An interesting group of patients we have been seeing are many women with hip dysplasia.
As shown in one of our earlier gait videos this past week, you note a vaulting to clear the long limb, she has a 2cm leg length discrepancy and a set of impairments that helps to define this clinical pattern. (PS. The model in the pictures where the face is showing, is not the patient, just a volunteer from the clinic.)
Significant loss of ipsilateral hip ER range of motion
Typically increased hip IR
Decreased left hip accessory mobility
Significant weakness of the hip abductors
Significant weakness of the hip extensors
As suggested by the clinical practice guidelines, our primary management involved manual therapy and exercises that helped to restore hip joint mobility as shown below…
Long axis distraction joint manipulations
Mobilizations with movement to improve hip external rotation
This was followed by exercises to improve the muscle power deficits of the hip abductors and extensors.
Clam shells to work on gluteus medius activation
Increasing the load with theraband for hip abduction external rotation
An orthotic to minimize the leg length discrepancy was used to improve the gait pattern.
This pattern is unique since we do not see much of this in our country where hip dysplasia is screened for and addressed early in life. Typically, we see hip pain with mobility deficits in the 50 and over age group as the hip joint osteoarthritis progresses. This mobility deficit (hip dysplasia), we find in young people and the loss of hip external rotation is very different than the hip osteoarthritis group, which generally lacks hip internal rotation. Ultimately, the key impairment is a loss of mobility and secondarily a loss of muscle strength.
Physical therapy can be successful for these patients as long as we recognize the clinical pattern and address it with relevant interventions!