Physical Therapy Continuing Education: Movement Impairment Syndromes of the Hip
We recently got to interviewer a very popular Physical Therapy continuing education Associate Professor on movement system impairments of the hip. Here is what she had to say:
Interviewer: If we start off just a little general before we go specific, for those not familiar with movement system impairment syndromes could you just give us a brief description?
Hip Movement Expert: Sure. I think our approach to all of this is the belief that as physical therapists – and I think this is true for the national organization – that movement is the system that we as physical therapists are the experts in understanding and in treating.
So, really the whole concepts that we started out with have really stayed the same only been maybe embellished a bit. In general, looking at movement in terms of the components of movement, whether they are the foundation components, such as your bone and muscle, or the nervous system components, or the cardiovascular-pulmonary support to the system of movement, we kind of look at it as what are all the pieces that fit together to allow us to move precisely?
Then with that as our level of expertise or our area of expertise, then we start to try to find movement syndromes. So, collections of impairments that together sort of focus us in on what is the primary movement dysfunction or impairment that this person has? Then that directs our treatment.
So, I think movement system is just sort of the system in which we’re experts in, and over the last several years we’ve been working hard to kind of collectively describe syndromes in different body regions.
Interviewer: Fantastic. If we talk a little more specifically about the hip, can you describe one of these syndromes?
Hip Movement Expert: OK then, let’s talk about hip adduction with medial rotation. As you can imagine if somebody has hip adduction medial rotation the primary muscles that aren’t performing are the hip abductors and the lateral rotators.
The pain problems that typically go with it are bursitis, trochanteric bursitis, ITB friction syndrome (more proximal), snapping hip, ITB fascititis, etc. You could have just buttock pain from the lateral rotators or gluteals being too long. You could have sciatica from the piriformis being overstretched and impinging on the sciatic nerve. So, you can get a lot of pain problems with adduction medial rotation.
I just had a student talking with me last week about her patient that she saw during her clinical who had lateral hip pain. The clinical instructor was looking at some asymmetries in her pelvis and was doing some muscle energy techniques on her sacroiliac joint.
Anyway, in the long run the patient got worse. The problem was that nobody was really watching the way she moved. The pain was lateral. This person was going into adduction and medial rotation and so once that was beginning to be addressed then the patient started to make some changes.
So, really with adduction and medial rotation you correct their movement.
When they’re going from sit to stand it’s “don’t squeeze your knees together.” “When you’re walking and you load your legs contract your gluteals or your lateral rotators. Keep your knee over your foot.”
Do things in sidelying to get the gluteus medius better. Do things sitting, lateral rotation, get the lateral rotators better. And then functionally – making them use those muscles in their functional activities.