In conjunction with medical management of the disease for inflammation and pain, correction of faulty mechanics is an integral part of decreasing pain in the hip. Faulty hip mechanics may be caused by conditions such as obesity, leg-length differences, muscle length and strength imbalances, sacroiliac dysfunction, poor posture, or injury to other joints in the chain. The following goals and interventions are emphasized during the acute stage of tissue healing and the protection phase of nonoperative management.

Decrease Pain at Rest

• Apply grade I or II oscillation techniques with the joint in the resting position.
• Have the patient rock in a rocking chair to provide gentle oscillations to the lower extremity joints as well as a stimulus to the mechanoreceptors in the joints.

Decrease Pain During Weight-Bearing Activities

• Provide assistive devices for ambulation to help reduce stress on the hip joint. If the pain is unilateral, teach the patient to walk with a single cane or crutch on the side opposite the painful joint.
• If leg-length asymmetry is causing hip joint stress, gradually elevate the short leg with lifts in the shoe.
• Modify chairs to provide an elevated and firm surface, and adapt commodes with an elevated seat to make sitting down and standing up easier.

Decrease Effects of Stiffness and Maintain Available Motion

• Teach the patient the importance of frequently moving the hips through their ROM throughout the day. When the acute symptoms are medically controlled, have the patient perform active ROM if he or she can control the motion or with assistance if necessary.
• If a pool is available, have the patient perform ROM in the buoyant environment.
• Initiate nonimpact activities such as swimming, gentle water aerobics, or stationary cycling.

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