Therapy Exercises for the Hip

Welcome to <a href="Vrije Universiteit Brussel Evidence-based Practice Project">Vrije Universiteit Brussel's Evidence-based Practice project</a>. 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!!

Original Editors - <a href="User:Marlies Verbruggen">Marlies Verbruggen</a>

Top Contributors - <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="12" _fck_mw_template="true">  

Search Strategy

Keywords: hip and exercises and physiotherapy/physcial therapy were combined. The medical library books database(VUBIS) was searched.

Definition/Description

Exercises are described related to hip complaints and disabilities in walking and walking for a distance over 1km.

Clinically Relevant Anatomy

Hip joint. For example: 

http://www.physio-pedia.com/Hip_Osteoarthritis

Indication for Exercises

For example: loss of strength, impaired walking, disturbed gait analysis. Use Nijmeegse gait analysis screening tool.

Exercise Techniques    

1) Therapy exercises for specific disorders

a) Iliopsoas bursitis <a href="Iliopsoas Bursitis">(See iliopsoas bursitis)</a>

A rehabilitation program for the iliopsoas syndrome with hip rotation (to increase mobility), strengthening ( of the hip muscles) and stretching exercises is aiming to improve pain and functioning of patients with this syndrome. (Level of evidence: 2b)
First two weeks of the program

1. The internal rotation hip strengthening exercise
The patient needs to be in a sitting position. An elastic resistance strap is used to do this exercise.
The patient is sitting on the table. The elastic resistance strap is attached to the table leg 10 cm above the ground. The other side of the resistance strap is attached around the foot of the patient’s affected hip. The patient performs an internal rotation.
The patient should perform three sets of 20 repetitions on both the affected and unaffected side. When the strength test reveals that the affected side is weaker than the unaffected side, then the number of sets on the unaffected side needs to be reduced to two sets of 20 repetitions instead of three sets.
Patients can experience fatigue in the posterolateral hip region when they are
performing the internal hip rotation
exercise.
The internal rotation strengthening exercise needs to be performed daily and only on the affected side for two weeks. After two weeks the exercises will change to incorporate a more functional position for the hip joint.

<img src="/images/0/00/Internal_rotation_.jpg" _fck_mw_filename="Internal rotation .jpg" alt="" />

2. The external rotation hip strengthening exercise.
Same position as internal rotation but now the patient performs an external rotation. The strap is used to stabilize the thigh to prevent sagittal and frontal plane hip motion. This exercise can be used for the patellofemoral pain syndrome<a href="Patellofemoral Pain Syndrome">( See PFP)</a>.(Level of evidence: 2b)
The patient should perform three sets of 20 repetitions on both the affected and unaffected side. When the strength test reveals that the affected side is weaker than the unaffected side, then the number of sets of the unaffected side needs to be reduced to two sets of 20 repetitions instead of three sets.
Patients can experience fatigue in the anteromedial hip region when they are performing the external hip rotation.
After two weeks of the strengthening program we do another exercise for two weeks.
<img src="/images/6/65/External_2.png" _fck_mw_filename="External 2.png" alt="" />

3. The side-lying abduction/external rotation exercise
The patient lies on the table on his/her side with the hip in approximately 45 degrees of flexion (the elastic resistance strap surrounds the knees).The patient performs an abduction with his upper leg. He slowly lowers his leg: at this point the hipabductors contract eccentrically. 
The patient should perform this exercise three sets of 20 repetitions on the affected side and two sets of 20 repetitions on the unaffected side.
The side-lying abduction exercise should be performed daily for 2 weeks.
The initial internal and external exercises in sitting positions should be continued during this stage at a frequency of two or three times a week.
At the one month stage: the final progression of the strengthening program

<img src="/images/a/aa/Abductie.jpg" _fck_mw_filename="Abductie.jpg" alt="" />
4. Weightbearing hip strengthening exercise
The patient is standing against the wall on one leg. The patient bears his weight on the affected side en he/she performs a series of mini-squats.
The patient should maintain the external rotation of the affected hip so that the hip remains over the lateral portion of the foot/leg which is bearing the weight.
This exercise should be performed two or three times a week with three sets of 20 repetitions on the affected side and two sets of 20 repetitions on the unaffected side.

