Mentoring Minutes covers a helpful sequence in treating non-arthritic hip pain
*** NOTES & REFERENCES ***
DDx:
—FAI Labral, chondral lesions
—good research on what it is and assess it (guidelines A and B) but evidence limited with how to best manage/ treat it (F);
Assessment
—Trendelburg test (hold 3 sec without hip drop)
—FABER: pain, range side to side
—FADIR (90 deg hip knee flexion, then IR/add- postive ROS – if negative repeate in full flexion;
—PROM flexion- painful., repeate with inf glide
—Hip PROM IR/ER Seated at 90, prone at 0; - greater than 30 deg
—2012 those who display excessive hip internal rotation range of motion compared to external rotation range of motion have weakness in the hip exter- nal rotator muscles.
—MMT: Hip abd/ post glut med)- hold for 3 sec- add HHD 5 mm ablve malleolous
—MMT Hip ext: muscle activation: and MMT
MMT: hip ER 90 deg sitting nad 0 deg;
Rx:
—emphasis on abd and ER to improve rotational stability;
clams, with TB holds- progressed to in side plank; quadruped —hip ext/ER
—Standing (breugers wrap- squat hold weight shift,, heel taps, sliders, to lateral walks- progressed to single limb deadlifts, and rotational airplanes
—Education: avoid EOR motion, ER, IR, ext
Cliborne AV, Wainner RS, Rhon DI, et al. Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mo- bilization. J Orthop Sports Phys Ther. 2004;34:676-685. http://dx.doi.org/10.2519/jospt.2004.34.11.676
Cliborne AV, Wainner RS, Rhon DI, et al. Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mo- bilization. J Orthop Sports Phys Ther. 2004;34:676-685. http://dx.doi.org/10.2519/jospt.2004.34.11.676
Wyss TF, Clark JM, Weishaupt D, Nötzli HP. Correlation between in- ternal rotation and bony anatomy in the hip. Clin Orthop Relat Res. 2007;460:152-158. http://dx.doi.org/10.1097/BLO.0b013e3180399430
Krause DA, Schlagel SJ, Stember BM, Zoetewey JE, Hollman JH. Influ- ence of lever arm and stabilization on measures of hip abduction and adduction torque obtained by hand-held dynamometry. Arch Phys Med Rehabil. 2007;88:37-42. http://dx.doi.org/10.1016/j.apmr.2006.09.011
Cibulka MT, Strube MJ, Meier D, et al. Symmetrical and asymmetrical hip rotation and its relationship to hip rotator muscle strength. Clin Biomech (Bristol, Avon). 2010;25:56-62. http://dx.doi.org/10.1016/j. clinbiomech.2009.09.006