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COnduct a physical examination of a pt with hip pain in standing?
- Always compare sides!
- - deformities- flex/ ext, lordosis
- - weight bearing
- - swelling
- - mm spasm
- - mm wasting
- - leg lenght
- Trendelenburg test- standing on one leg- shift weight
- - weight bearing leg hip higher- no glutes
- Balance- rhombergs
- - if the knee is rotated the hip is- if femur rot the knee cap points out
- - look for lordosis
- - COG
Conduct a physical examination of a pt with hip problems in walking.
- - walk forwards/ backwards/ sideways
- - antalgic gait (penguin)- compensation
- - uneven
- - swinging- leg around
- - waddling
- - adducted
- - trendelenburg (weakness of abductors)- model
Conduct an active movement assessment of a pt with hip problems.
- always ask pt if a certain movement hurts
- Compare to the other side
- Minimise the lumbar spine movements during hip testing
- - flexion- can you bring you knees to your chest
- - abd/adduction- supine ??? bring across/ away from midline. To OP hand on other side of hip.
- - ER/IR- sitting is the easiest position. Can do it supine. OP in sitting stablise the femur on bed. Int rot take foot away fom midline, ext rot take foot across midline.
- - leg length
- thomas test
Conduct some functional tests on your pt with hip problems
Clear Lsp- full range flex/ ext, SIJ, knee- squat
- - anything the pt says is aggravating
- - aggravating/ injury movement
- - stairs- depstep up/ down
- - squat-full hip flex- feet flat
- - rot in standing- test ext and int rotation-pt standing, test leg off the floor at 90 degrees and int/ ext rotate hip.
Conduting passive movements of a pt withhip problems
- I am going to do the movements for you!
- Support leg
- compare to the other side
- - hip flexion (140 degrees)
- - abduction (45 degrees)
- - adduction (25 degrees)
- - int rotation- neurtal and at 90 degrees flex (45 degrees)
- - ext rotation- " " (60 degrees)
What should you palpate on a hip problem pt?
- Note specific palapation is to be done at theend of the examination
- - temp/ swelling
- - anatomy- greater trochanter
- - abductor insertion (pubic symphysis)
- - symphysis pubis
- - sciatic- 1/2 between greater trochanter and ischial tuberosity
- - femoral- 1/2 way between ASIS and pubic symphosis
- - lateral cutaneous (medial to ASIS, below inguinal lig)
- - trochanteric- side lying
- - psoas- in hip flexion
- - ischial- back
What are the special test you would conduct for a hip problemed pt?
- Do no harm!
- - Quadrants (flex/ add/ +/- IR)
- - fabers test (flex/ abd/ ER) - testing ant hip jt and capsule.
What static muscles test would you conduct on a pt with hip problems?
- - this is a way to differentiate - working out when the pain comes on- with/ without contraction
- - for groin tear- squeeze legs
- - flex
- - ext
- - abd
- - add
- - IR
- - ER
What is the obers test?
- - pt in sidelying
- - test for tightness of ITB
- - pull leg back in ext with knee flex
- - once at end range straighten leg and let it drop, watch for cheat movements
- - comapre to the other side
DONT FORGET ABOUT MOVEMENT DIAGRAMS
What can be conducted in sidelying when testing a hip pt?
- - static mm- abduction
- - accessories
- * Ap, PA
- * caudad glide
- * lateral glide
- Obers test
What are the accessories for a pt with hip problems?
- - longitudinal caudad (neutral/ 90 degrees flex) knee bent pull down
- - longitudinal cephalad (neutral/ 90 degrees flex)- knee bent push up
- - A/P, PA
- - lateral glide (neutral/ 90 degrees flex)- seat belt
What movements can you conduct when a pt is in prone lying for a hip?
- active movements:
- - ER, IR, Ext
- Passive physiological movements
- - ext 15 degrees
- -IR/ER- good in prone- hip in diff position
- Static mm tests
- - IR/ER
- - Ext
- -PA glide
How would you trefl;eat int rotation for a hip problem pt?
- supine: grade 1 and 2
- Ext: supine grade 3 and 4
- Ext: prone grade 3 and 4
- Flex: grade 3 and 4
- Why would you chose certain positions?
WHat are the grades of mobilisation and how long would you treat a pt for?
- grade 1- small movement- treat pain
- grade 2- larger movement but no into restriciton- treat pain
- garde 3- larger movmtent into restriction- treat stiffness
- grade 4- small movement at end of range- treat stiffness
test for 30 sec see how it goes then 3x 30 sec
How would you treat ext rotation for a hip problem pt?
- flexion supine (90 degrees hip/ knee flex)- grade 3/4
- ext prone (90 degrees knee flex)-grade 3/4
What are some passive physiological mobilisation techniques for flexion/ adduction of the hip?
- Flexion adduction:
- grade 4- smaller movement at end range
- grade 3- bigger movement
- grade 2- irritable pt easy to mid range
This technique is not often used at end range
What is a passive accessory mobilisation technique lateral movement?
- Grades 1- 4
- alt position- sidelying for grade 1.
- flex and int rotation
- if stiff bring into more flex
Conduct a PAM longitudinal caudad on a pt with hip pain.
Why chose this technique?
- pull down/ can flex leg and sit on foot.
- supine: neutral or flexion- grades 1-4
- sidelying: thumbs for grade 1 and hands around lower thigh for grade 1 and 2
- PAM- used for pain relieving when compression is an irritant.
Demonstrate how you would conduct a assive hysiological technique on a pt with hip pain, in abduction. When wouldnt you use this technique?
- Abd/ Felx
- Abd/ ext for grade 2
- for grades 1-4
- Not really used with abduction sprain
Passive physiological technique and ext for the hip.
Demonstrate a PA glide on a pt with hip problems? And why would you use this technique?
- ant to post
- - sidelying, identify greater trochanter
- - thumbs grade 1 and 2
- - heel of hand grade 3 and 4
- Ensure pt comfort
- trying to improve flex????
What exercise would you give to a pt with hip problems and why?
- stretching- of hip flexors, pulling pelvis into ant pelvic tilt
- strenghtening- glute mucles to stabilise the pelvis
- gai correction
- postural correction
- heat/ cold
What is a passive accessory movement?
- A movement that the pt cannot produce volumtarily
- Always compare to the other side
- roll, spin, glide, compress, distract
- low accessory movements = low physiological movements
WHat is a passive physiological movement?
- a physiological movement is one a pt can do, but due to it being passive it means the therapist does the movement for the pt!
- Muslces are not activated- non contractile, helps differentiate muscle vs inert structures as source of pain
- End feel, ROM- normal? COmpare sides
Demonstrate a thomas test for a hip pt.