Postoperative Management of hip fractures

Severe, persistent groin, thigh knee pain that increases with limb

movement or weight bearing progressive limb length inequality Persistent external rotation of the

operated limb A positive Trendelenburg sign during

weight bearing

Signs and Symptoms of Possible Failure of the Internal Fixation Mechanism

Postoperative Management

Exercise: Maximum Protection Phase Prevent vascular and pulmonary complications. Improve strength in the upper and sound lower

extremities. Prevent postoperative reflex inhibition of hip and

knee musculature Restore active mobility and dynamic control of

the involved hip and adjacent joints

Postoperative Management

Exercise: Moderate and Minimum Protection Phases

Increase flexibility of any chronically shortened improve strength and muscular endurance in

the lower extremities for functional activities. Improve postural stability and standing balance. increase aerobic capacity/cardiopulmonary

endurance

PAINFUL HIP SYNDROMES/OVERUSE SYNDROMES:

NONOPERATIVE MANAGEMENT

• Related Pathologies and Etiology of Symptoms

• Tendinitis or Muscle Pull

• Trochanteric Bursitis

• Psoas Bursitis

• Ischiogluteal Bursitis (Tailor’s or Weaver’s Bottom)

Common Impairments and Functional

Limitations/Disabilities

• Pain• Gait deviations.• Imbalance in muscle

flexibility and strength.

• Decreased muscular endurance.

Management: Protection Phase

• Control Inflammation and Promote Healing

• Develop Support in Related Areas

Management: Controlled Motion Phase

• Develop a Strong Mobile Scar and Regain Flexibility.

• Develop a Balance in Length an Strength of the Hip Muscles.

• Develop Stability and Closed-Chain Function.• Develop Muscle and Cardiopulmonary

Endurance.• Patient Education

Management: Return to Function Phase

• Progress Strength and Functional Control

• Return to Function

Exercises to Increase MobilityAccessory movements

Anterior Glide to Increase Hip Extension and External Rotation

Posterior Glide to Increase Hip Flexion & Internal Rotation

Mobilization with movement

An inferolateral glide

To increase

pain-free

internal rotation

Mobilization with movement

An inferolateral glide

To increase

pain-free

flexion

Mobilization with movement

An inferolateral glide

To increase

pain-free

extension

Mobilization with movement

An inferolateral glide

To increase

extension during

weight bearing.

Techniques to FlexibilityPhysiological Movements

Techniques to StretchRange-Limiting Hip Structures

To Increase Hip ExtensionModified Fencer Thomas Test Stretch

Stretch

Techniques to StretchRange-Limiting Hip Structures

Self-stretching of the

adductor muscles

with the hips

at 90

Techniques to StretchRange-Limiting Two-Joint Muscles

Gluteus maximus

self-stretch

Techniques to StretchRange-Limiting Hip Structures

Self-stretch of the rectus femoris

while standin

Techniques to StretchRange-Limiting Hip Structures

Self-stretching the tensor

fasciae latae occurs as the

trunk bends away from

and the pelvis shifts

toward the tight side.

Techniques to StretchRange-Limiting Hip Structures

Tensor fasciae latae self-stretching: side-lying position

Strength Training

Strength Training

• Resisted flexion of the hip with the knee flexed.

Strength Training

• Resisted end-range hip extension with stabilization of the pelvis.

Strength Training

Resisted external rotation of the hip with the patient lying

supine.

Strength Training

Resisted internal

rotation of the hip with

the patient lying

prone.

Strength Training

• Resisted hip abduction.

EXERCISESTO DEVELOPANDIMPROVE MUSCLE PERFORMANCE

AND FUNCTIONAL CONTROL

Isolated training and strengthening of the gluteus maximus.

EXERCISESTO DEVELOPANDIMPROVE MUSCLE PERFORMANCE

AND FUNCTIONAL CONTROL

Training and strengthening the hip adductors.

Closed-Chain Weight-Bearing Exercises

Training the hip abductor and hiker muscles for frontal plane strenthening and stability.

Closed-Chain Weight-Bearing Exercises

Closed-chain exercise with elastic resistance around the

opposite leg

Closed-Chain Weight-Bearing Exercises

Training and strengthening the hip extensor muscles using

bridging exercises.

Closed-Chain Weight-Bearing Exercises

Lunge with cane assistance to develop balance and control

for lowering body weight.

Closed-Chain Weight-Bearing Exercises

Wall slides/partial squats to develop eccentric control of body

weight.

Closed-Chain Weight-Bearing Exercises

Resisted walking using a large elastic resistance band secured

around the pelvis.