The Hip

Chapter 20

Part IV: Exercise Interventions by Body

Region
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 STRUCTURE AND FUNCTION OF
THE HIP

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Anatomical Characteristics of the
Hip Region
 Bony Structures
– The pelvis
– The femur
 Hip Joint Characteristics
– Characteristics
– Articular surfaces
– Ligaments

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Anatomical Characteristics of the
Hip Region (cont'd)
 Hip Joint Arthrokinematics
– Motions of the femur
– Motions of the pelvis
 Influence of the Hip Joint on Balance and
Posture Control

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Functional Relationships of the
Hips and Pelvis
 Motions of the Femur and Muscle Function
 Motions of the Pelvis and Muscle Function
– Anterior pelvic tilt
– Posterior pelvic tilt
– Pelvic shifting
– Lateral pelvic tilt
– Pelvic rotation
– Pelvifemoral motion (lumbo-pelvic rhythm)

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Pathomechanics in the Hip Region
 Decreased Flexibility
 Muscle Weakness
– Patellofemoral impairment
– Anterior cruciate ligament strain
– Piriformis syndrome

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Pathomechanics in the Hip Region
(cont'd)
 Hip Muscle Imbalances and Their Effects
– Shortened tensor fasciae latae and/or gluteus
maximus
– Dominance of the TFL over the gluteus medius
– Dominance of the two-joint hip flexor muscles
over the iliopsoas
– Dominance of hamstring muscles over the gluteus
maximus
– Use of lateral trunk muscles for hip abductors
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Pathomechanics in the Hip Region
(cont'd)
 Asymmetrical Leg Length
– Unilateral short leg
– Coxa valga and coxa vara
– Anteversion and retroversion

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The Hip and Gait
 Hip Muscle Function and Gait
– Hip flexors
– Hip extensors
– Hip abductors
 Effect of Musculoskeletal Impairments on Gait

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Referred Pain and Nerve Injury
 Major Nerves Subject to Injury or Entrapment
• Sciatic nerve
• Obturator nerve
• Femoral nerve
 Common Sources of Referred Pain in the Hip
and Buttock Region

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 MANAGEMENT OF HIP DISORDERS
AND SURGERIES

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Joint Hypomobility:
Nonoperative Management
 Related Pathologies and Etiology of Symptoms
– Osteoarthritis (degenerative joint disease)
– Post immobilization hypomobility
 Common Structural and Functional Impairments
 Common Activity Limitations and Participation
Restrictions
– Early stages
– Progressive degeneration

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Joint Hypomobility:
Nonoperative Management (cont'd)
 Management: Protection Phase
– Provide patient education
– Decrease pain at rest
– Decrease pain during weight-bearing activities
– Decrease effects of stiffness and maintain
available motion

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Joint Hypomobility:
Nonoperative Management (cont'd)
 Management: Controlled Motion and Return
to Function Phases
– Progressively increase joint play and soft tissue
mobility
– Improve joint tracking and pain-free motion
– Improve muscle performance in supporting
muscles, balance and aerobic capacity
– Patient education

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Total Hip Arthroplasty
 Indications for Surgery
 Preoperative Management
 Procedures
– Background
• Prosthetic designs and materials
• Cemented versus cementless fixation

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Total Hip Arthroplasty (cont'd)
 Overview of Operative Procedures
– Standard surgical approaches
– Minimally invasive approaches
– Implantation of components and closure

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Total Hip Arthroplasty (cont'd)
 Complications
– Intraoperative complications
– Early postoperative complications
– Late complications
– Dislocation: a closer look
– Leg length inequality: a closer look

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Total Hip Arthroplasty (cont'd)
 Postoperative Management
– Immobilization
– Weight-bearing considerations
– Exercise progression and functional training
– Accelerated rehabilitation

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Total Hip Arthroplasty (cont'd)
 Postoperative Management
– Exercise
• Maximum protection phase after traditional THA
• Moderate protection phase after traditional THA
• Minimum protection phase and resumption of full
activity
– Extended rehabilitation and modification of activities
– Return to sport activities

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Total Hip Arthroplasty (cont'd)
 Outcomes
– Pain relief, patient satisfaction, and quality of life
– Physical functioning
– Implant design, fixation, and surgical approach
– Impact of rehabilitation

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Hemiarthroplasty of the Hip
 Indications for Surgery
 Procedures
– Background
– Operative procedure
 Postoperative Management
 Outcomes

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Hip Fracture
 Incidence, Risk Factors and Impact on
Function
 Sites and Types of Hip Fracture

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Open Reduction and Internal
Fixation of Hip Fracture
 Indications for Surgery
 Procedures
– Types of fixation and surgical approach

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Open Reduction and Internal
Fixation of Hip Fracture (cont'd)
 Postoperative Management
– Weight-bearing considerations
– Exercise and functional training
– Exercise
• Maximum protection phase
• Moderate and minimum protection phases
– Extended exercise programs after surgery for hip fracture

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Open Reduction and Internal
Fixation of Hip Fracture (cont'd)
 Outcomes
– General outcomes
– Impact of rehabilitation

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Painful Hip Syndromes:
Nonoperative Management
 Related Pathologies and Etiology of Symptoms
– Musculotendinous impairments
• Tendinopathies and muscle strains
• Repetitive trauma
– Bursitis
• Trochanteric bursitis
• Psoas bursitis
• Ischiogluteal bursitis (Tailor’s or Weaver’s bottom)

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Painful Hip Syndromes:
Nonoperative Management (cont'd)
 Femoroacetabular Impingement (FAI)
 Common Structural and Functional Impairments,
Activity Limitations, and Participation Restrictions
– Pain
– Gait deviations
– Imbalance in muscle flexibility and neuromuscular
control
– Decreased muscular endurance

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Painful Hip Syndromes:
Nonoperative Management (cont'd)
 Management: Protection Phase
– Control inflammation and promote healing
– Develop support in related areas

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Painful Hip Syndromes:
Nonoperative Management (cont'd)
 Management: Controlled Motion Phase
– Develop a strong mobile scar and regain flexibility
– Develop a balance in length and strength of the
hip muscles
– Develop muscle and cardiopulmonary endurance
– Patient education
 Management: Return to Function Phase

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 EXERCISE INTERVENTIONS FOR THE
HIP REGION

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Exercise Techniques to Increase
Flexibility and Range of Motion (ROM)
 Techniques to Stretch Range-Limiting Hip
Structures
– To increase hip extension
– To increase hip flexion
– To increase hip abduction
– To increase hip abduction and external rotation
simultaneously
– To increase hip internal rotation

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Exercise Techniques to Increase
Flexibility and ROM (cont'd)
 Techniques to Stretch Range-Limiting Two-
Joint Muscles
– Rectus femoris stretches
– Hamstring stretches
– Tensor fasciae latae and iliotibial band stretches

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Exercises to Develop and Improve Muscle
Performance and Functional Control
 Open-Chain (Non-Weight-Bearing) Exercises
– To develop control and strength of hip abduction
(gluteus medius, gluteus minimus, and TFL)
– To develop control and strength of hip extension
(gluteus maximus)
– To develop control and strength of hip external
rotation
– To develop control and strength of hip adduction

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Exercises to Develop and Improve Muscle
Performance and Functional Control (cont'd)
 Closed-Chain (Weight-Bearing) Exercises
– Closed-chain isometric exercises
– Closed-chain dynamic exercises
 Functional Progression for the Hip

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Independent Learning Activities
 Critical Thinking and Discussion
 Laboratory Practice
 Case Studies

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