Hip Rehab: Things to Consider. Sue Torrence, MS, PT, ATC Lead Physical Therapist

Transcription

1 Hip Rehab: Things to Consider Sue Torrence, MS, PT, ATC Lead Physical Therapist

2 Where to Start?

3 Objectives: Discuss injuries related to hip dysfunction Review commonly used functional tests for posteriolateral hip strength Review exercises best supported by research when choosing exercises for patients Discuss other thoughts related to commonly used rehab exercises

4 Extreme Skateboarding

5 Injuries Related to Hip Weakness or Dysfunction (Besides the -itis, -opathy, intra- and extraarticular involvement at the hip) Low back pain ITBand pain Patellofemoral pain Ankle instability What other injuries should you consider?

6 Common Functional Tests to Assess Hip Status: Single Leg Balance Single Leg Squat Lateral Step Down Overhead Deep Squat (SFMA) Drop Vertical Jump Test List is not all inclusive and not limited to these

7 Single Leg Stance Hip drop Trunk lean

8 Single Leg Squat Lateral Step Down

9 Deep Squat Drop Vertical Jump

10 You ve Identified Strength and/or ROM Deficits, which exercises to choose?

11 Initiating Rehab: Regardless of athlete s sport, level of ability, appropriate assessment is always necessary. DUH! Starting with basic rehab specific exercises are appropriate prior to moving onto higher level strengthening, in order to restore appropriate neuromuscular function, regardless of sport or ability.

12 Ideas for Increasing ROM: Moreside et al (2012) found that passive stretching program for healthy males increased hip ROM in extension/ir/er and total rotation alone and when accompanied by hip/spine dissociation exercises. Core strength and hip/spine dissociation increased total rotation and IR, but not ext.

13 Most Bang for Your Buck: Of 11 common exercises used in PT for glut strength, the following had the highest glut med/upper glut max:tfl ratio: 1. Clam 2. Side stepping (monster walks) 3. Unilateral Bridge 4. Quadriped hip ext with knee extended 5. Quadriped hip ext with knee flexed Selkowitz et. al in JOSPT in Feb 2013

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15 How About Other Common Exercises? Sumo and Monster Walks Progressive glut med>max recruitment with band placement at the feet>ankles and significantly more than at the knees. The foot position increases not only the lever arm, but the ER moment to maximize gluts. Cambridge et al, Journal of Biomechanics 2012

16 Other Thoughts with Strengthening: Other thoughts with balance: Tall kneeling versus ½ kneeling balance With and without theraband resistance in various planes Squats: With bands for trunk stabilization and proprioception Lunges: With bands for trunk stabilization and proprioception

17 Tandem ½ Kneel for Proximal Stability

18 Variations with Squats and Lunges

19 References: Selkowitz, D.M., Beneck, G.J., Powers, C.M., Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes. J. Orthop. Sprots Phys. Ther. 2013;43: Cambridge, E.D.J., Sidorkewicz, N., Ikeda, D.M., McGill, S.M., Progressive hip rehabilitation: The effects of resistance band placement on gluteal activation during two common exercises. Clin. Biomech. 2012;27: Willcox, E.L., Burden, A.M., The Influence of Varying Hip Angle and Pelvis Position on Muscle Recruitment Patterns of the Hip Abductor Muscles During the Clam Exercises.. J. Orthop. Sprots Phys. Ther. 2013;43: Moreside, J.M., McGill, S.M., Hip Joint Range of Motion Improvements Using Three Different Intervensions. J Strength Cond Res. 2012;26: Earl, J.E., Hoch, A.Z., A Proximal Strengthening Program Improves Pain, Function, and Biomechanics With Patellofemoral Pain Syndrome. Am J Sports Med : Crow, J.F., Duttifant, D., Kearny, S.G., Hrysomallis, C., Low Load Exercises Targeting the Gluteal Muscle Group Acutely Enhance Explosive Power Output in Elite Athletes. J Strength Cond Res. 2012; 26: Selective Functional Movement Assessment Seminar Manual, McBeth, J.M., Earl-Boehm, J.E., Cobb, S.C., Huddleston, W.E., Hip Muscle Activity during 3 Sidelying Hip-Strengthening Exercises in Distance Runners. J Athl Train. 2012; 47: Anloague, P.A., Spees, V., Smith, J., Herbenick, M.A., Rubino, L.J., Glenohumeral ROM and Lower Extremity Flexibility in Collegiate-Level Baseball Players, Sports Health; 2012;4: Reed Ferber, K.D., Farr, K., Farr, L., Changes in Knee Biomechanics After a Hip-Abductor Strengthening Protocol for Runners with Patellofemoral Pain Syndrome, J Athl Train., 2011; 46:

20 Thank You!