<img src="/images/1/1a/Mini_squat.jpg" _fck_mw_filename="Mini squat.jpg" alt="" />
5. Stretching program
The patients need to stretch daily. The main stretches are: stretching of the hip flexor, the quadriceps, the lateral hip/piriformis and the hamstring muscles.
The patients should perform more stretches on the affected side than on the unaffected side. They have to repeat them as often as they can throughout the day.
They should keep stretching their muscles as long as they’re in pain.

<img src="/images/3/31/Hip_flexor_stretch.jpg" _fck_mw_filename="Hip flexor stretch.jpg" alt="" /><img src="/images/1/16/Quadricepsstretch.jpg" _fck_mw_filename="Quadricepsstretch.jpg" alt="" /><img src="/images/9/95/Hamstring_stretch.png" _fck_mw_filename="Hamstring stretch.png" alt="" />

 
b) Piriformis syndrome<a href="Piriformis Syndrome">(See Piriformis syndrome)</a>

1. Hip muscle Strengthening exercises and movement re-education
In its case report, Tonley et al. describes an alternative treatment approach for piriformis syndrome. The intervention focused on functional exercises aimed at strengthening the hip extensors, abductors and external rotators, as well as the correction of faulty movement patterns. Despite positive outcomes (full resolution of low back pain, cessation of buttock and thigh pain) in this case report, care must be taken in establishing cause and effect based on a single patient. Further investigation is needed to extrapolate the outcomes to other patients with piriformis syndrome.
The patient in this article followed physical therapy 8 times over a 3-month period. The exercises are divided over 3 phases.

1. Phase 1 (week 0-4):
non-weight-bearing exercises to accentuate isolated muscle recruitment

1) Bridge with Thera-band resistance

• Wrap Thera- band around the thighs just proximal to the knee.
• Supine position + flexion of the knees and hip
• Elevate the pelvis, with in the meantime abduction and external rotation of the hips.
• It’s important to avoid adduction and internal rotation while lowering the hip.
• 3 sets of 15 repetitions

<img src="/images/d/d1/Hip_exercises_1.png" _fck_mw_filename="Hip exercises 1.png" alt="" />

2) Clamshells with thera-band resistance

• Sidelying, flexion of hip and knee in 45°, holding feet together
• Raise knees up and back + hip abduction and external rotation
• Use theraband as resistance if patient is able to perform 3 sets of 15 repetitions without resistance.
• 3 sets of 15 repetitions

<img src="/images/0/0e/Hip_exercises_2.png" _fck_mw_filename="Hip exercises 2.png" alt="" />

2. Phase 2 (week 4-9):
Weight-bearing strengthening exercises

1) Squat with Thera-band resistance

• Wrap Thera-band around the thighs just proximal to the knee.
• Execute a squat maneuver to a dept of 45° (later 75°) with back s
• 3 sets of 15 repetitions

<img src="/images/9/9e/Hip_exercise_3.png" _fck_mw_filename="Hip exercise 3.png" alt="" />

2) Side-step with Thera-band resistance

• Wrap Thera-band around the thighs just proximal to the knee
• Squat position, 45° hip and knee flexion
• Take steps to the right and the left along a 10-m walk-away, abduct and external rotate the hips
• Keep trunk erect during the exercise
• Avoid knees over toes
• 3 sets of 15 repetitions
  

<img src="/images/a/ad/Hip_exercise_4.png" _fck_mw_filename="Hip exercise 4.png" alt="" />

3) Single-limb sit to stand

• Sit on a treatment table (start at 70 cm)
• Squat position
• Stand up and control hip motions and keep alignment of lower extremity in frontal and transverse planes during the exercise
• Progress by lowering the surface in 4 cm increments., double-limbed to single-limbed
• 3 sets of 15 repetitions
  

<img src="/images/b/b5/Hip_exercise_5.png" _fck_mw_filename="Hip exercise 5.png" alt="" />

4) Step Down

• Stand on a 20 cm high step stool
• Touch the heel to the ground and return slowly to the start position over a 3-second period
• Control hip motions and keep alignment of lower extremity in frontal and transverse planes during the descending and ascending
• Perform with contralateral upper extremity support first, later without support (if patient is able to execute 3 sets of 15 repetitions with control of hip motions)
  

<img src="/images/4/4c/Hip_exercise_6.png" _fck_mw_filename="Hip exercise 6.png" alt="" />

