1. Copyright © 2013. F.A. Davis Company Part IV: Exercise Interventions by Body Region Chapter 20 The Hip

2. Copyright © 2013. F.A. Davis Company STRUCTURE AND FUNCTION OF THE HIP

3. Copyright © 2013. F.A. Davis Company  Bony Structures – The pelvis – The femur  Hip Joint Characteristics – Characteristics – Articular surfaces – Ligaments Anatomical Characteristics of the Hip Region

4. Copyright © 2013. F.A. Davis Company  Hip Joint Arthrokinematics – Motions of the femur – Motions of the pelvis  Influence of the Hip Joint on Balance and Posture Control Anatomical Characteristics of the Hip Region (cont'd)

5. Copyright © 2013. F.A. Davis Company  Motions of the Femur and Muscle Function  Motions of the Pelvis and Muscle Function – Anterior pelvic tilt – Posterior pelvic tilt – Pelvic shifting – Lateral pelvic tilt – Pelvic rotation – Pelvifemoral motion (lumbo-pelvic rhythm) Functional Relationships of the Hips and Pelvis

6. Copyright © 2013. F.A. Davis Company  Decreased Flexibility  Muscle Weakness – Patellofemoral impairment – Anterior cruciate ligament strain – Piriformis syndrome Pathomechanics in the Hip Region

7. Copyright © 2013. F.A. Davis Company  Hip Muscle Imbalances and Their Effects – Shortened tensor fasciae latae and/or gluteus maximus – Dominance of the TFL over the gluteus medius – Dominance of the two-joint hip flexor muscles over the iliopsoas – Dominance of hamstring muscles over the gluteus maximus – Use of lateral trunk muscles for hip abductors Pathomechanics in the Hip Region (cont'd)

8. Copyright © 2013. F.A. Davis Company  Asymmetrical Leg Length – Unilateral short leg – Coxa valga and coxa vara – Anteversion and retroversion Pathomechanics in the Hip Region (cont'd)

9. Copyright © 2013. F.A. Davis Company  Hip Muscle Function and Gait – Hip flexors – Hip extensors – Hip abductors  Effect of Musculoskeletal Impairments on Gait The Hip and Gait

10. Copyright © 2013. F.A. Davis Company  Major Nerves Subject to Injury or Entrapment Sciatic nerve Obturator nerve Femoral nerve  Common Sources of Referred Pain in the Hip and Buttock Region Referred Pain and Nerve Injury

11. Copyright © 2013. F.A. Davis Company MANAGEMENT OF HIP DISORDERS AND SURGERIES

12. Copyright © 2013. F.A. Davis Company  Related Pathologies and Etiology of Symptoms – Osteoarthritis (degenerative joint disease) – Post immobilization hypomobility  Common Structural and Functional Impairments  Common Activity Limitations and Participation Restrictions – Early stages – Progressive degeneration Joint Hypomobility: Nonoperative Management

13. Copyright © 2013. F.A. Davis Company  Management: Protection Phase – Provide patient education – Decrease pain at rest – Decrease pain during weight-bearing activities – Decrease effects of stiffness and maintain available motion Joint Hypomobility: Nonoperative Management (cont'd)

14. Copyright © 2013. F.A. Davis Company  Management: Controlled Motion and Return to Function Phases – Progressively increase joint play and soft tissue mobility – Improve joint tracking and pain-free motion – Improve muscle performance in supporting muscles, balance and aerobic capacity – Patient education Joint Hypomobility: Nonoperative Management (cont'd)

15. Copyright © 2013. F.A. Davis Company  Indications for Surgery  Preoperative Management  Procedures – Background Prosthetic designs and materials Cemented versus cementless fixation Total Hip Arthroplasty

16. Copyright © 2013. F.A. Davis Company  Overview of Operative Procedures – Standard surgical approaches – Minimally invasive approaches – Implantation of components and closure Total Hip Arthroplasty (cont'd)

17. Copyright © 2013. F.A. Davis Company  Complications – Intraoperative complications – Early postoperative complications – Late complications – Dislocation: a closer look – Leg length inequality: a closer look Total Hip Arthroplasty (cont'd)

18. Copyright © 2013. F.A. Davis Company  Postoperative Management – Immobilization – Weight-bearing considerations – Exercise progression and functional training – Accelerated rehabilitation Total Hip Arthroplasty (cont'd)

