● Single limb stance: Note the duration of balance on each leg. Objective measures and provocative testing should include, at a minimum: ● Spine range of motion in flexion, extension, side-bending, and rotation. ● The Stork (Gillet) test to assess sacroiliac joint mobility and dysfunction. ● Manual muscle testing of all hip, abdominal, and knee musculature, with particular attention to weak hip abductor musculature, which is highly correlated with many forms of knee pathology including patellofemoral pain syndrome and general knee pain (Noehren, 2010). ● Hip and knee range of motion including hip flexion and extension, internal and external rotation, and knee flexion and extension. ● Flexion, Abduction, External Rotation (FABER) test to assess hip mobility and pain in the sacroiliac joint. ● Ober test to assess iliotibial band tightness. ● Thomas test to assess quadriceps length. ● Hip scour to assess pain between the femoral head and acetabulum. ● Posterior Shear (POSH) test of the pelvis to assess sacroiliac joint mobility and pain. ● Straight-leg raise, both passive and active, to assess for disc lesion and the effect of core strength on lower back and hip symptoms. Outcome measures for the hip Outcome measures are standardized assessment tools used to assess baseline levels of ability or pain, and utilized during re-evaluation and progress reporting to demonstrate progress towards goals set by the patient and physical therapist. Some outcome measures are based on the patient’s self-report and some tools and tests are conducted by a physical therapist or other qualified examiner. The following tools are the most widely used and validated tools used for the hip: ● Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): This patient self-report tool assesses pain, stiffness, and physical function in patients with osteoarthritis (OA) in the knee or hip. There are 24 patient self-reported items within three subcategories (pain, stiffness, and physical function; American College of Rheumatology, n.d.). The WOMAC tool is useful to analyze changes in patient function following physical therapy treatment. The WOMAC tool has been validated for delivery via mobile phone, making it a quick and convenient method for patient use (Bellamy et al., 2011). ● Lower-Extremity Function Scale (LEFS): The LEFS is a self-reported measure of activity limitation developed for the lower extremities and has been shown to be a valid tool in the measurement of lower-extremity function in a population of patients with orthopedic problems. A change of 9 points
● Spine passive intervertebral test to assess joint mobility. ● Hamstring flexibility. ● Limb length, which is measured from the anterior superior iliac spine to the medial malleolus. Assessment specific to the knee patient will include all of the above tests in addition to: ● Lachman’s test to assess for integrity of the anterior cruciate ligament (ACL). ● Anterior drawer test to assess the integrity of the ACL. ● Pivot shift test, a clinical phenomenon of anterior subluxation of lateral tibial plateau in relation to the femoral condyle when the knee approaches extension, used to diagnose ACL injury. ● Posterior drawer test to assess the integrity of the posterior cruciate ligament (PCL). ● McMurray’s test to assess for meniscus tear. ● Varus/Valgus test to assess for lateral collateral or medial collateral integrity, respectively. ● Apley’s Grind test to assess for meniscus tear. ● Patella Grind test to assess for sub-patellar dysfunction. ● Patella lateral apprehension test to assess for patellar hypermobility and subluxation. ● Ely’s test to assess rectus femoris length. on the LEFS has been shown to represent a minimal clinically important difference (Binkley et al., 1999). ● Hip Disability and Osteoarthritis Outcome Score (HOOS): This a self-reported measure useful for evaluation of patient- relative outcomes including pain, sport and recreation, and hip-related quality of life for patients with OA, and was most recently found to be valid and responsive for patients undergoing total hip arthroplasty. It was found to be most responsive for patients under 66 years of age (Nilsdotter et al., 2003). ● Harris Hip Score: This is a 10-point self-reported functional outcome measure valid for use on patients with hip OA. A change in 4 points indicates a clinically meaningful difference. This outcome is often used for research purposes (MacDonald et al., 2006). ● Timed Up and Go (TUG): This tool is conducted by an examiner and measures the time in seconds that a patient requires to stand up from an armless chair (chair height = 45 cm), walk a distance of 3 meters, turn, walk back to the chair, and sit down (Ibrahim, 2017). ● Patient-specific Functional Scale: This clinical outcome measure allows patients to report their functional status in areas meaningful to them at baseline and follow-up (Mathis, 2019).
HIP PATHOLOGIES AND EVIDENCE FOR INTERVENTIONS
Hip pathology and impairments are prevalent across all ages and genders (Larkin, 2017). Additionally, they are commonly seen in the clinical environment, thus a thorough examination to Hip osteoarthritis Osteoarthritis (OA) is a progressive disorder characterized by loss of articular cartilage and formation of osteophytes resulting in loss of motion, decreased functional capability, and decreased quality of life. OA is associated with joint pain and functional limitation and is a leading cause of disability among older people. OA is considered the most common form of arthritis from which 15-18% of the population suffers (Damen 2019). Hip OA also affects younger adults, with a profound impact on well-being and work capacity. Structural hip deformities including those contributing to femoroacetabular impingement syndrome are strong predictors of early-onset hip OA. Increased
determine the driver of impairment is important for proper plan of care and intervention strategy.
rates of obesity and sports injuries may induce a future surge in OA incidence among younger people (Akerman, 2017). Assessment of hip OA in younger people should focus on a patient-centered history, comprehensive physical examination, performance-based measures, and patient-reported outcome measures to enable monitoring of symptoms and function over time. Referral for imaging should be reserved for people presenting with atypical signs or symptoms that may indicate diagnoses other than OA. Nonpharmacological approaches are core strategies for the management of hip OA in younger people, and these include appropriate disease- related education, activity modification
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