Hip Mobility Exercises

Hip Mobility Exercises include Articular Mobilization Techniques and Soft Tissue Extensibility Techniques.

See Also: Hip Joint Anatomy

Passive Articular Mobilization Techniques

In a single-blind randomized study investigating interventions for hip OA, 109 subjects were randomly assigned to receive Hip Mobility Exercises or active exercises designed to improve strength and ROM for nine visits over a period of 5 weeks. Success rates after 5 weeks were 81% in the manual therapy group and 50% in the exercise group. Furthermore, patients in the manual therapy group had significantly better outcomes on pain, stiffness, hip function, and ROM. The effects of manual therapy on the improvement of pain, hip function, and ROM remained after 29 weeks.

Hip Mobility Exercises are typically performed using a sustained stretch to decrease a hip joint capsular restriction, with the stretch being governed by the direction of the restriction, rather than by the concave–convex rule.

For example, if hip joint extension is restricted, the distal femur is moved into the direction of hip extension. The joint is initially positioned in its neutral position and is progressively moved closer to the end of range. A belt can also be used for this technique. Rotations can be combined with any sustained stretch performed in a cardinal plane. Distraction or compression techniques can be used alone or combined with rotations.

See Also: Hip Range of Motion

Hip Distraction:

Hip distraction mobilizations are indicated for pain and any hypomobility at the hip joint, as in the case when pain is reported by the patient before tissue resistance is felt by the clinician. The lateral distraction technique can be used to increase hip joint ROM into adduction and internal rotation.

Leg Traction (Inferior Glide):

An inferior distraction can be used for temporary relief of joint pain, to increase ROM into hip joint abduction and for stretching capsular adhesion that is pronounced in the inferior portion of the joint capsule.

Quadrant (Scouring) Mobilizations:

Quadrant mobilizations involve flexion and adduction of the hip, combined with simultaneous joint compression through the femur. The flexed and adducted thigh is swept through a 90–140-degree arc of flexion, while maintaining joint compression. This arc of motion should feel smooth and should be pain free. In an abnormal joint, pain or an obstruction to the arc occurs during the movement. In selected nonacute cases, the procedure may be used as an effective mobilizing procedure, where grade II to III mobilizations are applied perpendicular to the arc throughout.

Hip Posterior Glide:

The posterior glide mobilization is used to increase flexion and to increase internal rotation of the hip.

Hip Anterior Glide:

The anterior glide is used to increase extension and to increase external rotation of the hip.

Hip Inferior Glide:

The inferior glide is used to increase abduction of the hip.

Mobilizations with Movement:

To Restore Internal Rotation of the Hip:

This technique is employed when the patient presents with early signs of hip joint degeneration, as indicated by minor capsular signs and slight degenerative changes on radiographs. A belt that can be altered in length is required for the technique.

The patient is positioned in supine with the involved hip and knee flexed and the foot just off the edge of the bed, with the clinician standing on the involved side, facing the patient’s head. A belt is placed around the back of the clinician, just below the hip joints, and around the patient’s thigh as proximal as possible, so that the belt is approximately horizontal.

Using the hand closest to the patient’s head, the clinician grasps the lateral iliac crest of the involved side, with the elbow in the crease of the clinician’s groin to stabilize the pelvis during the maneuver. The clinician wraps the other hand around the patient’s midthigh. From this position, the clinician slowly extends their own hips to apply a distraction force to the patient’s hip joint, while maintaining the fixation of the ilium.

If the maneuver produces any pain, it should be discontinued. This should be differentiated from discomfort, which might be caused by inappropriate placement of the belt.

To Restore Flexion of the Hip:

The technique to restore flexion of the hip is identical to the one described above, except that during the distraction, the clinician passively flexes the patient’s hip into flexion by side bending at the waist.

Techniques to Increase Soft Tissue Extensibility

The efficacy of manual techniques for improving hip ROM has been reported in the literature. Crosman and colleagues studied the effects of hamstring massage (effleurage, petrissage, and friction) on hip flexion range in normal individuals and noted significant range improvements after the soft tissue massage.

Godges and colleagues reported improved hip flexion and hip extension ranges in normal individuals after the application of manual stretches to muscle groups opposing each respective motion, combined with exercise of agonistic muscles.

Iliopsoas stretching:

The patient is positioned in side lying. The patient is instructed to flex the uninvolved hip and maintain its position by using their arms to help stabilize the lumbopelvic region. While monitoring the lumbopelvic motion with one hand, the clinician passively extends the thigh with the other arm/hand. The advantage of psoas muscle stretch technique is that varying degrees of hip adduction/abduction and knee flexion/extension can be controlled. The disadvantage is that the technique is more physically demanding for the clinician.

See Also: Thomas Test

Iliopsoas and Rectus Femoris stretching:

Although a number of exercises have been advocated to stretch Iliopsoas and Rectus Femoris muscle groups, because of their potential to increase the anterior shear of the lumbar vertebrae either directly or indirectly, the standing/ kneeling position is preferred.

A pillow is placed on the floor, and the patient kneels down on the pillow with the other leg placed out in front in the typical lunge position. The patient is asked to perform a posterior pelvic tilt and to maintain an erect position with respect to the trunk. From this starting position, the patient glides the trunk anteriorly, maintaining the trunk in a near vertical position. A stretch on the upper aspect of the anterior thigh of the kneeling leg should be felt. The rectus femoris can be stretched further from this position by grasping the ankle of the kneeling leg and raising the foot toward the buttock.

Tensor Fascia Latae stretching:

The patient is positioned supine with the legs straight. The foot of the leg to be stretched is placed on the table on the outside of the uninvolved straight leg. The patient reaches and grasps the knee of the involved leg and pulls the knee across and over the straight leg. Both shoulders should be kept flat against the table. At the point the stretch is felt, the position is maintained for approximately 30 seconds. The TFL stretch is repeated 10 times.

References

1. Hoeksma HL, Dekker J, Ronday HK, Heering A, van der Lubbe N, Vel C, Breedveld FC, van den Ende CH. Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis Rheum. 2004 Oct 15;51(5):722-9. doi: 10.1002/art.20685. PMID: 15478147.
2. Maitland G: Peripheral Manipulation. 3rd ed. London: Butterworth, 1991
3. Turek SL: Orthopaedics – Principles and Their Application. 4th ed. Philadelphia, PA: JB Lippincott, 1984
4. Yoder E: Physical therapy management of nonsurgical hip problems in adults. In: Echternach JL, ed. Physical Therapy of the Hip. New York, NY: Churchill Livingstone, 1990:103–137.
5. Maitland GD: The hypothesis of adding compression when examining and treating synovial joints. J Orthop Sports Phys Ther 2:7, 1980
6. Mulligan BR: Mobilisations with Movement (MWMS) for the hip joint to restore internal rotation and flexion. J Man Manip Ther 4:35– 36, 1996
7. Crosman LJ, Chateauvert SR, Weisberg J: The effects of massage to the hamstring muscle group on range of motion. J Orthop Sports Phys Ther 6:168, 1984.
8. Godges JJ, MacRae H, Longdon C, et al: The effects of two stretching procedures on hip range of motion and gait economy. J Orthop Sports Phys Ther 10:350, 1989.