Have you ever treated a patient with a chronic (atraumatic) injury who continues to complain of pain and functional limitations no matter how much rehab they’ve completed? This scenario often leads to months (or years!) of failed treatments, or even unnecessary surgeries.
In hip injuries (and all rehabilitation), these 3 principles of the movement-based approach to assessment can guide your clinical decision-making and treatment planning.
1. Regional Interdependence
If you look at each joint’s primary function, you notice that the body is made up of alternating segments of mobile and stable joints. In the hip, good stability is obviously important; however, a lack of mobility at the hip can be detrimental to the kinetic chain. Think of stability at these mobile joints as controlled mobility.
For example, look at chronic low back pain. The “normal” pattern includes:
- Mobile hip
- Stable lumbopelvic girdle
- Mobile thoracic spine
If the hip is stiff and immobile, the body will find a way to move, often flipping the normal pattern:
- Stiff thoracic spine
- Mobile lumbopelvic girdle
- Stiff hip joint
The lumbar spine is designed to rotate about 1-3 degrees per segment, or about 10 degrees total for the entire lumbar spine on average. If the hip doesn’t rotate and the lumbar spine picks up the slack, stress is increased in the tissues of the spine, resulting in pain and/or damage over time.1
2. Altered Motor Control and Pain
Pain alters motor control;2,3 it can both inhibit and facilitate improper muscle recruitment.
- Inhibitory example: hip pain causes gluteal shutdown
- Facilitatory example: neck pain causes upper trap facilitation
When you assess or treat patients with pain in any region, remember that they move differently.
3. Neurodevelopmental Perspective
Humans develop their strength and ability to move in patterns, not in isolation. Traditional medical management of orthopedic injuries and pain leads to an isolated approach that often fails to restore function. As normal mobility and stability or motor control are restored, it’s crucial to integrate them into functional movement patterns in both general activity and sport.
Example of regression to progression for hip stability:
- Supine hip thrusters and side lying clams
- Quadruped resisted diagonals
- Tall to ½ kneeling transitions without and with rotation
- D2 pattern lunge
We Are Movement System Specialists
To apply these principles in the clinic, ask the following 3 key questions:
- Is there a mobility or a stability problem?
- Is there pain involved?
- How can movement patterns regress and progress throughout the rehab process for our patient?
It’s time to take a leap forward in the way we think about therapy, or more importantly the way the rest of the world views therapy. We are the human movement system specialists and should be evaluating and treating every patient with that mindset.
Below, watch Mike Voight discuss the assessment, treatment, and outlook for a patient with a chronic hip injury in a short video from his and Ashley Campbell’s course, Management and Treatment of Hip Injuries Part A.