JOINT MOBILIZATION OF THE HIP

Cập nhật lần cuối vào 23/10/2021

ANATOMY REVIEW

Bone and Joints

Terminology/Từ vựng:

• Greater trochanter: Mấu chuyển lớn
• Lesser trochanter: Mấu chuyển bé
• Iliac crest: Mào chậu
• Sacrum: Xương cùng
• Pubic symphysis: Khớp mu
• Ischial tuberosity: Ụ ngồi
• Femur: Xương đùi,
• Femoral head: chỏm xương đùi
• Acetabulum: Ổ cối (xương chậu) 

Physiologic (Osteokinematic) Motions of the Hip

Các vận động sinh lý (chuyển động xương) của khớp háng: Gập/Duỗi, Dạng/Khép, Xoay trong/Xoay ngoài

• Flex: gập/Ext: duỗi
• Abd: dạng/Add: khép
• IR (internal rotation): xoay trong
• ER (external rotation) xoay ngoài
• SLR: Straight Leg Raise: Nâng thẳng chân

Accessory (Arthrokinematic) Motions of the Hip

Các chuyển động phụ trợ (chuyển động học khớp): theo quy luật lồi (chỏm xương đùi) và lõm (ổ cối).

Notes/Ghi chú:

• Physiologic Motions: vận động sinh lý, chuyển động xương
• Accessory Motions: vận động phụ trợ, chuyển động học khớp, joint play
• OPP: Open Packed Position/ Tư thế khớp mở = resting position, tư thế khớp nghỉ: là tư thế thường dùng bắt đầu để di động khớp. Ghi nhớ quy luật mặt lồi/lõm
• CPP: Closed Packed Position/ Tư thế khớp khoá
• OKC: Open Kinetic Chain: Chuỗi động mở: Kỹ thuật di động khớp thường dùng ở chuỗi động mở để khu trú lên khớp được thực hiện
• Concave: lõm
• Convex: lồi
• Glide: trượt
• Distraction: kéo tách
• Trong kỹ thuật, kỹ thuật viên thực hiện cố định đầu gần/phần xương cố định: Dấu chéo đỏ
• Kỹ thuật viên thực hiện vận động phụ trợ: Mũi tên xanh
• Người bệnh có thể thực hiện vận động sinh lý phối hợp: Mũi tên vàng

Lưu ý:

• OPP của khớp háng là háng gấp 30°, dạng 30°, và xoay ngoài nhẹ.
• Cố định (Stabilization): Thường là cố định xương chậu lên bàn điều trị với các dây đai.

JOINT MOBILIZATION TECHNIQUE

Các kỹ thuật di động khớp háng bao gồm kéo tách khớp và trượt khớp xuống dưới/ra trước/ra sau/vào trong/ra ngoài.

Hip Distraction

Indications:

• Testing; initial treatment; pain control; general mobility.
• (Chỉ định để đánh giá, bắt đầu điều trị, kiểm soát đau, tăng vận động chung)

Accessory Motion Technique

• Patient Position: supine position with the hip in the open-packed position. 
• Clinician Position & Hand Placement: 
  • Stand at the patient’s feet in a stride stance facing cephalad. 
  • The patient’s body weight provides stabilization, which can be enhanced by placing the foot of the contralateral leg on the table. 
  • A belt may be utilized at the patient’s pelvis for additional stabilization. 
  • Both of your hands grasps the patient’s distal tibia/fibula just proximal to the ankle (or above the knee if knee pathology exists). 
  • You may also use a mobilization belt around your gluteals and the patient’s leg to reinforce your hand contacts.
• Force Application: While maintaining your hand contacts, shift your weight from your front to your back foot. You may also move the patient’s hip in the direction of greatest restriction, while maintaining hand contacts and distraction force throughout the range of motion.

Accessory With Physiologic Motion Technique 

• Patient Position: the same position as described above.
• Clinician Position & Hand Placement: the same as described above.
• Force Application: While maintaining force, move the hip in the direction of greatest restriction. Be prepared to move during the mobilization to ensure correct force application. Force is maintained throughout the entire range of motion and sustained at end range.

