Manual Therapy and Therapeutic Exercise for Common Orthopedic Conditions and Functional Mobility: Summary 54
HIP JOINT: BIOMECHANICS AND CONDITIONS Hip Joint Mechanics The hip is a ball-and-socket joint (convex femur on concave acetabulum) allowing motion in three planes with significant open chain mobility: • Flexion: Anterior roll, posterior glide • Extension : Posterior roll, anterior glide • Abduction : Lateral roll, inferior glide • Adduction : Medial roll, superior glide • External Rotation : Posterior roll, anterior glide • Internal Rotation : Anterior roll, posterior glide LEARNING TIP!
TOTAL HIP ARTHROPLASTY (THA) THA is considered the "surgery of the century" due to high patient satisfaction and functional improvements. The direct anterior approach shows better outcomes with less pain. Therapeutic Exercise for THA A comprehensive program includes: • Pelvic Stability Training : Exercises to stabilize the pelvis: ○ Weight shifts (on/off foam), supported/ unsupported SL stance, hip hikes, balance board weight shifts, balance on foam or BOSU, core training, bridging • Functional Training : Activities that mimic daily movements: ○ Gait training (multi directions), sit to stands, step ups, step downs • Strength Training : Progressive resistance exercise into hip ABD, flexion, extension, and knee extension: ○ Standing 3 way hip kick with pulley resistance, increasing by 10% every 2 weeks Research shows that about 12% of patients continue to limp after THA due to decreased hip abductor and adductor strength, highlighting the importance of addressing muscle length and strength. Hip Fractures The most common hip fractures are femoral neck and intertrochanteric fractures. Trochanteric fractures are generally more painful with greater weakness and gait difficulty. SHOULDER JOINT: BIOMECHANICS AND CONDITIONS Shoulder Mechanics The shoulder's primary role is positioning the hand in space, making it the most mobile joint and therefore the most unstable . Glenohumeral motion is accompanied by scapulothoracic, acromioclavicular, and sternoclavicular joint movements. ACTIVITY ROM Brushing hair 120 degrees abduction 90 degrees external rotation Tuck in shirt 30 degrees extension 90 degrees internal rotation 60 degrees adduction Eating 60 degrees abduction 45 degrees horizontal adduction Applying deodorant 45 degrees flexion 60 degrees horizontal adduction Cleaning ear 110 degrees abduction 80 degrees external rotation
In closed chain mechanics, the concave acetabulum moves on the convex femoral head with physiologic and accessory movements in the same direction. For example, as the pelvis progresses forward over the planted lower extremity during gait, the concave surface of the acetabulum rolls anteriorly and glides anteriorly.
HIP OSTEOARTHRITIS As a large weight-bearing joint, the hip commonly develops OA, characterized by cartilage loss, subchondral cysts, osteophyte formation, ligamentous laxity, and possible inflammation. Manual Therapy for Hip OA Clinical practice guidelines recommend thrust, non-thrust, and soft tissue mobilization for mild to moderate hip OA. Common techniques include long axis distraction, lateral and caudal glides, and mobilization with movement for flexion and internal rotation. Therapeutic Exercise for Hip OA Research shows decreased muscle volume in the gluteal muscles on the affected side . Exercise positively impacts pain, function, and quality of life. Specific interventions include: • Gluteus Medius Strengthening : During walking, the gluteus medius muscle is responsible for stabilizing the pelvis in a single leg stance. Exercises for strengthening include side plank, single leg bridge, side-lying hip abduction with internal rotation, lateral step-up, and hip hitch exercises • Gluteus Maximus Strengthening : Tightness in the iliopsoas muscles and hip joint pain can inhibit gluteus maximus function. Strengthening activities include front plank with hip extension, gluteal squeeze, lateral step-up, and forward step-up • High-Intensity Strengthening : Programs at ≥70% 1RM or multiple sets of <12 repetitions show better functional outcomes
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