could expect to see what at the ankle and foot?
eversion of calcaneus and pronation of the foot
This diagnosis occurs when the femoral head does not have full ROM in the acetabulum - causing pinching and pain (possibly damage over time) (pain anterior hip/jt line/groin)
Femoral Acetabular Impingement (FAI)
Cam: too much bone around the femoral head
Pincer: abnormal rim of the acetabulum
During the protection phase (2-4 weeks s/p) following an ORIF, what is the reasonable expectation for hip flexion ROM?
80-90 degrees flexion
Who is at risk for hip fractures?
Women (1 in 7) vs men ( 1 in 17)
women over 5’8 = 2X more likely than women 5’2 and under
Individuals with low bone density (lifestyle factors/smoking, genetic predisposition)
Individuals with high fall risk / balance impairments