Hip Inferior Glide

Indications:

• to increase hip flexion./Tăng gấp háng

Accessory Motion Technique

• Patient Position: supine position with the leg being mobilized placed over your shoulder with the knee flexed. 
• Clinician Position & Hand Placement: 
  • Stand to the side facing the patient. You may incorporate abduction/adduction or ER/IR to pre-position the hip in the direction of greatest restriction.
  • Stabilization is provided by the patient’s body weight with assistance from a stabilization belt placed around the patient’s pelvis. 
  • Mobilization hands: clasped and placed over the anterior aspect of the proximal femur with your forearms in the direction in which force is applied. 
  • A mobilization belt may be used around your gluteals to reinforce hand contacts.
• Force Application: Apply an inferiorly directed mobilization force through your hand and belt contacts.(Lực kéo xuống dưới qua hai tay và dây đai)

Accessory With Physiologic Motion Technique 

• Patient Position: the same position as described above.
• Clinician Position & Hand Placement: the same as described above.
• Force Application: Apply an inferiorly directed mobilization force at the proximal femur as counterforce is elicited distally through your shoulder contact in a scooping-type motion as the hip is brought into progressively greater ranges of hip flexion. The position of the hip may be altered slightly so that it is placed in the position of greatest restriction. Be prepared to move during the mobilization to ensure correct force application. Force is maintained throughout the entire range of motion and sustained at end range.

Hip Anterior Glide

Indications:

• to increase hip extension and external rotation./Tăng duỗi và xoay ngoài háng

Accessory Motion Technique

• Patient Position: prone position near the edge of the table, with the hip in slight flexion, abduction, and external rotation (FABER), with the foot secured at the posterior aspect of the contralateral leg (figure-4 position) (Tư thế số 4 hoặc FABER ở tư thế nằm sấp). 
• Clinician Position & Hand Placement: 
  • Stand contralateral to the side being mobilized with your leg securing the patient’s foot against the table as needed.
  • Stabilization is provided by the patient’s body weight and through securing the leg close to the surface of the table. A mobilization belt may also be used, around the patient’s waist. 
  • Hand-over-hand contact is placed at the posterior aspect of the proximal femur just below the gluteal fold. Your elbows are extended and your forearms are positioned in line with the anterolateral direction of force. You may alternately place your stabilization hand at the anterior superior iliac spine on the side being mobilized with your mobilization hand is at the posterior aspect of the proximal femur.
• Force Application: An antero-laterally directed force is applied through your hand contacts.

Accessory With Physiologic Motion Technique

• Patient Position: 
  • Prone position with the hip in neutral or standing position. 
• Clinician Position & Hand Placement: 
  • In prone position:  Stand on the ipsilateral side of the hip being mobilized. Stabilization is provided by the patient’s body weight or mobilization belt around the patient’s waist. Use one hand to grasp the anterior aspect of the patient’s thigh to provide physiologic motion into hip extension. Place the other hand at the posterior aspect of the proximal femur, just inferior to the patient’s gluteal fold with your forearm in line with the direction of force.
  • In standing position: Stand in front of the patient with a mobilization belt around the posterior aspect of the patient’s proximal femur and your gluteals. Both hands stabilize the patient’s pelvis as the belt is placed over the proximal femur.
• Force Application: 
  • In prone, take up the slack in the joint and apply an anterior glide as the patient’s hip is moved into progressively greater ranges of extension. 
  • In standing, the patient performs trunk backward bending or side-stepping, rotation, or lunging while anteriorly directed mobilizing force is provided through the belt contact. 
  • Be prepared to move during the mobilization to ensure correct force application. Force is maintained throughout the entire range of motion and sustained at end range.

Hip Posterior Glide

Indications:

• to increase hip flexion and internal rotation/Tăng gấp háng và xoay trong

Accessory Motion Technique

• Patient Position: supine, with the hip flexed, slightly abducted, and internally rotated with the knee flexed. 
• Clinician Position & Hand Placement: 
  • Standing on the contralateral side of the hip being mobilized.
  • Stabilization is provided by the patient’s body weight. Additionally, your stabilization hand or bolster is placed under the patient’s posterior ischium just proximal to the patient’s hip. 
  • Place your clasped mobilization hands or single mobilization hand over the patient’s flexed knee with your forearms in line with the postero-lateral direction of force.
• Force Application: 
  • With your hand contacts in place, take up the slack in the joint and apply a postero-lateral glide through the long axis of the femur. 
  • Alternately, you may apply a postero-lateral glide as you bring the patient’s hip into progressively greater ranges of hip flexion.

