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The Hip

The Hip. Chapter 20. Structure and Function of the Hip. Anatomical Characteristics of the Hip Region. Bony Structures The pelvis The femur Hip Joint Characteristics Characteristics Articular surfaces Ligaments. Anatomical Characteristics of the Hip Region (cont'd).

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The Hip

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  1. The Hip Chapter 20

  2. Structure and Function of the Hip

  3. Anatomical Characteristics of the Hip Region • Bony Structures • The pelvis • The femur • Hip Joint Characteristics • Characteristics • Articular surfaces • Ligaments

  4. Anatomical Characteristics of the Hip Region (cont'd) • Hip Joint Arthrokinematics • Motions of the femur • Motions of the pelvis • Influence of the Hip Joint on Balance and Posture Control

  5. Functional Relationships of the Hips and Pelvis • 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)

  6. Pathomechanics in the Hip Region • Decreased Flexibility • Muscle Weakness • Patellofemoral impairment • Anterior cruciate ligament strain • Piriformis syndrome

  7. Pathomechanics in the Hip Region (cont'd) • 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

  8. Pathomechanics in the Hip Region (cont'd) • Asymmetrical Leg Length • Unilateral short leg • Coxa valga and coxa vara • Anteversion and retroversion

  9. The Hip and Gait • Hip Muscle Function and Gait • Hip flexors • Hip extensors • Hip abductors • Effect of Musculoskeletal Impairments on Gait

  10. Referred Pain and Nerve Injury • Major Nerves Subject to Injury or Entrapment • Sciatic nerve • Obturator nerve • Femoral nerve • Common Sources of Referred Pain in the Hip and Buttock Region

  11. management of hip disorders and surgeries

  12. Joint Hypomobility: Nonoperative Management • 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

  13. Joint Hypomobility: Nonoperative Management (cont'd) • Management: Protection Phase • Provide patient education • Decrease pain at rest • Decrease pain during weight-bearing activities • Decrease effects of stiffness and maintain available motion

  14. Joint Hypomobility: Nonoperative Management (cont'd) • 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

  15. Total Hip Arthroplasty • Indications for Surgery • Preoperative Management • Procedures • Background • Prosthetic designs and materials • Cemented versus cementless fixation

  16. Total Hip Arthroplasty (cont'd) • Overview of Operative Procedures • Standard surgical approaches • Minimally invasive approaches • Implantation of components and closure

  17. Total Hip Arthroplasty (cont'd) • Complications • Intraoperative complications • Early postoperative complications • Late complications • Dislocation: a closer look • Leg length inequality: a closer look

  18. Total Hip Arthroplasty (cont'd) • Postoperative Management • Immobilization • Weight-bearing considerations • Exercise progression and functional training • Accelerated rehabilitation

  19. Total Hip Arthroplasty (cont'd) • 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

  20. Total Hip Arthroplasty (cont'd) • Outcomes • Pain relief, patient satisfaction, and quality of life • Physical functioning • Implant design, fixation, and surgical approach • Impact of rehabilitation

  21. Hemiarthroplasty of the Hip • Indications for Surgery • Procedures • Background • Operative procedure • Postoperative Management • Outcomes

  22. Hip Fracture • Incidence, Risk Factors and Impact on Function • Sites and Types of Hip Fracture

  23. Open Reduction and Internal Fixation of Hip Fracture • Indications for Surgery • Procedures • Types of fixation and surgical approach

  24. Open Reduction and Internal Fixation of Hip Fracture (cont'd) • 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

  25. Open Reduction and Internal Fixation of Hip Fracture (cont'd) • Outcomes • General outcomes • Impact of rehabilitation

  26. Painful Hip Syndromes: Nonoperative Management • 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)

  27. Painful Hip Syndromes: Nonoperative Management (cont'd) • 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

  28. Painful Hip Syndromes: Nonoperative Management (cont'd) • Management: Protection Phase • Control inflammation and promote healing • Develop support in related areas

  29. Painful Hip Syndromes: Nonoperative Management (cont'd) • 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

  30. Exercise interventions for the hip region

  31. Exercise Techniques to Increase Flexibility and Range of Motion (ROM) • 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

  32. Exercise Techniques to Increase Flexibility and ROM (cont'd) • Techniques to Stretch Range-Limiting Two-Joint Muscles • Rectus femoris stretches • Hamstring stretches • Tensor fasciae latae and iliotibial band stretches

  33. Exercises to Develop and Improve Muscle Performance and Functional Control • 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

  34. Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd) • Closed-Chain (Weight-Bearing) Exercises • Closed-chain isometric exercises • Closed-chain dynamic exercises • Functional Progression for the Hip

  35. Independent Learning Activities • Critical Thinking and Discussion • Laboratory Practice • Case Studies

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