Physiotherapeutic techniques and exercises for the problem area of movement restriction | Treatment of hip arthrosis from a physiotherapeutic perspective

Physiotherapeutic techniques and exercises for the problem area of movement restriction

Goal: Pain relief, movement expansion, metabolic improvement in the joint and counteracting capsular contracture. The current resting position of the hip joint in supine position is selected as the starting position for manual therapy in coxarthrosis. This often corresponds to a slight flexion and outward rotation of the joint.

In order to allow the patient to relax really well, it is recommended to “hang up” the affected leg in the sling table. The joint is then relieved from this position using intermittent traction (pulling) and -or vibration techniques. This achieves a relaxing effect on the muscles, improves the elasticity of the joint capsule and thus the freedom of movement of the hip joint, the surrounding tissue is decongested and the pain relief achieved is often reflected in the improved gait pattern immediately after treatment.

After passive joint mobilisation, the patient can further consolidate the gained range of motion by active exercises in the sling table, while the leg is reduced in weight by the sling. A second sensible way to increase the freedom of movement of the hip joint is to mobilise the joint from the prone position. In this case, hip extension and internal rotation are improved with the aim of achieving a more fluid movement sequence when walking in the standing leg phase.

Manual therapy is also used for secondary movement restrictions and pain in the sacroiliac joint (ISG) and lumbar spine (lumbar spine) caused by hip joint sathrosis. Dosage: 2/3 per weekThe pendulum exercises can be performed independently. For this purpose, the patient stands with the healthy leg on the side of a step and holds on to the banister.

The affected leg is now loosely pendulated back and forth within the scope of the hip joint mobility. To exert a pull on the hip joint capsule, a weight cuff can be attached to the affected leg for support. The pelvis should be kept as still as possible during the pendulum exercises so that the movement takes place in the hip joint and not in the lumbar spine.

Dosage: daily Due to the shortening of the muscles caused by coxarthrosis and the (among other causative factors) resulting movement restrictions, the hip flexors, the extensor muscles and the external rotators of the hip joint must be stretched. To prepare for the stretching, a loose, general warm-up programme (e.g. on a bicycle ergometer) and passive, soft lateral stretching and friction of the shortened muscles by the physiotherapist are recommended. This is followed by the actual active/passive stretching techniques (e.g. postisometric relaxation -PIR- link stretching) for the shortened muscles.

All important stretching techniques are explained to the patient as homework. Dosage: 2/3 per week, exact description of the stretching techniques and the execution under stretching starting position supine, the affected leg in the overhang at the edge of the table, the healthy leg is fixed to the body in flexion. Exercise execution the affected leg is lifted for 5-10sec.

in the direction of hip flexion, relax for 5-20sec., while letting the leg sink further towards the floor, repeat the sequence 3 times = 1 series, a total of 4 series of tension/relaxation and stretching Other possibility of stretching the hip flexion from the lateral position. Starting position supine position, the affected leg is stretched towards the ceiling, while simultaneously stretching the calf muscles pull the foot towards the nose, the hands support under the thigh Exercise execution the leg is stretched against the hands towards the floor for 5-10sec, 5-20sec Relax and continue to stretch position, repeat 3 times the sequence = 1 series, a total of 4 series of tension/relaxation and stretchingStarting position Lateral lunge with support against a chair back, the affected leg is stretched Exercise execution the foot is anchored in the floor for 5-10sec. and stretched down to the floor, 5-20sec. Relax and bend the bent leg further towards the floor, the affected leg remains stretched, repeat the sequence 3 times = 1 series, a total of 4 series of tension/relaxation and stretching Alternative starting position itz on a chair, the affected leg is placed with the foot on the thigh of the healthy leg Supporting the opening of the hips with the handRecommended is the active movement therapy in warm water, because the buoyancy of the water relieves the hip joint, the heat relaxes the muscles and thus the muscles can be moved with less pain to a greater extent of movement. Strength training can also be done in water by moving against the water resistance and using equipment.