Hip Interventions

Question 1

Hip fx -strong evidence of? (2 obvious)

Answer 1

-prevent and identify delirium
-assess and manage fall risks (must assess and document rfs for falls)
-PT must provide exercise (progressive high-intensity resistive strength, balance and WB, functional mobility training)

Question 2

Hip fx -expert opinion

Answer 2

-MUST asses pain at rest and during activity, try to minimize pt during session
-MUST screen for pressure ulcers
-Secondary fx prevention (osteoporosis pts)
-Determine and communicate functional assistance required
-Identify individual goals (get to PLOF, return to residence, indepen.)
-Transition of care from inpatient setting

Question 3

Rfs for pressure ulcers

Answer 3

-sig. limited mobility
-sig. loss sensation
-previous or current ulcers
-nutritional deficiency
-inability to reposition selves
-incontinence
-sig. cog. impairment

Question 4

Hip fx inpatient guidelines

Answer 4

-MUST transfer pt OOB and ambulate ASAP (A)
-High frequency PT following sx (B)
-Provide UE aerobic training (C)
-E-stim for quad strengthening (C)
-E-stim for pain (C)

Question 5

Hip fx -postacute period

Answer 5

PTs offer strength, balance, gait, and functional therapy if there are still limitations. OP therapy and HEPs (A)
Provide recs to maximize safety (A)
PTs can do aerobic training along with resistive, balance, and mobility training (C)

Question 6

Improve mobility P1

Answer 6

-activation/coordination exercise
-mobility exercises
-inhibitory exercises
-STM
-joint mobs, manips.

Question 7

Improve mobility P2

Answer 7

-progression to strength/endurance training (retrain/strengthen motion with new range)

Question 8

Improve mobility P3

Answer 8

increase challenge of exercises (progress toward activity limitations)

Question 9

OA -pt education and interventions

Answer 9

edu: patient empowerment / progression to indepen. and activity mods.
Manual therapy
Strengthening/endurance exercise
Diet/weight loss
Walking/gait training
Pain control modalities

Question 10

OA CP guidelines

Answer 10

-Functional, gait, balance training with ADs (C)
-Flexibility, strengthening, and endurance exercises- address ROM, weakness, limited flexibility (1-5x week over 6-12wks)(A)
-Patient education (mods., exercise, weight reduction, unloading joints)(B)
-Manual therapy (3x week over 6-12wks)(A)
-Modalities (US, exercise and hot packs)(B)
-Weight loss (collab with other drs to support weight loss)(C)

Question 11

Improve stability P1

Answer 11

-exercises: physiologic effects
-activation/coordination exercises
-joint mobs, manips.

Question 12

Improve stability P2

Answer 12

progression to strength/endurance training of stabilizers

Question 13

Improve stability P3

Answer 13

increase challenge of exercises (progress toward activity limitations)

Question 14

Non-arthritic hip pain

Answer 14

Multimodal interventions:
-activity mods
-exercise for strengthening (hip muscles, trunk, LE in general)
-manual therapy
-postural movement correction
-stretching
-balance exercises
-movement pattern training
-education (weak)
-ther ex and activities (weak)

Question 15

Non-arthritic hip pain -conflicting and expert opinions

Answer 15

bracing is conflicting evidence when used alone
manual therapy- with pain, STM with impaired mobility good
NM re-ed good

Question 16

Mechanical loading (3 things that matter)

Answer 16

duration, intensity, frequency (if we can cut down on duration with pillow between legs, this can take out a large part of loading)

Question 17

FAI guidelines

Answer 17

-avoidance of impingement position (especially end range IR)
-pt education
-muscle performance (eccentric ERs)
-some pt dependent interventions

Question 18

Acetabular labral tear (conservative P1)

Answer 18

P1: activity mod/ pt edu
gait training maybe with AD
oscillation mobs/ ST mobs
mobility/ pain mng exercises

Question 19

Acetabular labral tear (conservative P2)

