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
***REFERENCES***
Holla JF, Steultjens MP, van der Leeden M, et al. Determinants of range of joint motion in patients with early symptomatic osteoarthritis of the hip and/or knee: an exploratory study in the CHECK cohort. Osteoarthritis Cartilage. 2011;19:411-419. https://doi.org/10.1016/j.joca.2011.01.013
French HP, Cusack T, Brennan A, et al. Exercise and manual physiotherapy arthritis research trial (EMPART) for osteoarthritis of the hip: a multicenter randomized controlled trial. Arch Phys Med Rehabil. 2013;94:302-314. https://doi.org/10.1016/j.apmr.2012.09.03
Wright AA, Cook C, Abbott JH. Variables associated with the progression of hip osteoarthritis: a systematic review. Arthritis Rheum. 2009;61:925- 936. https://doi.org/10.1002/art.24641
Kim C, Nevitt MC, Niu J, et al. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ. 2015;351:h5983. https://doi.org/10.1136/bmj.h5983
Bieler T, Magnusson SP, Kjaer M, Beyer N. Intra-rater reliability and agree- ment of muscle strength, power and functional performance measures in patients with hip osteoarthritis. J Rehabil Med. 2014;46:997-1005. https:// doi.org/10.2340/16501977-1864
Choi YM, Dobson F, Martin J, Bennell KL, Hinman RS. Interrater and intra- rater reliability of common clinical standing balance tests for people with hip osteoarthritis. Phys Ther. 2014;94:696-704. https://doi.org/10.2522/ ptj.20130266
Pua YH, Wrigley TV, Cowan SM, Bennell KL. Intrarater test-retest reliability of hip range of motion and hip muscle strength measurements in per- sons with hip osteoarthritis. Arch Phys Med Rehabil. 2008;89:1146-1154. https://doi.org/10.1016/j.apmr.2007.10.028
Bennell KL, Egerton T, Martin J, et al. Effect of physical therapy on pain and function in patients with hip osteoarthritis: a randomized clinical trial. JAMA. 2014;311:1987-1997. https://doi.org/10.1001/jama.2014.4591
Beselga C, Neto F, Alburquerque-Sendín F, Hall T, Oliveira-
Campelo N. Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: a randomised controlled trial. Man Ther. 2016;22:80-85. https://doi.org/10.1016/j.math.2015.10.007
Paans N, van den Akker-Scheek I, Dilling RG, et al. Effect of exercise and weight loss in people who have hip osteoarthritis and are overweight or obese: a prospective cohort study. Phys Ther. 2013;93:137-146. https:// doi.org/10.2522/ptj.20110418