Manual Therapy Techniques | Description | Dosage |
---|---|---|
Mandatory techniques: | Â | Â |
Long axis distraction with thrust | Supine. The hip is in 15-30° flexion, 15-30 ° AB, slight ER. Preferably use seat belt. Perform 3-6 thrusts at the beginning of the first set then perform oscillations in the remaining sets. | 3-6 sets of 30 secs |
Seatbelt glide, or distraction mobilisations, with the hip flexed | Supine with hip flexed and using a seatbelt, oscillatory passive accessory mobilisation forces applied caudally or laterally to the proximal thigh. | 3-6 sets of 30 secs |
Internal rotation in prone | Prone with knee flexed. IR until contralateral pelvis rises, apply oscillatory force downwards to contralateral pelvis. | 3-6 sets of 30 secs |
Soft-tissue or deep-tissue massage of quads, adductors, hamstrings, psoas, lateral hip muscles and/or posterior hip muscles and associated fascia | Firm effleurage stroke, deep frictions or sustained pressure trigger point release with the muscle on stretch. | 2-5 mins |
Optional techniques: | Â | Â |
Long axis distraction in prone | Prone. The hip is in 10-15 ° AB. Preferably use seat belt. Perform caudally directed oscillations. May perform 3-6 thrusts at the beginning of the first set. | 3-6 sets of 30 secs |
Antero-posterior progression (posterior glide) | Supine with hip in flexion and adduction. Use body weight to impart passive oscillations to the postero-lateral hip capsule through the long axis of the femur. Add more flexion, adduction, &/or internal rotation to progress. | 3-6 sets of 30 secs |
Postero-anterior progression (anterior glide) | Prone with knee bent. Leg supported at knee (may use seatbelt). Pressure applied inferior and medial to greater trochanter in posterior to anterior direction. Vary amount of hip flexion/extension, AB/AD, IR/ER. Modify to use figure-4 position and apply pressure through sacrum. | 3-6 sets of 30 secs |
Manual stretches to one joint knee extensors, rectus femoris, hip flexors, hamstrings, hip internal rotators, hip external rotators, or hip adductors | Stretch should be felt in target muscle. Manual stretches should match the soft or deep tissue massage technique selected. | 6 reps × 20 secs or 4 × 30 secs or 2 × 60 secs |
Lumbar spine mobilisation | - Unilateral postero-anterior accessory glides - Passive physiological lumbar spine rotation - Lumbar spine manipulation (supine) - Lumbar spine manipulation (side lying with affected hip up) | 3-6 sets of 30 secs |
Home exercises | Description | Dosage |
Mandatory techniques: | [Exercise difficulty must be progressed] | Â |
Hip abductor strengthening | Progressed through supine, standing, side lying and standing wall press. | 3 × 10 repetitions |
Quads strengthening exercise | Progressed through sitting elastic band press or knee extension, partial squats, partial wall squats*, sit-to stand* and split sit to stand. | 3 × 10 repetitions |
Muscle stretch (should match with the soft tissue/deep tissue massage technique chosen in the manual therapy section | - Hip extension - Hip flextion - Hip abduction and external rotation - Hip internal rotation | 2 mins total with 20-60 sec hold times |
Challenging functional neuromuscular balance/gait drills set | - standing weight shifting forwards#, lateral# and tandem stance# - standing hip control progressing to eccentric hip abductor exercise - balance in double leg stance on foam# or single leg stance# - side stepping progressing to 'carioca' (or braiding) - shuttle walking - stairs | 1-2 exercises (4 minutes total time) |
Optional techniques: | [Maximum of two] | Â |
Strengthening exercise(s) | - hip extensors progressed through gluteal sets, bridging* and unilateral bridging - hip external rotators progressed through clamshells (or sitting or 4-point kneeling internal rotation), resisted clamshells (or sitting internal rotation) and standing wall press - hip internal rotators progressed through 4-point kneeling, sitting and bottom-leg clamshells | 3 × 10 repetitions |
Additional stretches(s) | (as above) | Â |
Lumbopelvic control exercise | Supine pelvic tilt with progressions | 10 repetitions |
 | * Option to add elastic band resistance around both knees. # Option to close eyes. |  |
Patient education | Â | Â |
- About osteoarthritis - Response to exercise and daily physical activity - Activity-rest cycle versus over-activity cycle - Joint protection advice | ||
Prescription of a single walking stick | Only if it will enable the patient to improve their gait pattern and increase their daily physical activity. | |
Stationary cycling | Up to 10 minutes at a moderate level of intensity (rated as "hard" up to "very hard" - level 5-8 on the Modified Borg Rating Scale of Perceived Exertion achieved within 2 minutes of activity if possible) after each treatment session while at the physiotherapy clinic. |