Various anatomical disorders of the hip joint are generally described as hip malposition. The most common clinical pictures here include rotational malpositions and hip dysplasia. The hip joint is formed by the femur and the acetabulum.
The acetabulum encloses the head of the femur like a nut in its shell, which is why it is called a nut joint. This structure allows the leg a great deal of mobility in all degrees of freedom in the hip joint. We now speak of hip dysplasia when the acetabulum does not enclose the head of the femur sufficiently and is usually congenital. It often causes problems only in adulthood and manifests itself through the unphysiological wear and tear as pain under stress and a change in gait pattern. Rotational felsal positions are also usually congenital or developed after a bone fracture and faulty fusion of the bone ends.
Causes
As already mentioned, hip dysplasias are congenital malpositions. During the growth of the bones in infancy, ossification disorders of the acetabulum occur, so that it is not sufficiently pronounced to give the joint its guidance. Depending on the severity of the growth disorder, it sooner or later causes problems with early wear and tear of the joint. Rotational malpositions can be caused by the incorrect growth, among other things, and can also be the result of hip dysplasia or, as already mentioned, after a bone fracture due to incorrect fusion or incorrect reduction, the insertion of an artificial joint, or even as a result of constant overloading.
Physiotherapeutic procedure
Internal hip rotation/internal rotation gait incl. exercises If the hip rotation is not very pronounced, an attempt can be made to use conservative treatment. However, in the case of severe malpositioning, surgery must be considered in order to avoid consequential damage.
Since this is a bony structural malposition, conventional therapeutic measures can only achieve limited success. It is important that the patient actively participates and also performs exercises at home on a regular basis. With hip malpositions, it is now important to build and maintain a stable muscular skeleton around the joint – exercises must therefore be continued continuously.
The missing bony guidance is basically replaced by muscle power. Stretching exercises must also be performed regularly to compensate for muscular imbalances caused by the malposition. In our case, there is now an internal rotation of the hip.
In congenital cases, this gait pattern is usually caused by an acetabulum that is rotated too far forward. The result is an inward rotation of the legs. Consequently, during active physiotherapy, exercises must be performed to strengthen the external rotators.
For example, the PNF concept (Propropceptive Neuromuscular Facilitation) is well suited for three-dimensional strengthening involving the entire muscle chain. Here, a pattern of outward rotation of the leg is simply selected, which can be dealt with more intensively. Initially passive movement is used, then active movement and finally manual resistance for controlled strengthening.
External hip rotation/external rotation gait including exercises The same procedure applies to the external rotation malposition or the external rotation gait. Here, in contrast, the inward rotators must be strengthened and the outward rotators stretched and loosened. The therapist selects a different PNF pattern for this, which is more responsive to the inward twisting.
This allows the affected structures to be kept mobile and strengthened at the same time. Thera bands can be used for self-exercise and home exercise to strengthen the structures. In general for a straight leg axis training, common strengthening exercises can be performed with the help of a mirror, such as leg press, knee bends, etc.
The only thing you need to pay more attention to is that the ankle, knee and hip joints are in exact alignment and that the toes are also straight forward and up (depending on the exercise). Further exercises for strengthening the hip muscles can be found here: Physiotherapy for hip pain Further exercises for strengthening the hip muscles can be found here: Physiotherapy for hip painPhysiotherapy alone is only successful up to a certain point in cases of hip malpositions. If it is a bony malformation, it can be massaged, exercised and stretched, bones cannot be bent.However, symptoms can be alleviated, such as the loosening of tense muscles and the containment of poor posture and its consequences, by building up a stable posture and gait schools.
The joint itself can also be relieved with manual techniques, such as traction (gentle pull) or passive movement, which can also reduce tension. In the end, each therapeutic measure must be individually adapted to the patient and filtered out together, which is sensible and helpful. However, if the deformity is too severe, surgery should not be considered too late, as it cannot be avoided that the joint wears out prematurely, which leads to arthrosis with very painful movement restrictions. The operation is also prepared with physiotherapy and regeneration is supported by similar measures as during conservative therapy. Alternatively, you can learn more here:
- Exercises from physiotherapy for the hip
- Physiotherapy for leg length difference
