HIP RESURFICING CLAIRE HESLOP 25/10/13 COURSE YEAR: 2013/LONDON- WIMBLEDON

Transcription

1 HIP RESURFICING CLAIRE HESLOP 25/10/13 COURSE YEAR: 2013/LONDON- WIMBLEDON

2 ABSTRACT My case study is about a client who contacted me 9 years after her hip resurfacing procedure as she was suffering with sciatica in her right side. Alison, age 41, walks with a severe limp and has suffered with her right hip from being a teenager. With very little physiotherapy following her procedure (2 x physiotherapy sessions, 9 years ago) she has lost all strength in her right hip stabiliser s and struggles on a daily basis with walking and putting her socks and shoes on. During Alison s first assessment I begin to see that Alison has no pelvis and lumber stabilisation and struggles to engage her right hamstring and gluteal. Alison attends the studio once a week as a private session and is also given a home program that she must do to support our work at the studio. After 6 weeks Alison has seen a noticeable change in her limp and also her stamina when walking to the shops.

3 TABLE OF CONTENTS Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8-9 Page 10 Page 11 Title page Abstract Table of contents Anatomical description of hip joint Introduction of case study Hip resurfacing procedure First assessment and reason for choosing my exercises BASI conditioning program utilising the block system Conclusion Bibliography

4 ANATOMICAL DESCRIPTION The hip joint is a Spheroid joint, also known as a synovial ball and socket joint and is the second most moveable joints in the body. Movement occurs between the head of the femur (ball) and the acetabulum (socket). The acetabulum is formed by the fusion of the illium, ishium and pubis. Flexion, extension, abduction, adduction, medial, lateral rotation and circumduction (limited) movements are achieved in the hip joint. The hip joint is a very stable joint by virtue of its structure and ligaments. All surrounding muscles, ligaments and tendons contribute to its stability. The 3 ligaments of the hip joint are : Iliofemoral ligament (attaches the illiacs and femur) Ischiofemoral ligament (sit bones and femur ) Pubofemoral ligament There is a thin protective layer that lies between the head of the femur and acetabulum called the articular cartilage which allows a friction free movement for bones to glide over one another. Damage to this cartilage (thinning) creates pain/stiffness and discomfort in the hip which can lead into condition s known as arthritis.

5 CASE STUDY History My client Alison Hill, age 41 was diagnosed with osteoarthritis in her right hip at the age of 28. She recalls always having trouble with her right hip through her teenage years. In 2004 she gave birth to her daughter by C section and 2 weeks after this her right leg completely collapsed and could only walk with the assistance of crutches. In 2004, she was advised to have her right hip resurfaced as she was relatively young and met the criteria for this procedure. Alison is 6ft 2, big bones and a healthy normal weight. The process of this procedure was carried out as an emergency and unfortunately Alison feels as if she slipped through the net with her post rehab physiotherapy. Alison only received 2 physiotherapy (NHS) sessions after her procedure. The exercises that she was told to do where too difficult (side lying, lift straight leg up and down Abduction and adduction to work gluteus medius) In 2011, Alison began to experience sciatic symptoms, this continued for 6 months. In 2012, Alison was recalled for a review as the hip resurfacing procedures across the board where experiencing bad publicity due to the metal becoming loose in the part. Alison was given a MRI scan and blood test and the results came back normal. In July 2013, Alison is still encountering problems with her sciatica and hip pain. Alison contacted me in September My client s limitations and restrictions Alison walks with a very noticeable limp on her right side. She is very conscious of this too. Alison struggles to put her socks on (hip flexion, when seated) and has expressed that she just wishes she could have more mobility in her hip. I noticed that she just wears fit flops and I asked her about this and she replied that all of her shoes have to be slip on as she struggles to bend down to her feet. Alison also struggles to walk great distances like going from shop to shop over the day. Alison has no previous Pilates experience and has not carried out any exercises in 9 years now.

6 THE PROCEDURE OF HIP RESURFICING AND ITS OUTCOME Hip resurfacing is a procedure carried out on patients who are experiencing severe pain in their hip joint due to the thin articular cartilage been worn away which lies between the head of the femur and acetabulum. Hip resurfacing is the stage before hip replacement and has been around since the 1980s. Hip resurfacing is recommended to patients who are generally under the age of 65(55 women), have healthy bones, not obese and are active. The 2hr procedure is carried out under general anaesthetic in which a small cut is made to the hip and thigh so that the surfaces around the hip joint can be cleaned, removing any traces of worn bone and cartilage and preparing the area for the metal cover (shaped like a mushroom) to be fitted over the head of the femur while a matching cup is placed in the acetabulum. ADVANTAGES of this procedure are: 1. Less invasive treatment compared to the full hip replacement 2. Less bone removed than the full hip replacement 3. Reduced chance of hip dislocation 4. Delays the need for full hip replacement with younger patients. DISADVANTAGES of this procedure are: 1. Research shows that 1 out of 9 operations fail within 7 years, especially with woman who have small bones 2. Failure rates are up to 6 times higher than full hip replacement 3. Metal parts can be broken down and found in the area. 4. These procedures are now been recalled.

