Exercises in the problem area of strength and coordination | Treatment of hip arthrosis from a physiotherapeutic perspective

Exercises in the problem area of strength and coordination

The increasing pain and restriction of movement associated with hip joint arthrosis and the resulting strain on the hip joint cause a significant loss of strength in the muscles surrounding the hip, the leg muscles and the trunk muscles. Intensive preoperative strength training helps to postpone the hip joint replacement operation for longer and offers the chance of an improved preoperative quality of life and an optimal postoperative result. This is reflected in faster postoperative mobilisation and lower dislocation frequency (risk of “dislocating” the prosthesis, see: hip luxation after a hip prosthesis).

Even after a hip endoprosthesis (artificial hip joint), the existing force reductions are only compensated for to a small extent. In follow-up examinations 6 months post-op, only 50% of the strength endurance was measured in a strength ratio comparison with healthy subjects. A lack of strength in the hip extensor and abduction muscles worsens the prognosis with regard to the durability of the prosthesis.

These studies clearly speak in favour of intensive pre-operative strength coordination and mobilisation training. General training recommendation for hip joint arthrosis: Special emphasis in muscle strengthening is placed on the entire hip surrounding musculature, as pain and shortening reduce the strength potential, especially the hip extensors, abduction and rotation muscles are affected. In addition, when selecting exercises, emphasis should be placed on strengthening the trunk muscles, as the restricted movement of the hip joint often results in postural and gait changes and back pain.

Small supporting devices for the home: Theraband, elastic band, weight cuffs, unstable pads such as mat, Airpad In addition, the patient can be introduced to medical strength training on machines. This can take place in the physiotherapeutic practice in individual or group therapy, as part of a rehabilitation sports programme or in the gym (prerequisite: functional equipment and good instruction and control). – Dosage: 2/3 week

  • 3-6 series/muscle group with 20-30 repetitions, slow execution, at the end of the number of repetitions a clear feeling of exertion should be noticeable (intensity 40-60% of maximum force)
  • Regular training instead of individual high-intensity exercise sessions
  • Continue to breathe regularly during the exercises or endurance training, avoid pressurized breathing
  • Possibly check the mirror to avoid evasive movements during the exercises
  • Avoid pain intensification through training or exercise

Practice examples: Strengthening the back muscles, buttocks and back leg muscles with Theraband

Starting position: Supine position with legs turned up to hip width, feet positioned close to the buttocks, a Thera-band stretched across the pelvis Exercise: Starting at the lumbar spine, roll up and hold vertebra by vertebra against the resistance of the Thera-band, roll back again in the same controlled manner. To strengthen the back leg muscles in particular, place your feet on the heels and pull your heels towards your buttocks without moving. Caution, the exercise is very crampy Starting position lateral position or forearm support on the side, front hand supported, the upper leg is stretched out, the lower leg angled Exercise execution lift the affected leg towards the ceiling and lower it again Important: the heel leads the movement, the pelvis must not roll backwards Caution: please do not execute the exercise in the forearm support with a hip joint prosthesis Starting position: sitting upright on a stool, lower leg open, Theraband in 8th position Loop around the thighs Exercise: open and close the thighs against the resistance of the band, feet remain standing, upper body straightenedStarting position: upright sitting on a stool, Thera-band in 8th position Loop around feet and thighs, the ends are wrapped around the hands Exercise execution: stand up against the pull of the theraband from the stool, at the same time straighten the upper part of the body and open the forearms (outward rotation of the shoulderStarting position: four-footed stand, theraband wrapped around the foot of the affected leg and fixed with the hand Exercise execution: stretch the leg against the resistance of the theraband backwards to hip level, the pelvis should not move upwards towards the ceiling