Slide 1 ___________________________________ Manual Therapy for the Hip and Lower Quarter ___________________________________ Techniques and Supporting Evidence ___________________________________ Mitchell Barber Scarlett Morris ___________________________________ PT, MPT, CMT, OCS, FAAOMPT PT, DPT, CMT, OCS ___________________________________ ___________________________________ ___________________________________ Slide 2 ___________________________________ Disclosures: ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 ___________________________________ Session 1: The Hip ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 4 ___________________________________ The Hip Hip Anatomy ___________________________________ o Synovial ball-and socket joint o The head of the femur points in an ___________________________________ anterior/medial/superior direction o The acetabulum faces lateral/inferior/anterior ___________________________________ o Anteversion angle of the neck is 10-15 degrees ___________________________________ ___________________________________ ___________________________________ Slide 5 ___________________________________ The Hip Hip Anatomy ___________________________________ o Femoral head articulates with acetabulum, which covers 50% of the femoral head ___________________________________ o Attached to the rim of the acetabulum is the fibrocartilaginous labrum, deepening the socket o Neck angle is 125-135 degrees ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 ___________________________________ The Hip Ligamentous Stability ___________________________________ ◦ Strong fibrous joint capsular extends from the bony rims and labrum of the ___________________________________ acetabulum to the inter-trochanteric line just super to the inter-trochanteric crest ◦ Three ligaments, or thickenings, of the joint capsular provide stability to the hip joint ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 7 ___________________________________ The Hip ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 ___________________________________ The Hip Ischiofemoral Ligament ___________________________________ Forms the posterior margins of the capsule ___________________________________ Extends from the ischial portion of the acetabulum to the superior femoral neck ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 ___________________________________ The Hip Pubofemoral Ligament ___________________________________ Pubofemoral ligament lies medially and inferiorly and extends from the inferior ___________________________________ acetabular rib to the inferior femoral neck Helps to limit abduction and extension ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 10 ___________________________________ The Hip ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 11 ___________________________________ The Hip Iliofemoral Ligament ___________________________________ Extends from the ventral edge of the ilium to the inter-trochanteric line ___________________________________ It is taught in full extension and promotes stability of the pelvis on the femur in erect stance ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 12 ___________________________________ The Hip ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 13 ___________________________________ The Hip Ligamentum Teres ___________________________________ From the acetabular notch to the head of the femur ___________________________________ Aids little in joint stability and helps to arrest abduction ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 14 ___________________________________ The Hip The anterior and posterior hip ligaments ___________________________________ wind around the column in a clock-wise direction Extension 'winds' or tightens these ___________________________________ ligaments, while flexion, 'unwinds' or relaxes them In ER the anterior fibers are taut and in IR the posterior fibers are taut ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 15 ___________________________________ The Hip Range of Motion ___________________________________ Flexion: • 120 deg w/ knee flexed ___________________________________ • 30-40 deg abduction: 150 degrees Abduction: 45 degrees ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 16 ___________________________________ The Hip Range of Motion ___________________________________ Adduction: 30 degrees Ext. Rotation: 45 degrees ___________________________________ Int. Rotation: 30 degrees Extension: 20 degrees w/knee ___________________________________ extended ___________________________________ ___________________________________ ___________________________________ Slide 17 ___________________________________ The Hip Joint Arthrokinematics ___________________________________ Follows convex on concave rules – roll and glide are in opposite directions ___________________________________ Flexion/extension: Spin movement of the head of the femur Abduction: Head of femur rolls superior, ___________________________________ glides inferior ___________________________________ ___________________________________ ___________________________________ Slide 18 ___________________________________ The Hip Joint Arthrokinematics ___________________________________ Adduction: Head of femur rolls inferior, glides superior ___________________________________ External Rotation: Head of femur rolls posterior, glides anterior ___________________________________ Internal Rotation: Head of femur rolls anterior, glides posterior ___________________________________ ___________________________________ ___________________________________ Slide 19 ___________________________________ The Hip Joint Arthrokinematics ___________________________________ Resting position: Flexion 30 degrees Abduction 30 degrees Ext. rotation 20 degrees ___________________________________ Closed-packed: Full extension, abduction, internal rotation ___________________________________ Capsular pattern: Flexion, abduction, internal rotation (order may vary) ___________________________________ ___________________________________ ___________________________________ Slide 20 Joint Mobilizations ___________________________________ Distraction • Belt can be used. ___________________________________ • Be as close to the joint as possible. • Hip should be placed in ___________________________________ resting position – 30 flex, 30 abd, 20 ER. • Lean away from patient gliding femoral ___________________________________ head in lateral, inferior and posterior direction – “down and out”. ___________________________________ ___________________________________ ___________________________________ Slide 21 ___________________________________ Long axis distraction • Hip in open-packed position ___________________________________ • Grasp ankle above malleoli • Distract by leaning back *Can also be a manipulation ___________________________________ **Think about what is behind you/body mechanics! ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 22 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 23 ___________________________________ Anterior glide femoral head in prone ◦ Place cranial hand on proximal part femur. ___________________________________ Caudal hand under distal part femur. Flex knee. ◦ Extend hip with caudal ___________________________________ hand, while mobilizing the proximal femur in anterior direction. ___________________________________ ◦ >>> Increases extension ___________________________________ ___________________________________ ___________________________________ Slide 24 ___________________________________ Anterior glide of