Original Editor - David Drinkard
There are a variety of manual techniques used to increase joint play/joint ROM of the hip complex. Several of these techniques are listed below. For relevant hip anatomy, see Hip Anatomy. Hip mobilizations may also be beneficial for individuals with hip osteoarthritis; for more information, see CPR for hip mobs with knee OA.
- Patient is positioned in prone with knee bent. Therapist supports the knee with one hand, while the opposite hand is placed on the posterior portion of the proximal femur on the involved side. The mobilizing hand imparts a glide directly perpendicular to the long axis of the femur. The femur may be placed into varying degrees of abduction or rotation depending on desired effect. As with other glides, this glide can be performed in other positions. Anterior glide is used to increase joint play and capsular stretch to encourage external rotation and extension ROM.
- Patient is positioned supine, knee is supported with stabilizing hand and the mobilizing hand is placed on anterior portion of proximal femur. Using heel of hand, a posterior glide is imparted directly downward by keeping arm straight and leaning trunk. This technique can be used to increase joint play necessary for internal rotation.
- Patient is positioned supine, with hip and knee flexed to 90 degrees. The opposite leg is supported on the operator's shoulder in flexion (this technique can be performed with varying degrees of flexion and/or rotation depending on intended effect). An inferior glide of the femur is applied through either the hands or a mobilization belt. This technique can be used for capsular stretching and to encourage accessory motion necessary for hip flexion and rotation.
Hip Distraction with Knee Extended
Patient is positioned supine, with hip in slight flexion and knee extended. A belt or therapist's hands are placed firmly around the patient's ankles (hand position varies depending on clinician preference). Distraction of the hip can be produced by the therapist leaning backward, producing slight joint gapping at the femoroacetabular joint. This technique can be used for decreasing muscle spasm or pain, and is also useful to increase accessory joint movement for flexion and abduction movements.
Hip Distraction with Knee Flexed
Patient is positioned supine, target leg in "crook lying" hip at 50-degree flexion, knee at around 100 degrees of flexion> The Sits on foot, forearm closest to the patient between the thigh and lower leg, Hand furthest from patient rests on patients thigh. Forearm and hand-pulls towards therapist, distracting the knee
Patient is positioned supine target leg in "crook lying" hip at 50-degree with Knee in maximal flexion, but raised off plinth. The therapist "hugs the target leg" with forearms around the patients abductors and pulls the leg towards them. (Watch from 4:23)
Rotation Oscillations in Crook-Lying
Patient is positioned in supine, target leg in "crook lying" hip at 50-degree flexion, knee at around 100 degrees of flexion. The therapist places hands around either side of the knee, of target leg moving into abduction and adduction (Watch from 3:30)
Internal Rotation with Knee Flexed
Patient is positioned in supine, target leg in "crook lying" hip at 50-degree. Knee in maximal flexion, but raised off plinth. The therapist "hugs the target leg" with caudal forearm around the patients abductors, ventral hand on patients thigh. Then Internally rotates femur, pulling thigh towards self
- Online video, last accessed 4/5/10, available at: http://www.youtube.com/watch?v=kSCbHpkPjso&NR=1
- Online video, last accessed 4/5/10, available at: http://www.youtube.com/watch?v=CkfUCjuOU-k&feature=related