Mentoring Minutes: Hip OA

Today's #MentoringMinutes covers Hip OA diagnostics along with manual therapy & therapeutic exercise options in treatment.

***Hip pain with mobility deficits:
For Diagnosis (new changes form 2017 guideline revisions
o Moderate anterior or lateral hip pain during WB
o AM stiffness < 1 hour
o Hip IR ROM < 24 deg
o or < 15 deg opp side
o or painful PROM hip IR
o Hip Flexion < 15 deg from opp side

Important to look at functional activity and make objective
o 6 min walk test, 30 sec STS (ave 12, arms across chest), Step test (15 cm step, 15 sec, mean 14, MDIC 3)

For Assessment:
o ROM: Flexion, IR/ER supine or prone; hip ext — change with lateral distraction
o MMT: Hip abd, Ext, IR/ER in sitting (HHD 5cm ablve malleolus)

Interventions: multiple studies that show a combination of manual therapy, exercise and education, better than just exercise, or manual therapy alone) 
o Distraction thrust
o MWM flexion, and IR with lateral glide (12 deg increased flex, 4 deg increased IR)- 2016 study comparing to sham
o Supine cross over post glide
o Ext PA

Therapeutic exercise
o Rock back with belt
o Supine SKTC with belt (foot or distraction)
o Ext stretch (kneeling or standing)

Patient education
o Activity modification, unloading with assistive decvices and weight loss (loss 5% BMI and 3.3% body fat had improved womac 17% and pain levels 25% improves at 8 months)

Poor prognosis: mod to severe OA, increased joint space 0.3-0.7 mm per year: total rot 42 deg or less, and sx’s longer than 36 months- no change after PT

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