Patients may present with a flexed posture and be unable to extend because of increased neurological symptoms and decreased mobility; these patients would benefit from early interventions that emphasize flexion of the involved segments to relieve symptoms. The patients may have a medical diagnosis of spondylosis or spinal stenosis, may have sustained an extension load […]

Disk lesions in the cervical spine are less common than in the lumbar spine. Often disk extrusions are an indication for surgery because of potential compromise of the spinal canal and pressure on the spinal cord. Patients may present with peripheral neuropathy and forward-head posture without a diagnosis of disk pathology. Symptoms increase with activities […]

These techniques are used only if the test movements have shown that the postures and movements used decrease the symptoms. If no test movements decrease the symptoms, this mechanical approach to treatment should not be used.
Management of Acute Symptoms
If symptoms are severe, bed rest is indicated with short periods of walking at regular intervals. Walking […]

Patients with an extension bias often assume a flexed posture or a flexed posture with lateral deviation of the trunk or neck, but during the examination sustained or repetitive extension maneuvers reduce or relieve their symptoms. These patients would benefit from early interventions that emphasize extension of the involved segments. The impairments may be due […]

Indications for Surgery
The following are possible indications for prosthetic replacement of the proximal femur.
• Acute, displaced intracapsular (subcapital, transcervical) fractures of the proximal femur in an elderly patient with poor bone stock and an anticipated low-demand level of activity after surgery
• Failed internal fixation of intracapsular fractures associated with osteonecrosis of the head of the […]

Indications. Extension is used if pain and/or neurological symptoms centralize (decrease of move more proximally) during extension testing maneuvers and peripheralize (worsen) during flexion. Extension is also indicated for flexed postural dysfunctions with limited range into extension.
Contraindications to Specific Spinal Movements
Extension of the spine is contraindicated
• When no position or movement decreases or centralizes the […]

During examination, some patients do not respond to extension, flexion, or even mid-range spinal positions or motions due to the acuity of or mechanical stimuli from their condition. The person is often more comfortable lying down and may have partial or full relief with a traction test maneuver to the painful region of the spine.
For […]

Despite the number of sources in the literature that emphasize the importance of rehabilitation programs or, more specifically, a postoperative exercise and ambulation program after THA, the impact of these postoperative interventions has not been clearly established. The NIH reported that there is currently insufficient evidence to determine what constitutes an appropriate level of physical […]

Two to three decades of studies indicate that both cemented and cementless THA have yielded equally positive postoperative outcomes in all areas of assessment, with the most consistent being reduction of pain. Despite the success of both cemented and uncemented THA, debate continues as to the benefits and limitations of both types of fixation. What […]

When the signs and symptoms of the inflammatory process are under control and pain is no longer constant, the patient is progressed through a program of safe muscle endurance and strengthening exercises to prepare the tissue for functional activities and rehabilitation training. Functional activities that can be performed safely are resumed. Pain may still interfere […]

Improvements in ROM, postural stability, strength, and functional mobility are significant but occur gradually after THA. Patients typically achieve 90% of their expected level of overall functional improvement by the end of the first year. During the next 1 to 2 years, patients have self-reported additional gains in strength, with improvement in function reaching a […]

Patients who have been treated through the acute and subacute phases of healing with appropriately graded exercises should have minimal impairments that prevent or restrict daily activities. Individuals who must do heavy material handling (e.g., a manual laborer, firefighter, caregiver of small children or patients) or who participate in high-demand sports activities may require additional […]

Patient satisfaction after THA as well as the assessment of pain and perceived level of function and quality of life as judged by the patient and/or the surgeon generally reflect a marked decrease in pain and improvement in function. Historically, patient-related outcomes were assessed by the surgeon rather than the patient. During the past decade […]

• Supine:
Hook-lying flexes the lumbar spine; legs extended extends the spine. A pillow under the head flexes the neck; a small roll under the neck stabilizes a mild lordosis with the head neutral.
• Prone:
Use of a pillow under the abdomen flexes the lumbar spine; no pillow extends the spine. To maintain the cervical spine in […]

For carefully selected patients who have undergone minimally invasive primary THA, an accelerated rehabilitation program may be feasible to achieve optimal outcomes as rapidly as possible. However, few guidelines have been published to date.
Berger and colleagues developed and implemented a program specifically designed for patients undergoing primary cementless THA with a two-incision approach. Patients eligible […]

After traditional THA the intermediate and late phases of rehabilitation begin about 4 to 6 weeks postoperatively. The degree of protection of the operated hip required varies substantially from patient to patient. Some degree of moderate protection may be necessary for 12 weeks postoperatively. However, full healing of soft tissue and bone continues for up […]