Answer 19

-lumbopelvic coordination/strengthening exercises (improve hip stability w/ ADDs, IRs, ERs)
-LE strengthening
-balance/coordination exercises

Question 20

Acetabular labral tear (conservative P3)

Answer 20

increase challenge of exercises (toward activity limitations)

Question 21

Acetabular Labral tear (operative restrictions)

Answer 21

no flex >90, ABD/ER/IR >30, ext >0 for first 3 weeks

Question 22

Acetabular labral tear (operative P1)

Answer 22

days (1-7)
w/b to tolerance with crutches
isometric quad and glut
AROM all planes
closed chain- bridge, weight shift, balance exercises
open chain- hip flex, ext, ADD, ABD
*AVOID SLR

Question 23

Acetabular labral tear (operative P2)

Answer 23

weeks 1-3
progress off crutches- normalize gait
progress ROM, stretch at end range w/in tol
stationary bike
light open chain above knee RT (pulley or t band)

Question 24

Acetabular labral tear (operative P3)

Answer 24

weeks 4-6
progress flexibility exercises
progress resisted strengthening (lumbopelvic stability, strength imbalances, biomechan control)
functional exercises introduced

Question 25

Tendinopathy

Answer 25

pain and inflamm. mx w/ acute address impairments (guarding, hypomobility) protection vs. mod stressing/facilitating healing -eccentrics! (and concentrics) address contributing factors - repet. microtrauma -capsule hypomobility -hip, lumbopelvic discoordination -l-spine hypomob. -muscle tendon unit tightness

Question 26

Eccentric loading

Answer 26

promotes collagen fiver cross-linkage within tendon, facilitates remodeling improved tensile loading capacity, tissue strength

Question 27

GTPS

Answer 27

-decreased loading -thermotherapy -exercise interventions (tendinopathy) -concentration on ABD and ER -manual therapy (hip joint mobs, STM) -activity mods (avoid sleep on side, avoid hip ADD, avoid crossing legs, use of handrail on non-symp side when using stairs) ITB stretching ILL ADVISED

Question 28

Muscle strain (POLICE)

Answer 28

Protection (limit excess loading on injured side) Optimum Loading (guide collagen fiber formation, just right amount of exercise) Ice (limits ECF and hematoma to be reabsorbed) Compression (limits swelling) Elevation (limits swelling)

Question 29

Hamstring strain injury (reinjury risk and return to play)

Answer 29

-Already having a hamstring injury, higher risk for future reinjury (B) -Use caution in RTP for pts that did not complete exercise program with eccentrics (B) -Use hamstring strength, pain, days from injury, area of tenderness on IE to estimate time to RTP

Question 30

Hamstring strain (dx)

Answer 30

Presents with sudden onset of P. thigh pain, with pain reproduced when hamstring stretched or activated, tenderness with palp, and loss of func (B)

Question 31

HSI (examin)

Answer 31

-Quantify knee flexor strength using handheld or isokinetic dynamometer (A) -Assess hamstring length by measuring knee ext deficit with hip at 90, using inclinometer (A) -Length of muscle tenderness and prox to ischial tub to predict timing of RTP (C) -Assessing trunk and pelvic posture during func. movements (F)

Question 32

HSI interventions

Answer 32

-Include Nordic hamstring exercise as HSI prevention program, along with warm-up, stretching, stability training, strengthening, func. movements (A)

Question 33

!!!HSI (interventions after injury)

Answer 33

-Eccentric training, stretch, strengthen, stabilizing, progressive running to improve RTP time -

Question 34

Nerve entrapments -Mobs

Answer 34

attempt to retore dynamic balance between movement of neural tissues and surrounding mechan interfaces

Question 35

N. entraps (types, mechanisms)

Answer 35

Types: gentle stretching, nerve mobs (active or passive, gliders or tensioners) -decrease adhesions and improved movement of peripheral ns., increase neural vascularity (increase O2 decreases ischemic pain), dispersion of noxious fluids, improve axoplasmic flow