As healing progresses and symptoms subside, the emphasis of management includes the following goals and interventions.

Progressively Increase Joint Play and Soft Tissue Mobility
Joint mobilization techniques. Progress joint mobilization to stretch grades (grade III sustained or grade III and IV oscillation) using the glides that stretch restricting capsular tissue at the end of the available ROM. Vigorous stretching should not be undertaken until the chronic stage of healing.

Passive stretching, neuromuscular inhibition, and self-stretching techniques.
Stretch any range-limiting tissues. Suggested techniques are described in and in the exercise section later in this chapter.

Improve Joint Tracking and Pain-Free Motion
Mobilization with movement (MWM) techniques may be applied through the use of a mobilization belt to produce a pain-free inferolateral glide and then superimposing motion to the end of the available range. As with all MWM techniques, no pain should be experienced during application of the technique. Principles of MWM are described in; specific hip MWM techniques are described here.

Increase Internal Rotation
Patient position. Supine with the involved hip flexed and a mobilization belt secured around the proximal thigh and your pelvis.

Procedure. Stabilize the patient’s pelvis with the palm of the hand closest to the patient’s head. Use the mobilization belt to produce a pain-free inferolateral glide while the caudal hand grips around the flexed thigh and shin to create pain-free end-range internal rotation

Increase Flexion
Patient position. Supine with the involved hip flexed and a mobilization belt secured around the proximal thigh and the pelvis.

Procedure. Stabilize the patient’s pelvis with the palm of the hand closest to the patient’s head. Use the mobilization belt to produce a pain-free inferolateral glide while the caudal hand grips around the flexed thigh and shin to create pain-free end-range flexion.

Increase Extension
Patient position. Supine with the pelvis near the end of the treatment table in the Thomas test position (opposite thigh held against the chest) and a mobilization belt secured around the proximal thigh and your pelvis.

Procedure.Stabilize the patient’s pelvis with the palm of the hand closest to the patient’s head. Use the mobilization belt to produce a pain-free inferolateral glide while the caudal hand presses against the extended thigh to create pain-free end-range extension .

Increase Extension During Weight Bearing
Patient position. Standing with the unaffected foot up on a stool and a mobilization belt secured around the proximal thigh and your pelvis.

Procedure. Stabilize the pelvis with both hands and apply a pain-free lateral glide with the mobilization belt while the patient lunges forward to produce painless extension of the affected hip.

Improve Muscle Performance in Supporting Muscles
• Initiate exercises that develop strength and control of the hip musculature (especially the gluteus maximus, gluteus medius, and rotators) and that improve stability and balance when performing weight-bearing activities. Begin with submaximal isometric resistance; progress to dynamic resistance as the patient tolerates movement. If any exercises exacerbate the joint symptoms, reduce the intensity. Also reassess the patient’s functional activities and adapt them to reduce the stress.

• Progress to functional exercises as tolerated using closed-chain and weight-bearing activities. The patient may require assistive devices while weight bearing. Use a pool or tank to reduce the effects of gravity to allow partial weight-bearing exercises without stress.

• Develop postural awareness and balance.

• Progress the low-impact aerobic exercise program (swimming, cycling, or walking within tolerance).

Patient Education
Help the patient establish a balance between activity and rest and learn the importance of minimizing stressful deforming forces by maintaining muscle strength and flexibility in the hip region.

Buy the Book that holds this excerpt: Therapeutic Exercise: Foundations and Techniques (Therapeutic Exercise: Foundations & Techniques)

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