Common impairments exhibited by patients during the acute and subacute stages of soft tissue healing and the initial phase of postoperative rehabilitation after THA are pain secondary to the surgical procedure, decreased ROM, muscle guarding and weakness, impaired postural stability and balance, and diminished functional mobility (transfers and ambulation activities). Depending on the type of […]

Use of modalities and massage to decrease pain and swelling from acute symptoms is appropriate during the acute stage. It is also important that the patient becomes an active participant in his or her program. Kinesthetic training of neutral or functional spinal posture, nondestructive movements in the pain-free range, awareness and activation of core musculature, […]

General—Stage of Recovery

• Acute with inflammation (0-4 weeks).
• Acute without inflammation (0-4 weeks): intermittent symptoms with acute nerve root symptoms.
• Subacute (4-12 weeks).
• Chronic (> 12 weeks).
• Chronic pain syndrome (> 6 months).
Non-Weight-Bearing Bias (Traction Syndrome)
• Patient does not tolerate being upright for basic ADLs and IADLs.
• Movement testing makes symptoms worse.
• Traction (or other […]

Posterior/Posterolateral Approaches
ROM
• Avoid hip flexion > 80 to 90 and adduction and internal rotation beyond neutral.
ADL
• Transfer to the sound side from bed to chair or chair to bed.
• Do not cross the legs.
• Keep the knees slightly lower than the hips when sitting.
• Avoid sitting in low, soft chairs.
• If the bed at home […]

At the time of a low back or cervical injury, impairments, functional limitations, and disabilities are not known. Usually 80% to 90% of acute injuries resolve within 1 month. Disabilities are dependent on the extent of the injury. If it involves the spinal cord, levels of complete paralysis may occur. If it involves the nerve […]

The use of therapeutic exercise interventions for patients after THA has been reported in the literature for several decades. Although the time frame for and extent of patient-therapist contact have decreased substantially since these early descriptive reports were published, the ultimate goal of rehabilitation remains the same: to optimize a patient’s postoperative level of function. […]

The mechanical model of stability in which stability is maintained over the base of support by the guy wire function of the global and core musculature was reviewed, as was the functional model proposed by Penjabi and colleagues in which stability is visualized as a three-legged stool that requires not only the active muscle function […]

In two recent randomized, controlled investigations, the effects of immediate weight bearing as tolerated during ambulation and other functional activities after cementless or hybrid arthroplasty were compared with the effects of restricted weight bearing. No short-term or long-term adverse effects of immediate weight bearing were identified in either study. It is important to note that […]

Method of Fixation
• Cemented.
Immediate postoperative weight bearing as tolerated.
• Cementless and hybrid.
Recommendations vary from partial weight bearing (toe-touch or touch-down) for at least 6 weeks to weight bearing as tolerated (no restrictions) immediately after surgery.
Surgical Approach

• Standard versus minimally invasive.
Weight-bearing usually more restricted after standard (traditional) approach because of more extensive surgical disturbance and repair […]

• Length of incison: ≤ 10 cm, depending on the location of the approach and the size of the patient.
• Most if not all muscles and tendons left intact
• Single-incision or two-incision approach
• Single incision: usually posterior or anterior, or occasionally lateral.
• Two-incision: approach: two 4- to 5-cm incisions, one anterior for insertion of acetabular […]

The operative approaches used to gain access to the involved joint and to implant the prosthetic components during THA can be divided into two broad categories: standard and minimally invasive approaches. For decades hip arthroplasty procedures have involved the use of rather long surgical incisions (15 to 25 cm) to expose the joint. Although long-term […]

• Examination and evaluation of pain, ROM, muscle strength, balance, ambulatory status, leg lengths, gait characteristics, use of assistive devices, general level of function, perceived level of disability
• Information for patients and their families about joint disease and the operative procedure in nonmedical terms
• Postoperative precautions and their rationale including positioning and weight bearing
• Functional […]

Absolute
• Active joint infection
• Systemic infection or sepsis
• Chronic osteomyelitis
• Significant loss of bone after resection of a malignant tumor or inadequate bone stock that prevents sufficient implant fixation
• Neuropathic hip joint
• Severe paralysis of the muscles surrounding the joint

Relative
• Localized infection, such as bladder or skin
• Insufficient function of the gluteus medius muscle
• Progressive […]

One of the most widely performed surgical interventions for advanced arthritis of the hip joint is total hip arthroplasty . Osteoarthritis is the underlying pathology that accounts for most primary total hip procedures.
Indications for Surgery
The following are common indications for total hip arthroplasty (THA), also referred to as total hip replacement (THR).
• Severe hip pain […]