Manual Therapy

10-26-09

Hip

The lecture in manual therapy was completely geared towards the hip(i.e. anatomy, pathology, mobilisations & manipulations). As a basic review we went over all the hip anatomy: joints, inert structures and contractile structures. We go on to talk about capsule and non-capsule patterns. When diagnosing a capsular pattern in the hip you will notice pain from the patient when they are flexed while medially rotated. There are three main causes for capsular pattern: Osteoarthrosis(OA), Rhematoid arthritis (RA) and Traumatic arthritis (TA). There are five different treatments we can do to the patient which are: lateral glide mobilisation, caudad longitudinal mobilisation, lateral rotation mobilisation, medial rotation mobilisation and felxion mobilisation. All of these treatments will be graded according to the clinical assessment findings.

Flexion Mobilisation


Lateral Rotation Mobilisation

Caudad Longitudinal Mobilisation in Flexion

Medial Rotation Mobilisation
Lateral Glide Mobilisation




The biggest indicator for a non-capsular pattern is restriction on flexion but not medially.

Loose body is one of the causes to non-capsular pattern. Clinical features to look for are springy end feel movement, locking/ giving way and twinges of pain. The Tx we would use is called Loose Body Manoeuvre of Hip Joint.

Another big indicator to non capsular pattern could be a contractile lesions. Three major muscles involved with contractile lesions being Adductor Longus, Quadriceps and Hamstring strain. The key clinical features to check for all three of these muscles are fairly similar. Adductor Longus you will have pain with resisted adduction as well as pain with passive abduction. For the Quads, you will find pain with resisted knee extension, passive knee flexion and maybe slight pain resisted hip flexion. Finally, looking at the hamstrings you will tend to have pain resisted knee flexion and hip extension. All of these strains/contusions will be given Tx of deep transverse friction directly to the muscle.