3. Phase 3 (week 9-14):
Functional Training, namely dynamic and ballistic training

1) Forward lunge

• The lead knee is flexed to a dept of 75°
• Don’t pass the knee beyond the foot
• Keep alignment femur in frontal and transverse planes during the exercise
• 3 sets of 15 repetitions

<img src="/images/3/34/Hip_exercise_7.png" _fck_mw_filename="Hip exercise 7.png" alt="" />

2) Lateral Lunge at 45°

• The lead knee is flexed to a dept of 75°
• Don’t pass the knee beyond the foot
• Keep alignment femur in frontal and transverse planes during the exercise
• 3 sets of 15 repetitions

<img src="/images/7/7f/Hip_exercise_8.png" _fck_mw_filename="Hip exercise 8.png" alt="" />

3) Double limb take-off jumps with double-limb landings

• Perform maximal effort double-limb take –off jumps to double-limb landings to a deep squat, with flexion of the knee (90°) , without hip adduction or internal rotation
• Control hip motions and keep alignment of lower extremity in frontal and transverse planes
• 3 sets of 15 repetitions

<img src="/images/9/93/Hip_exercise_9.png" _fck_mw_filename="Hip exercise 9.png" alt="" />

4) Double limb take-off jumps with single-limb landings

• Perform maximal effort double-limb take –off jumps to single limb landings, with flexion of the knee (90°) , without hip adduction or internal rotation
• Control hip motions and keep alignment of lower extremity in frontal and transverse planes
• 3 sets of 15 repetitions

<img src="/images/5/51/Hip_exercise_10.png" _fck_mw_filename="Hip exercise 10.png" alt="" />

 2) Therapy exercises to improve several functions

a) Strength

1. Pelvicdrop(Level of evidence: 2c )

This is a simple exercise to improve the strength in the gluteal muscles. By training these muscles, you will be able to prevent not only hip problems, but also back or knee problems. Moreover, you can maintain appropriate functional mobility. 

Exercise:
Stand on a step stool. Hang one leg off the step and keep your abdominals tight and your pelvis horizontal. Let this leg slowly fall towards the ground by allowing your pelvis to slowly drop down. Drop your pelvis down as far as possible (your foot may not touch the ground) and hold this position for two seconds. After these two seconds, raise your pelvis up by using the hip muscles in your support leg.
Repeat this exercise a few times (10-15).
If it becomes easy to perform, you can hold a dumbbell to add resistance.

During the execution of this exercise it’s important to hold you’re back straight and your abdominals tight. Your support leg should also remain straight.

<img src="/images/c/ca/Pelvic_drop.png" _fck_mw_filename="Pelvic drop.png" alt="" />

b) Agility

1. Hamstrings

This exercise is to stretch the hamstrings. You can use this with shortened or stiff hamstrings.

Straight leg raise test:
The patient lays on his back in front of a wall. The hip is in neutral position (the hip angle can vary).
Then he/she places his heel against the wall. The passive tension is applied by gradually increasing the hip flexion angle. (Level of evidence: 1b)

The patient holds his leg, without moving, during 10 seconds in the air against the wall. After the 10 seconds, the patient needs to bring his leg slowly to the floor. The patient repeats this exercise 4 x 10 seconds.

Remark! The patient needs to stop raising the leg when his pelvic rotates. It’s a kind of compensation.

The value can be measured with three instruments: Goniometer, flexometer and tape measure. (Level of evidence: 4)

This exercise can also be performed as a passive exercise.
The patient needs to lay on a table. The hip needs to be extended 180°.
Now it’s the therapist who raises the leg from the patient, as high as he can. (without compensation! Without pain!)

Duration: The therapist holds the leg in the air for 10 seconds and repeats this 4 times.

<img src="/images/3/32/Slr.png" _fck_mw_filename="Slr.png" alt="" />

Key Research

add links and reviews of high quality evidence here (case studies should be added on new pages using the <a href="Template:Case Study">case study template</a>)

Resources

add appropriate resources here

Clinical Bottom Line

add text here

Recent Related Research (from <a href="http://www.ncbi.nlm.nih.gov/pubmed/">Pubmed</a>)

see tutorial on <a href="Adding PubMed Feed">Adding PubMed Feed</a>

Feed goes here!!|charset=UTF-8|short|max=10

References

see <a href="Adding References">adding references tutorial</a>.

<span class="fck_mw_references" _fck_mw_customtag="true" _fck_mw_tagname="references" />