Accessory With Physiologic Motion Technique

• Patient Position: the same position as that which is described above.
• Clinician Position & Hand Placement: 
  • In supine, clasp your hands over the patient’s flexed knee. 
  • In standing, the mobilization belt is placed from your gluteals to the anterior aspect of the patient’s proximal femur.
• Force Application: 
  • In supine, patient moves into progressively greater ranges of hip flexion while clinician maintains posteriorly directed mobilizing force. 
  • In standing, patient performs trunk forward bending or side-stepping rotation, or lunging while posteriorly directed mobilizing force is provided through the belt contact. 
  • The mobilization force is maintained throughout the entire range of motion and sustained at end range.

Hip Medial Glide

Indications:

• to increase  hip abduction and ER/ Tăng dạng háng và xoay ngoài

Accessory Motion Technique

• Patient Position: side-lying or supine position with the hip in neutral. You may pre-position the hip at the point of restriction. 
• Clinician Position & Hand Placement: 
  • Stand on the ipsilateral side of the hip being mobilized.
  • Stabilization hand: supports the leg at the medial aspect of the knee. 
  • Mobilization hand: contacts the lateral aspect of the proximal femur. Your forearm is in line with the direction in which force is applied.
• Force Application: With your hand contacts in place, take up the slack in the joint and apply a medial glide to the proximal hip.

Accessory With Physiologic Motion Technique 

• Patient Position: the same position as described above.
• Clinician Position & Hand Placement: the same as described above.
• Force Application: The patient moves into progressively greater ranges of hip abduction, ER, or flexion while you maintain your medially directed mobilization force. The mobilization force is maintained throughout the entire range of motion and sustained at end range.

Hip Lateral Glide

Indications:

• to increase  hip adduction and IR/ Tăng khép háng và xoay trong

Accessory Motion Technique

• Patient Position: supine position with the hip in neutral or with the hip flexed to 90 degrees and in varying degrees of ER/IR and abduction/adduction or standing. 
• Clinician Position & Hand Placement: 
  • Stand on the ipsilateral side of the hip being mobilized.
  • Stabilization hand: placed on the lateral aspect of the knee. A mobilization belt may also be used at the patient’s pelvis for stabilization. If a mobilization belt is used, your stabilization hand is placed at the lateral aspect of the patient’s pelvis. 
  • Mobilization hand:  placed on the medial aspect of the proximal femur with your forearm in the direction in which force is applied. 
  • If a mobilization belt is used, force is applied through the mobilization belt, which is placed between your gluteals and the medial aspect of the patient’s proximal femur.
• Force Application: Apply a laterally directed force through either the mobilization hand contact at the medial aspect of the proximal femur or the mobilization belt while providing stabilization with your other hand.

Accessory With Physiologic Motion Technique

• Patient Position: 
  • For the supine technique, the patient is lying supine with the hip flexed to 90 degrees and in varying degrees of external or internal rotation. You may pre-position the hip at the point of restriction. 
  • For the standing technique, the patient is standing in single leg stance position on the side being mobilized. 
• Clinician Position & Hand Placement: 
  • In supine position: 
    • Stand in a straddle stance on the ipsilateral side of the hip being mobilized and facing the patient with the mobilization belt on the inner thigh at the proximal femur and around your gluteal folds. 
    • Stabilization hand: placed on the lateral aspect of the patient’s pelvis with the elbow of the stabilization arm placed at your anterior superior iliac spine (ASIS) and your forearm placed on the inner side of the mobilization belt. 
    • Mobilization hand: placed over the patient’s flexed knee and maintains the flexed knee in contact with your body. 
    • The mobilization belt is placed on the patient’s inner thigh at the proximal femur and around your gluteal folds. 
  • In standing position: 
    • Stand on the side of the hip being mobilized.
    • Both stabilization hands are placed over the lateral aspect of the patient’s pelvis.
• Force Application: 
  • In supine, move the patient’s hip into progressively greater ranges of hip internal or external rotation while you maintain a laterally directed force through the mobilization belt contact. 
  • In standing, with contacts in place, apply a laterally directed force through the mobilization belt while the patient rotates to the left or right, lunges forward or back, or performs a squatting motion.

References:

• Christopher H. Wise, Dawn T. Gulick. Mobilization Notes: Rehabilitation Specialist’s Pocket Guide. F. A. Davis Company, 2009.
• Christopher H. Wise. Orthopaedic Manual Physical Therapy: FROM ART TO EVIDENCE. F. A. Davis Company. 2015.
• Carolyn Kisner, Lynn Allen Colby, John Borstad. Therapeutic exercise : foundations and techniques, Seventh edition. F.A. Davis Company. 2018