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| == Physical Therapy Management <br> == | | == Physical Therapy Management <br> == |
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| <!--StartFragment--> | | <!--StartFragment--> <span lang="EN-US" style="font-family:Arial;mso-bidi-font-family: Arial;mso-ansi-language:EN-US">Treatment goals: improve strength, coordination, |
| <span lang="EN-US" style="font-family:Arial;mso-bidi-font-family: | |
| Arial;mso-ansi-language:EN-US">Treatment goals: improve strength, coordination, | |
| mobility, balance, stand, stability, flexibility. Reduce pain. | | mobility, balance, stand, stability, flexibility. Reduce pain. |
| | </span> |
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| <u> | | <u></u> |
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| USUAL CARE</u>
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| <u>Passive exercises<sup>2</sup><o:p></o:p></u></span> | | <u>USUAL CARE</u> |
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| *<span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
| | <u><!--StartFragment--><u><span lang="EN-US" style="font-size:11.0pt;line-height: |
| EN-US">Position patient: supine, hip in 15-30° flexion, 15-30° AB, slight ER
| | 115%;font-family:Arial;mso-fareast-font-family:Calibri;mso-fareast-theme-font: |
| </span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
| | minor-latin;mso-bidi-font-family:Arial;mso-ansi-language:EN-US;mso-fareast-language: |
| EN-US">
| | EN-US;mso-bidi-language:AR-SA">Passive exercises<sup>2</sup></span></u><!--EndFragment--></u> |
| Physiotherapist: perform 3-6 thrusts at the beginning of the first set then
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| perform oscillations.</span>
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| *<span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US"><o:p></o:p></span><span lang="EN-US" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
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| Symbol;mso-ansi-language:EN-US"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman""> </span></span></span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">Positions patient: supine with hip flexed
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| </span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">
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| Physiotherapist: oscillatory passive mobilizations, applied caudally or
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| laterally to the proximal thigh<o:p></o:p></span>
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| *<span lang="EN-US" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
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| Symbol;mso-ansi-language:EN-US"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman""> </span></span></span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">Position patient: Prone with knee flexed.
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| </span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">
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| Physiotherapist: IR until contralateral pelvis rises, apply oscillatory force
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| downwards to contralateral pelvis.<o:p></o:p></span>
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| *<span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">Firm effleurage stroke, deep frictions or sustained pressure trigger
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| point release with the muscle on stretch.<o:p></o:p></span>
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| *<span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">Position patient: Prone. The hip is in 10-15 ° AB.
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| </span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">
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| Physiotherapist: Perform caudally directed oscillations. May perform 3-6
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| thrusts at the beginning of the first set.<o:p></o:p></span>
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| *<span lang="EN-US" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
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| Symbol;mso-ansi-language:EN-US"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman""> </span></span></span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">Position patient: Supine with hip in flexion and adduction.
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| <o:p></o:p></span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:
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| Arial;mso-ansi-language:EN-US">Physiotherapist: Use body weight to impart
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| passive oscillations to the postero-lateral hip capsule through the long axis
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| of the femur. Add more flexion, adduction, &/or internal rotation to
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| progress.<o:p></o:p></span>
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| *<span lang="EN-US" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
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| Symbol;mso-ansi-language:EN-US"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman""> </span></span></span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">Massage of quads, hamstrings, psoas, adductors, abductors,
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| gluteus-muscles<o:p></o:p></span>
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| <u><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family: | | <u><u><span lang="EN-US" style="font-size:11.0pt;line-height: |
| Arial;mso-ansi-language:EN-US"></span></u>
| | 115%;font-family:Arial;mso-fareast-font-family:Calibri;mso-fareast-theme-font: |
| | | minor-latin;mso-bidi-font-family:Arial;mso-ansi-language:EN-US;mso-fareast-language: |
| <u><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:
| | EN-US;mso-bidi-language:AR-SA"><sup></sup></span></u></u> |
| Arial;mso-ansi-language:EN-US"></span></u><u><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:
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| Arial;mso-ansi-language:EN-US">Active exercises<o:p></o:p></span></u>
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| *<span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">Knee to chest exercise (strengthens the abdominal muscles and improves
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| the flexibility of the hip, back and neck)
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| </span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">
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| Patient lies on the floor with left leg straight and right foot flat on the
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| floor. Grabs his knee and bring it toward to his chest, holds for 30seconds and
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| switches legs.<u><o:p></o:p></u></span>
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| *<span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">Bridging exercise ( strengthens buttock abdominal and hamstrings
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| muscles)
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| </span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">
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| Patient lies on his back with knees bent and feet flat on the floor. While
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| tightening abdominal muscles he lifts his pelvis slightly upwards. Hold for
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| 15-20 seconds. Repeat 8-12 times.<u><o:p></o:p></u></span>
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| *<span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">Balance exercises<sup>2
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| </sup><o:p></o:p></span><span lang="EN-US" style="font-family:Arial;
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| mso-bidi-font-family:Arial;mso-ansi-language:EN-US">( Standing weight shifting forwards/ | |
| lateral, Standing in double leg stance on foam, Shuttle walking, Stairs)<u><sup><o:p></o:p></sup></u></span>
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| *<span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US">Endurance exercises
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| </span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US"> | |
| Walk, cycle, swim</span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language:
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| EN-US"></span><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:Arial;mso-ansi-language: | |
| EN-US"><o:p></o:p></span>
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| <u><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:
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| Arial;mso-ansi-language:EN-US"></span></u>
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| <u><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:
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| Arial;mso-ansi-language:EN-US">Advice and education<sup><o:p></o:p></sup></span></u>
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| <span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:
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| Arial;mso-ansi-language:EN-US">In the treatment it is very important to tell
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| the patient about his condition. Why does it occur? What's the treatment?
