How to work with children who have hip problems? Gabriella Papp – Conductor, Hungarian Trained Physiotherapist Bence Kun – Conductor - Teacher

In our presentation we’d like to delve into the anatomy and the function of the articulatio coxae to get a better view of the treatment and our options in working with children who have hip issues.

ABOUT THE HIP JOINT ball and-socket type joint connects the lower extremity and the trunk usually works in a closed kinematic chain What can cause hip subluxation, dilsocation? Dysplasia of the hip (congenital) General connective tissue looseness Developmental disorder Secunder hip dysplasia (adductor spasm) Teratological hip dysplasia

COMPOSER BONES Femur – Caput femoris: 2/3 sphere surface Collo-dyaphiseal angle: 125° →childhood 150-170°.

Acetabulum synostosis of 3 bones – os ilium, os ischii, os pubis. half- sphere shaped inferior tilt → 30° in adulthood → smaller in newborns and children → decreases joint stability → risk of superior dislocation anterior tilt (anteversion) → 18-22° →increase → risk of anterior dislocation

JOINT CAPSULE AND LIGAMENTS The joint capsule is stabile. The ligaments surrounding the joint are very strong.

Movements in the hip joint STAND UP, PLEASE!

Main muscles Movement Flexion Extension Abduction Adduction M. iliopsoas, M. rectus femoris, M. tensor fasciae latae, M. sartorius Extension Gluteus maximus, Hamstring Abduction Gluteus medius et minimus Adduction M. Adductor magnus/longus/brevis, M. Gracilis, M. Pectineus Inward rotation Gluteus medius/minimus, Tensor fasciae latae, Adductor magnus, pectineus Outward rotation M. piriformis, M. quadratus femoris, M. obturator internus/externus, Mm. gemelli Circumduction Combining all the above

OPEN PACKED AND CLOSED PACK POSITION Closed packed position: Full extension, internal rotation, abduction E.g.: W sitting Open packed position: flexion, slight abduction, slight extarnal rotation E.g.: Crossed legs sitting

THE TWO MOST COMMON CASES IN CP Spastic Hip Dysplasia Developmental Dysplasia of the Hip SIGNS AND SYMPTOMS OF HIP ABNORMALITIES Possible pain, limping Assymetric posture Abduction is decreased more on the affected side External rotation of the hip Difference between the length of the two legs between the ASIS and the medial malleolus (true leg length)

Studying hospital discharge summaries and medical papers WHAT SHOULD WE DO AS CONDUCTORS TO PROVIDE THE BEST TREATMENT TO OUR KIDS WITH SHD OR DDH? Studying hospital discharge summaries and medical papers Positioning (pillow between the knees, turning the leg in a neutral position, knee block, posterior tilt of the hip, position of the hip) Strengthening the abductor and adductor! muscles Stretching the adductor muscles

WHAT WE SHOULDN’T DO? Avoid to flex the hip more than 90degrees (pull up the leg to the stomach, crouching down too low, W sitting) Avoid to (either passively or actively) extend the hip (for instance; do not lift the knee up in prone) Carefully select exercises considering the directions and angle of the movement in the hip joint

THANK YOU FOR YOUR KIND ATTENTION!