Pathologies of the hip are highly subjective to ______?
Regional Interdependence
It is not uncommon for pts. to have LBP that mimics hip pain and vice versa
What are 6 medical history/conditions that may contribute to hip pain?
- Back pain
- Hip sprains/fractures,
- Congenital abnormalities
- Known hip osteoarthritis
- History of slipped capital femoral epiphysis (SCFE)
- History of Legg Calve Perthes disease as a child?
True or False: Tenderness to palpation should be assessed at the beginning of an examination
FALSE
Save tenderness to palpation to end of exam so that finding does not skew your examination
List 5 muscles for which a muscle length examination should be performed for when addressing pathologies at the hip.
- Iliopsoas
- Rectus femoris
- Hamstrings
- TFL/ITB
- Piriformis
Inferior glide is done to increase ______ ROM at the hip.
Abduction
Posterior glide is done to increase ______ ROM at the hip.
flexion and internal rotation
Anterior glide is done to increase ______ ROM at the hip.
Extension and external rotation
Posterolateral glide is done to increase ______ ROM at the hip.
Internal rotation
Lateral glide is done to increase ______ ROM at the hip.
Adduction and internal rotation
What structure must be cleared prior to administering a special test on the hip?
Must clear the LUMBAR SPINE
What are four common sites of avulsion fractures?
- ASIS
- AIIS
- Lesser trochanter
- Ischial tuberosity
Where do stress fractures typically occur at the hip?
Femoral Neck
What are the 7 criteria used to diagnose hip OA?
- Age 50 years or older
- Moderate anterior/lateral hip pain during WB
- Morning stiffness that lasts for < 1 hour after wakening
- Hip IR PROM is < by at least 24 deg OR limited hip IR and flexion PROM is < by at least 15 deg compared with the unaffected hip
- Increase in pain with hip IR PROM
- Absence of signs/ symptoms inconsistent with hip OA
- NOTE THE ABSENCE OF A CAPSULAR PATTERN AS A DIAGNOSTIC CRITERIA
What are 5 things that should be included in an examination to aid in generating a PT diagnosis?
- Demographics
- Pain (VAS)
- ‘What activities make the patient worse?’
- Gait
- Passive range of motion
List 4 functional tests that are relevant to administer on a patient with hip pain.
- WOMAC
- 6MWT
- TUG
- Timed SLS
List 4 areas to consider providing patient education on in patients with hip pathologies.
- WB activity modification
- Methods of unloading arthritic joints
- Exercise
- Weight loss (if overweight)
Patients should receive training in what 3 areas?
- Functional training
- Balance training
- Gait training
Hip __(1)___ PROM and __(3)___ strength should be checked for impairment prior to prescribing flexibility, strengthening and endurance exercises.
Hip Extension PROM
Hip abductor, extensor and ER strength
What modality has been recommended in treating hip OA? Parameters?
Ultrasound
1 MHz; 1 W/cm2 for 5 minutes each to the anterior, lateral and posterior hip for a total of 10 treatments over a 2-week period
True or False: Bracing is recommended as part of the first line of treatment for hip OA
FALSE, not recommended as part of first line treatment
List 3 situations where it is appropriate to use bracing as an intervention for treating OA.
- Bilateral OA
- after exercise / manual therapy has been determined to be unsuccessful in improving function
- For activities that require turning / pivoting for patients with mild to moderate hip OA
What are 3 ways glut med/min, hamstring, rec fem, and iliopsoas tendinopathy can be diagnosed?
- Resisted isometric (Strong and painful
- Passive stretching (PROM)
- Palpation (tenderness and soft tissue restriction evident)
What 3 examination findings are present with a gluteus medius tear?
- Lateral Hip Pain
- Positive SLS test (asymmetric drop of the contralateral pelvis evident)
- Possible positive Trendelenburg during gait
What 2 examination findings are present with a gluteus medius tendinopathy?
- Positive Trendelenburg sign
2. Pain with resisted hip abduction