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| What's the importance of exercise?
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| This will make the patient have a clear understanding in his condition and will
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| improve the healing. <sup>2</sup>
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| It’s also very important to tell the patient what he can and can not do.
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| <o:p></o:p></span>
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| <u><span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:
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| Arial;mso-ansi-language:EN-US">BGA</span></u><span lang="EN-US" style="font-family:
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| Arial;mso-bidi-font-family:Arial;mso-ansi-language:EN-US"><o:p></o:p></span>
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| <span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:
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| Arial;mso-ansi-language:EN-US">Behavioral graded activities is an kind of
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| treatment that contains normal exercise therapy comprising booster sessions.
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| The long term effectiveness have been showed, but it is never proved that this
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| treatment has a better efficacy than usual care. <sup>4</sup>
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| BGA intervention consists of 3 phases:<sup>3</sup>
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| <span style="mso-tab-count:1"> </span>1) Starting phase: The physiotherapist will educate the patient about his condition. <span style="mso-tab-count:1">
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| </span> And there will be made a list of treatment goals and problematic activities.<o:p></o:p></span>
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| <span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:
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| Arial;mso-ansi-language:EN-US"><span style="mso-tab-count:1"> </span>2) Treatment phase: increasingly difficult exercises.<o:p></o:p></span>
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| <span lang="EN-US" style="font-family:Arial;mso-bidi-font-family:
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| Arial;mso-ansi-language:EN-US"><span style="mso-tab-count:1"> </span>3) Integration phase: The physiotherapist will support and integrate<span style="mso-spacerun:yes"> </span>behavioral <span style="mso-tab-count:1"> </span>change.<o:p></o:p></span>
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| <!--EndFragment-->
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| == Key Research == | | == Key Research == |
Welcome to
Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
== Search Strategy
==
Database: Pubmed
Keywords: Treatment OA, Exercise OA, OA
Database: Website Library VUB
Keywords: Treatment OA, Exercise OA, OA
Hip osteoarthritis is a common type of osteoarthritis. Since the hip is a weight-bearing joint, osteoarthritis can cause significant problems.
Hip osteoarthritis is caused by deterioration of articular cartilage of the hip joint.
There are several reasons this can develop:
• Previous hip injury
• Previous fracture, which changes hip alignment
• Genetics
• Congenital and developmental hip disease
• subchondral bone that is too soft or too hard 5
Clinically Relevant Anatomy[edit | edit source]
The hip joint is a synovial ball and socket joint, with the convex femoral head articulating with the concave acetabulum. Stability of the joint is achieved through a combination of muscle action and several ligaments forming a loose, but strong joint capsule, the iliofemoral ligament, the ischialfemoral ligament and the pubofemoral ligament. Another ligament, the ligamentum teres, does not provide stability to the hip but offers a portion of blood supply to the femoral head in some individuals.
The femoral head and acetablum are covered by smooth hyaline cartilage, and the acetabulum contains a labrum, which functions to facilitate movement and support the forces passed through the joint.
The hip, despite the requirement to support the weight of the body, has the second largest exursion of motion of any joint in the body.
External Link: [Hip Anatomy Video]
<== Epidemiology /Etiology ==
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Characteristics/Clinical Presentation[edit | edit source]
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Altman et al have established guidelines by which clinical diagnosis of hip osteoarthritis can be made. The guidelines, established in 1991, present a 3 pronged approach to diagnosis of hip osteoarthritis including clinical, radiological, and laboratory findings. According to these guidlelines, a patient was considered to have osteoarthritis if they presented with:
- Hip Pain and...
- Hip Internal Rotation < 15 degrees and Hip Flexion less than or equal to 115 degrees
or, hip pain in combination with:
- Hip Rotation < 15 degrees or...
- Pain with Hip Internal Rotation or...
- Hip stiffness in the AM less than 60 minutes or...
- Age > 50 years
More recently, Sutlive et al have proposed a clinical prediction rule to identify individuals with hip osteoarthritis presenting with unilateral hip pain.
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add links to outcome measures here (also see Outcome Measures Database)
The beginning of OA is characterized by limited
abduction and rotation in the hip joint. Later on flexion, extension, adduction,.. will become more difficult.
Physiotherapeutic examination 1
1) Palpation of M. gluteus medius.
Position: patient lies on his side. Upper leg in adduction and flexion
OA: Zone of greater Trochanter is sensitive and painful.<o:p></o:p>
2)Flexion and forced flexion
Position: patient lies on his back.
OA: Flexion is limited.<o:p></o:p>
3) Extension
Position: Patient in prone. Physiotherapist stabilizes the pelvis and raises
the leg.
OA: Amplitude is limited<o:p></o:p>
4) Abduction and adduction
Position: Patient lies on his back. Physiotherapist stabilizes the pelvis and
performs abduction and adduction.
OA: abduction is limited, adduction keeps normal amplitude.<o:p></o:p>
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Physical Therapy Management
[edit | edit source]
Treatment goals: improve strength, coordination,
mobility, balance, stand, stability, flexibility. Reduce pain.
USUAL CARE
Passive exercises2
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
add appropriate resources here
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see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
see adding references tutorial.