19. Copyright © 2013. F.A. Davis Company  Postoperative Management – Exercise Maximum protection phase after traditional THA Moderate protection phase after traditional THA Minimum protection phase and resumption of full activity – Extended rehabilitation and modification of activities – Return to sport activities Total Hip Arthroplasty (cont'd)

20. Copyright © 2013. F.A. Davis Company  Outcomes – Pain relief, patient satisfaction, and quality of life – Physical functioning – Implant design, fixation, and surgical approach – Impact of rehabilitation Total Hip Arthroplasty (cont'd)

21. Copyright © 2013. F.A. Davis Company  Indications for Surgery  Procedures – Background – Operative procedure  Postoperative Management  Outcomes Hemiarthroplasty of the Hip

22. Copyright © 2013. F.A. Davis Company  Incidence, Risk Factors and Impact on Function  Sites and Types of Hip Fracture Hip Fracture

23. Copyright © 2013. F.A. Davis Company  Indications for Surgery  Procedures – Types of fixation and surgical approach Open Reduction and Internal Fixation of Hip Fracture

24. Copyright © 2013. F.A. Davis Company  Postoperative Management – Weight-bearing considerations – Exercise and functional training – Exercise Maximum protection phase Moderate and minimum protection phases – Extended exercise programs after surgery for hip fracture Open Reduction and Internal Fixation of Hip Fracture (cont'd)

25. Copyright © 2013. F.A. Davis Company  Outcomes – General outcomes – Impact of rehabilitation Open Reduction and Internal Fixation of Hip Fracture (cont'd)

26. Copyright © 2013. F.A. Davis Company  Related Pathologies and Etiology of Symptoms – Musculotendinous impairments Tendinopathies and muscle strains Repetitive trauma – Bursitis Trochanteric bursitis Psoas bursitis Ischiogluteal bursitis (Tailor’s or Weaver’s bottom) Painful Hip Syndromes: Nonoperative Management

27. Copyright © 2013. F.A. Davis Company  Femoroacetabular Impingement (FAI)  Common Structural and Functional Impairments, Activity Limitations, and Participation Restrictions – Pain – Gait deviations – Imbalance in muscle flexibility and neuromuscular control – Decreased muscular endurance Painful Hip Syndromes: Nonoperative Management (cont'd)

28. Copyright © 2013. F.A. Davis Company  Management: Protection Phase – Control inflammation and promote healing – Develop support in related areas Painful Hip Syndromes: Nonoperative Management (cont'd)

29. Copyright © 2013. F.A. Davis Company  Management: Controlled Motion Phase – Develop a strong mobile scar and regain flexibility – Develop a balance in length and strength of the hip muscles – Develop muscle and cardiopulmonary endurance – Patient education  Management: Return to Function Phase Painful Hip Syndromes: Nonoperative Management (cont'd)

30. Copyright © 2013. F.A. Davis Company EXERCISE INTERVENTIONS FOR THE HIP REGION

31. Copyright © 2013. F.A. Davis Company  Techniques to Stretch Range-Limiting Hip Structures – To increase hip extension – To increase hip flexion – To increase hip abduction – To increase hip abduction and external rotation simultaneously – To increase hip internal rotation Exercise Techniques to Increase Flexibility and Range of Motion (ROM)

32. Copyright © 2013. F.A. Davis Company  Techniques to Stretch Range-Limiting Two- Joint Muscles – Rectus femoris stretches – Hamstring stretches – Tensor fasciae latae and iliotibial band stretches Exercise Techniques to Increase Flexibility and ROM (cont'd)

33. Copyright © 2013. F.A. Davis Company  Open-Chain (Non-Weight-Bearing) Exercises – To develop control and strength of hip abduction (gluteus medius, gluteus minimus, and TFL) – To develop control and strength of hip extension (gluteus maximus) – To develop control and strength of hip external rotation – To develop control and strength of hip adduction Exercises to Develop and Improve Muscle Performance and Functional Control

34. Copyright © 2013. F.A. Davis Company  Closed-Chain (Weight-Bearing) Exercises – Closed-chain isometric exercises – Closed-chain dynamic exercises  Functional Progression for the Hip Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd)

35. Copyright © 2013. F.A. Davis Company  Critical Thinking and Discussion  Laboratory Practice  Case Studies Independent Learning Activities