Chapter 1: An Overview of Hip and Knee Rehabilitation for the Physical Therapist, Updated 4 Contact Hours
Expiration Date : June 3, 2025 Learning outcomes Describe the functional relationship and physical therapy examination of the hip and knee. Identify valid and reliable outcome measures for the hip. Describe hip pathologies and their physical therapy interventions. Course overview Due to the anatomy and importance of the essential functions of the hips and knees, severe pain in either one or both of these areas can have a direct adverse effect on everyday life and can severely reduce quality of life. There is a biomechanical reliance on each of these joints to function optimally during activities of daily living. Approximately 22% of the general population suffers from knee pain, and knee and hip pain are even more common in older people (Damen, 2019). Disruption in either one can result
Identify valid and reliable outcome measures for the knee. Describe knee pathologies and their physical therapy interventions.
in aberrant movements of the other, and they rely on coordination and common nerve and muscular performance during ambulation. This course will focus on these two joints individually and as they relate to each other, and discuss various symptoms, treatments, and effective plans of treatment for optimum patient outcome.
THE FUNCTIONAL RELATIONSHIP OF THE HIP AND KNEE AND IMPLICATIONS FOR REHABILITATION
Due to their proximity anatomically, biomechanical relationships during ambulation, and sharing of musculature and nerves, both the knee and hip should always be considered in treatment plans for the other. For example, Evaluation of the hip and knee Prior to the physical therapy evaluation of a new patient, the physical therapist can gather pertinent information through analysis of a body chart and subjective information provided on intake forms. When analyzing the body chart, the physical therapist should take note of the areas demarcated, type of pain, and duration of symptoms. The physical therapist must also screen for red flags including night sweats, change in appetite, sudden unexplained weight loss or gain, nausea, vomiting, and changes in bowel or bladder habits. If there is not a clear explanation for these red flags and symptoms do not appear to be musculoskeletal in nature, the patient should be immediately referred to their physician. Additionally, bone pain and visceral pain must be ruled out, as both tend to be painful regardless of position. Differential diagnosis requires the physical therapist to discern between localized pain and referred pain. The third lumbar nerve (L3 nerve root) refers pain to the lateral aspect of the hip, therefore evaluation of the spine is necessary to rule out lumbar pathology as the cause of hip pain. Analyses of risk factors for hip pathology include prior hip injury, developmental disorders, advanced age, and presence of osteophyte formation on radiograph films. Patient-reported problems and functional limitations should be noted, and goals should be made based upon this information (Cibulka et al., 2009). Objective evaluation measures should begin with an assessment of the patient’s dynamic capabilities including: ● Visual inspection of posture and alignment of the body, including pelvic position, knee alignment, and foot position: Take note of visible muscle wasting, swelling, discoloration, and deformities.
hip joint impairments have been identified in many patients with knee pain, including osteoarthritis (OA), and thus treatment of the hip is often implicated to address the primary symptom of knee pain. ● Gait analysis: Observe in both the sagittal and frontal plane, noting the type of assistive device used if necessary. ● Functional squat test: Ask the patient to squat down to the ground and observe symmetry of the lower extremities, alignment of the trunk, hips, and knees. Additionally, observe the patient’s ability to return to standing, and whether or not it is necessary to rely on the use of upper extremities. ● The ability to perform 10 heel raises with or without upper extremity support: Note symmetry of muscle tone in the lower extremity, and balance. ● 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.
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