There are a variety of manual techniques used to increase joint play/joint ROM of the hip complex. Several of these techniques are listed below. For relevant hip anatomy, see Hip Anatomy. Hip mobilizations may also be beneficial for individuals with hip osteoarthritis; for more information, see CPR for hip mobs with knee OA. Show
[1] - Patient is positioned in prone with knee bent. Therapist supports the knee with one hand, while the opposite hand is placed on the posterior portion of the proximal femur on the involved side. The mobilizing hand imparts a glide directly perpendicular to the long axis of the femur. The femur may be placed into varying degrees of abduction or rotation depending on desired effect. As with other glides, this glide can be performed in other positions. Anterior glide is used to increase joint play and capsular stretch to encourage external rotation and extension ROM. - Patient is positioned supine, knee is supported with stabilizing hand and the mobilizing hand is placed on anterior portion of proximal femur. Using heel of hand, a posterior glide is imparted directly downward by keeping arm straight and leaning trunk. This technique can be used to increase joint play necessary for internal rotation. - Patient is positioned supine, with hip and knee flexed to 90 degrees. The opposite leg is supported on the operator's shoulder in flexion (this technique can be performed with varying degrees of flexion and/or rotation depending on intended effect). An inferior glide of the femur is applied through either the hands or a mobilization belt. This technique can be used for capsular stretching and to encourage accessory motion necessary for hip flexion and rotation. Hip Distraction with Knee Extended[edit | edit source]Patient is positioned supine, with hip in slight flexion and knee extended. A belt or therapist's hands are placed firmly around the patient's ankles (hand position varies depending on clinician preference). Distraction of the hip can be produced by the therapist leaning backward, producing slight joint gapping at the femoroacetabular joint. This technique can be used for decreasing muscle spasm or pain, and is also useful to increase accessory joint movement for flexion and abduction movements. [2] Hip Distraction with Knee Flexed[edit | edit source]Patient is positioned supine, target leg in "crook lying" hip at 50-degree flexion, knee at around 100 degrees of flexion> The Sits on foot, forearm closest to the patient between the thigh and lower leg, Hand furthest from patient rests on patients thigh. Forearm and hand-pulls towards therapist, distracting the knee Patient is positioned supine target leg in "crook lying" hip at 50-degree with Knee in maximal flexion, but raised off plinth. The therapist "hugs the target leg" with forearms around the patients abductors and pulls the leg towards them. (Watch from 4:23) Rotation Oscillations in Crook-Lying[edit | edit source]Patient is positioned in supine, target leg in "crook lying" hip at 50-degree. Knee in maximal flexion, but raised off plinth. The therapist "hugs the target leg" with caudal forearm around the patients abductors, ventral hand on patients thigh. Then Internally rotates femur, pulling thigh towards self The hip joint is a ball and socket joint that is the point of articulation between the head of the femur and the acetabulum of the pelvis. Hip Joint
The hip joint connects the lower extremities with the axial skeleton. The hip joint allows for movement in three major axes, all of which are perpendicular to one another.
In addition to movement, the hip joint facilitates weight-bearing. Hip stability arises from several factors.
2. Acetabular labrum (fiibrocartilaginous collar surrounding the acetabulum) which provides the following functions:
In general, the hip joint capsule is tight in extension and more relaxed in flexion. The capsular ligaments include
The ligamentum teres (ligament of the head of the femur)
Joint Capsule:
Acetabular Labrum copyright and courtesy of Primal Pictures Ltd The labrum forms a fibrocartilagenous extension of the bony acetabulum, mostly composed of type 1 collagen that is typically between 2-3mm thick. It lines the acetabular socket and attaches to the bony rim of the acetabulum. It has an irregular shape, being wider and thinner anteriorly and thicker posteriorly.[3][4] On the anterior aspect, the labrum is triangular in the radial section. On the posterior aspect, the labrum is dimensionally square but with a rounded distal surface.[5][6] The labrum has three surfaces:
The transverse ligaments surround the hip and help hold it in place while moving. It is thought that the majority of the labrum is avascular with only the outer third being supplied by the obturator, superior gluteal and inferior gluteal arteries. There is controversy as to whether there is a potential for healing with the limited blood supply and this is an important clinical consideration. The superior and inferior portions are believed to be innervated, containing both free nerve endings and nerve sensory end organs (giving the senses of pain, pressure and deep sensation).[3][4] The functions of the acetabular labrum are:[3]
Image: Hip joint from different perspectives [10] The hip joint receives innervations from the femoral, obturator, superior gluteal nerves. Numerous variations in the blood supply to the hip.
Video: Anatomy of the hip joint [11] Muscles of the hip joint can be grouped based upon their functions relative to the movements of the hip Flexors: Extensors: Adductors: Abductors: Internal Rotators: External Rotators: Full extension of the hip joint is the closed packed postion because this position draws the strong ligaments of the joint tight, resulting in stability. The hip joint is one of the only joints where the position of optimal articular contact (combined flexion, abduction, and external rotation) is the open-packed, rather than closed packed position, since flexion and external rotation tend to uncoil the ligaments and make them slack.[2] Total hip arthroplasty (THA)
Femoral Triangle:
Femoral Angle of Inclination:
Femoral Angle of Torsion:
When any of the features of lateral balance control fails, the supporting is upset. The pelvis tends to fall on the unsupported side when the individual stands on the affected limb. This is called Trendelenburg sign. The person walks with a characteristic lurching or waddling gait. In A: Negative Trendlenburg's sign. The hip abductors are acting normally tilting the pelvis upwards when the opposite leg is raised from the ground. Which positioning aid prevents external rotation of the hips when the patient is in the supine position?Trochanter Roll:
This technique prevents external rotation of the hips when a patient is in a supine position. A rolled up towel is placed slightly underneath each hip.
What is the supine position used for quizlet?The supine position is used for most abdominal procedures, head and neck procedures, vascular surgery and breast surgery. Patient lies flat on back with the arms extended on padded arm boards. If the arms are placed on armboards, the hands should be placed with the palms facing upwards (supination).
In which area would the nurse place a pillow for a patient in the supine position?Supine Position Variation: pillow under the head - 2 pillows under the legs. 1. Place one pillow under the head and shoulders.
In what position is a patient lying on the back quizlet?Supine position with patient lying on the back, with head, shoulders, and extremities moderately flexed and legs extended.
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