The Effects of Hip Mobilization and Mobilization with Movement in the Physical Therapy

Management of a Person with Lateral Hip Pain: A Case Report.

Gray Carpenter PT, DPT, OCS
Fellow - Regis University Manual Physical Therapy Fellowship Program
Physical Therapist, Alamance Regional Medical Center
Manual Therapy Fellowship
Assistant Professor, Elon University
PURPOSE Methods
•The purpose of this case report is to describe the use of hip joint mobilization, hip mobilization
with movement and therapeutic exercise in a patient with lateral hip pain. (2,3,4)
•Mulligan’s Mobilization with Movement is a commonly used technique in the clinical setting but
Day Assessment Intervention Response to Treatment
Visit 1 See Initial Visit Home Program of sitting hip rotation, No change
there is little evidence to support the effectiveness of this technique. (1)
Day 1 standing hip extension, sitting hip flex
Case Report Subject Initial Visit
Subjective Exam
PA glides to L hip 30 second X 3 Report decreased pain with crossing leg. Had
•Patient Profile: Patient is a 53 year old female secretary. increased pain with piriformis stretch less
•Chief Complaint: L hip pain. than 90°
•Symptoms: Patient reported 4/10 deep ache pain at lateral hip now and at best, 6/10
at worst. Hip flex MWM with lateral glide, hip Able to cross leg without pain
•Present History: Patient reported a 3 month history of unchanging hip pain. She was adduction MWM with lateral glide X 30
unable to state how the pain started. She had received cortisone shot in hip without each.
change. Imaging of hip was unremarkable.
•Past History: She reported no prior hip, ankle, and knee pain but did have a prior
Visit 2 Reports difficulty with crossing legs Grade 3-4 hip PA glide in neutral and R =L FABER at end of treatment
episode of low back pain with repeated bending forward. Day6 but better overall. progressed to full extension 30 second X 3
•Aggravating Factors: Bringing leg up to tie shoes but decreases immediately when Reports pain with tying shoe. Grade 3-4 hip PA frog leg glide 30 sec X 3.
bring leg down, walking > 5 minutes that decreased with sitting, riding a motorcycle +L FABER Grade 3-4 AP glide 30 seconds X 3.
with husband > 15 minutes, swimming, and unstable with going down steps. Reports able to ride motorcycle 45 Hip MWM with lateral glide for flex,
•Easing Factors: Immediately with getting out of provocative positions. minutes without pain. adduction and IR/ER X 10 X 3.
•PMH: High Blood Pressure, Migraine Headaches, sleep apnea. 0/10 L Hip Pain
•Outcome Measures: Harris Hip Scale 64/100, Western Ontario and McMaster Hip AROM for adduction/ abduction X 10 GROC +4 “Moderately Better” for overall
Universities Osteoarthritis Index (WOMAC) 43/115, Lower Extremity Functional Scale treatment
(LEFS) 51/80
Physical Exam Visit 3 0/10 pain with occasional lateral hip Grade 3-4 AP in neutral and frog leg Pain in L hip piriformis >90° but no pain with
•AROM/PROM: L hip was minimally limited in all areas with capsular end feel Day 14 pain at 5/10. position 30 seconds X3 piriformis <90°. Low Back pain increase with
compared to the R. No hip pain with swimming, walking, treatment. FABER painful but decreased
•Strength: Grossly 5/5 in all areas without pain. Able to stand on heels and toes riding motorcycle with husband. since first day.
Acknowledgements
without compensation or discomfort. R=L hip passive accessory for PA and Acknowledgements
Special Thanks to Dr. Deborah Stetts PT,DPT,OCS, FAAOMPT
•Gait: No significant deviations. inferior. L hip MWM with lateral glide for flex, “Twinge “ pain with piriformis >90° and Special thanks to Dr. Deborah Stetts PT, DPT, OCS, FAAOMPT and
and the staff at ARMC
•Neurodynamic testing: Negative bilateral SLR and slump test.
•Passive Accessory Testing: Hypomobility in L hip for inferior, lateral, AP, PA, and PA
Meth L <R AP and frog leg passive adduction, IR/ER X 10 3 each FABER. the staff at ARMC
accessory. R =L hip PA and frog leg
in “frog leg” position. No hypomobility in R hip. GROC +6 “ A Great Deal Better” No pain after treatment
•Palpation: Tenderness along L lateral hip near greater trochanter.
•Lumbopelvic Exam: Presented with full lumbar AROM with no pain with movement.
Conclusion
•This case study suggests that hip mobilizations combined with MWM
PA glides to lumbar area exhibit no hypomobility or hypermobility. Negative pelvic
and therapeutic exercise may reduce pain and improve function for
compression, pelvic distraction, thigh thrust, and sacral compression.
patients with lateral hip pain.
•Special Tests: Negative bilateral Ober’s Test, Scour Test, and Ely’s Test.
•Muscle Length: Reported a stretch feeling and increased pain with piriformis less
•Further research is needed to investigate the effectiveness of MWM as
than 90 degrees in L hip. Reported no change with piriformis testing greater than 90
a component of manual therapy intervention and the particular patients
degrees. No difficulties noted in R hip.
that it would provide the most benefit.
•Functional Tests: Independent with squat without pain. Had pain with L leg crossing
right with a slight pull in left posterior hip.
References
Results •Mulligan, B. Manual Therapy: NAGs, SNAGs, MWMs, etc. Plane View
•Discharged 3 visits Services, Ltd. 4th Edition. 1999
•Reported no pain for the last two visits. Pain decreased from 4/10 to 0/10. •MacDonald, CW et al. Clinical Outcomes Following Manual Physical
•Was able to tying her shoes, swim, walk, and riding motorcycles with her husband without pain or Therapy and Exercise for Hip Osteoarthritis: A Case Series. J Orthop
difficulty. Sports Phys Ther 2006; 36(8): 588- 599.
•The LEFS improved 11 points and the Harris Hip Scale improved 24 points. •Hoeksma, HL et al. Comparison of Manual Therapy and Exercise
•Reported that she was “a great deal better” on the Global Rating of Change. Therapy in Osteoarthritis of the Hip: A Randomized Clinical Trial. Arth
• The left hip joint mobility was equal to the right with passive accessory motion. Rhuematism 2004; 5(15):722-729.
•Had no pain with piriformis muscle length below 90° and a small twinge of pain with piriformis •Cliborne AV et al. Clinical Hip Tests and a Functional Squat Test in
muscle length testing greater that 90°. Patients with Knee Osteoarthritis: Reliability, Prevalence of Position Test
•Reported greater ease with crossing her legs. Findings, and Short Term Response to Hip Mobilization. J Orthop Sports
Phys Ther 2004;34: 676 – 685.

Figure A Figure B Figure C

Figures represent hip Mobilization with Movement used in the case presentation. The arrows represent the movement
performed. The figures represents hip flexion (figure A), hip rotation (figure B) and hip adduction ( figure C).