7 First assessment BASI conditioning program utilising the block system Alison has no Pilates experience so I begin her with the fundamentals. We go through lateral breathing, exhale, pelvic floor and engagement of the pelvis and lumber stabilisers progressing onto pelvic curl, single knee lift, chest lift, side bend, clam and basic back extension. During our first assessment I note two things: 1. Alison has no pelvis and lumber stabilisation during her single leg knee lift and can only achieve an acute angle of 100` on hip flexion on her right side. 2. Alison is struggling to engage her right hamstring and right hip stabilisers and extensors (gluteus medius, minimus, maximus) REASONS FOR CHOICE OF EXERCISES FOR ALISON S PROGRAM Following on from Alison s first assessment I have decided to start Alison with footwork on the reformer as it s important that we learn to establish pelvis stability and correct muscle engagement during hip extension. The reformer is the perfect choice as it supports Alison in a supine position, whereas the Wunda chair requires a lot of pelvis stability and at this stage of her program she needs as much support as possible so she can achieve precision and alignment of the key muscles. Alison will refrain from all movements that involve both legs lifted when lying supine as for one she cannot perform this correctly due to the angle of her hip flexion being less than 90` and by doing so would cause pain in her lumber spine as she does not have the strength to maintain neutral at 90`.This is a mechanical restriction with the part she has fitted to her hip and therefore I will select more appropriate exercises to accommodate her limited hip flexion range when strengthening the abdominals. Alison s two goals are to decrease her limp during walking and achieve more hip mobility to put her socks and shoes on. With this in mind, I will work on Alison s hip stabilisers, hip extensors, obliques and supported hip mobility exercises.

8 WK 1 WK 2 WK 3 WK4 WK 5 WK 6 WARM UP FOOTWORK ABDOMINAL WORK Pelvic curl x 5 Single knee lift x 5 Supine twist (feet floor), x 5 Reformer P.H,P.T,S.V, W.V,TWV,CALF, PRANCES, Single leg heel 2 red springs Step barrel (feet on floor) Step barrel (feet on floor) SAME AS WEEK 1 Also add chest lift with rotation 2 red springs/1 blue Step barrel (feet on floor) 2 red springs/1 blue Step barrel (feet on floor) 2 red springs/1 blue Step barrel (feet on floor) 3 red springs Step barrel Reach (feet on floor) HIP WORK Frog legs Frogs legs Frogs legs Frogs legs, Circles down & up Frog legs, Circles down & up Frog legs, Circles down & up, walking STRETCHES Ladder Barrel stretch, hip Ladder Barrel stretch, hip Ladder Barrel stretch, hip Ladder Barrel stretch, hip Ladder Barrel stretch, hip Ladder Barrel stretch, hip ARM WORK PED O PULL Chest expansion & Hug a tree Chest expansion Hug a tree circles down up Chest expansion Hug a tree, circles down up

9 LEG WORK LATERAL FELXION/ROTATION BACK EXTENSION Hip extension /straight leg (no weights) Adductor lift (no weights and bent knees) LADDER BARREL Side over PREP MAT Basic back extension Introduce Leg press standing Reasons for exercise choices : Alison struggles with hip flexion hence my choice of arm work at this early stage of her program. Supine arms on the reformer would be far too challenging for Alison due to her restricted hip flexion I choose legs as I wanted Alison to work on her pelvis stability. Also felt that she coped better getting her feet into straps. Alison has very little strength in her hip extensors so I choose the additional leg series to work on her basic alignment and firing pattern of the hip extensors. Alison struggles with hip flexion so its important to keep her feet on floor and allow her time and support to focus on the key muscles during the abdominal block. The reformer is the best choice for Alisons footwork as it offers her pelvis and lumber support during movements.

10 CONCLUSION I am pleased to say that Alison has noticed a difference with her limp as she monitors this by an identity badge which she wears around her neck for work. She has said that the badge used to swing from shoulder to shoulder, where as know it swings only half way across the shoulder s. A strange way to monitor a limp but the reduction in her badge swinging has gave Alison great hope and positive feedback. I also have noticed an improvement in Alison s gait. Alison also commented on how much further she can walk without pain and tiredness and how she can manage to put her socks on a little easier now. Alison s Sciatica pain has completely gone and she speaks of being pain free every day. Alison continues on now with her Pilates at home and also small group apparatus classes once a week. I believe Pilates has helped Alison however her hip resurfacing procedure will need replacing in the very near future and Alison has already approached me regarding Pilates for her post hip operation. I feel that if we had not supported Alison s program with a home program her results would not of being as positive at the 6 week point as the beginning stages of Alison s program where very basic and slow. When a client is willing to embrace a Pilates program like Alison the results are more positive which in turn makes our ROLE AS A PILATES TEACHER VERY REWARDING!

11 BIBLIOGRAPHY BASI study guide 2013 author :Rael Isacowitz BASI Fully comprehensive manuals revised editions 2013 author : Rael Isacowitz The concise book of the moving body. Lotus publishing by Chris Jarmey, published in 2006 NHS website : http/ replacement BUPA private healthcare : http/ information/directory/hip replacement Alison Brown (Client) 36 blossom Terrace, low fell,gateshead, NE11 4BF, interviewed 16/9/13