Therapy Exercises for the Hip
Original Editors - Marlies Verbruggen
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File:Images exercises hip phase 1,2,3.docExercise Techniques[edit | edit source]
Tonley JC et al [[1]], who had an alternate theory about the cause of piriformis syndrome (see etiology piriformis syndrome), described an alternative treatment approach for piriformis syndrome. The patient in this article followed physical therapy 8 times over a 3-month period. The program was concentrated on strengthening the hip extensors, abductors and external rotators, as well as movement reeducation. The exercises were divided over 3 phases. [[1]]
The first phase (week 0-4) contained non-weight-bearing exercises to accentuate isolated muscle recruitment. This phase included two exercises, namely ‘bridge with Thera–band resistance’ and ‘clam with thera–band resistance’. The bilateral bridge (figure 4A) was executed with the Thera- band, that was wrapped around his thighs just proximal to the knee. The patient must elevate his pelvis, with in the meantime abduction and external rotation of his hips. It’s important to avoid adduction and internal rotation while lowering the hip. The clam exercise (figure 4B) was performed in sidelying, first without resistance. The point of departure contains flexion of hip and knee in 45° with holding his feet together. Then the patient raises his knee up and back, which was accomplished by hip abduction and external rotation. After a while , the Thera-Band was used as resistance during exercise. On one condition, that the patient must be able to perform 3 sets of 15 repetitions of the exercise without resistance. [[1]]
Phase 2 (week 4-9) contains weight – Bearing strengthening exercises. The patient started initially with double-limb weight-bearing exercises. Afterwards the patient performed single-limb movements to multiply the demands on the hip musculature. This phase included four exercises. The first exercise was a squat maneuver (figure 5A) performed with the thera–band resistance, which was applied around the thighs just proximal to the knees. The squat was first executed to a depth of 45° and later on to 75 °. During the second exercise the patient performed a sidestepping exercise with Thera-Band (figure 5B). The patient began the exercise in a squat position of 45° of hip and knee flexion. Subsequently he took steps to the right and the left along a 10-m walk-way by abducting and externally rotating his hips. It is important to keep the trunk erect during exercise and to avoid knees over toes. The next exercise, named single – limb sit to stand, was executed in a manner similar to the squat (figure 5C). The patient performed the exercise first from a 70-cm (measured from the floor to the top of a treatment table) high surface and finally when he could execute 3 sets of 15 repetitions, the height was each time reduced with 4 cm, to a final height of 58 cm. The last exercise called the step-up/step-down exercise (figure 5D). The patient used a 20-cm-high step stool. The exercise was performed by touching his heel to the ground and returning slowly to the start position over a 3- second period. First the patient had contralateral upper extremity support. This support was removed when the patient was able to control his hip motions and to perform 3 sets of 15 repetitions.[[1]]
Phase 3 (week 9-14) consisted of Functional Training, namely dynamic and ballistic training. This phase includes 4 exercises. The progression in this phase was achieved by increasing the rate of speed during exercises. Initially the patient performed forward lunges (figure 6A) and later he progressed to lateral lunges (figure 6B), to the left and the right at a 45° angle. The lead knee is flexed to a depth of 75 °. It’s not permitted to pass the knee beyond the foot. When the patient was capable to demonstrate 3 sets of 15 repetitions, he progressed to the lateral lunges. The third exercise were double-limb take –off jumps with double-limb landings to a deep squat, with flexion of the knee (90°) , without hip adduction or internal rotation(figure 6C). The fourth and last exercise included also the double-limb take-off jumps, but now right and left single-limb landings. (figure 6D) Excessive hip adduction or internal rotation are still not allowed. [[1]]
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