How to treat hip dysplasia

Treatment Options for Hip Dysplasia

In this video, the speaker discusses treatment options for hip dysplasia and provides eight steps that can be followed to help patients with this condition. The importance of understanding the anatomy of the patient is emphasized.

Understanding Anatomy

• Understanding the anatomy is key to management.

• Spend time experimenting with positions associated with instability using a hip model.

Eight Steps for Treatment

Step 1: Thorough Assessment

• Assess aggravating and easing factors, pain sources, muscle and tendon involvement, functional limitations, goals, barriers to those goals, pelvic and hip position, strength control in provocative positions, range of motion, and psychosocial factors.

Step 2: Education

• Educate patients on their condition and provide resources for further information.

Step 3: Pain Management

• Use pain management techniques such as ice or heat therapy as needed.

Step 4: Strengthening Exercises

• Focus on strengthening exercises for muscles around the hip joint.

Step 5: Range of Motion Exercises

• Incorporate range of motion exercises into treatment plans.

Step 6: Proprioception Training

• Include proprioception training to improve balance and stability.

Step 7: Functional Training

• Implement functional training exercises specific to the patient's needs and goals.

Step 8: Surgery Referral

• Refer patients who do not respond well to conservative treatment options to a surgeon for further evaluation.

Overall, this video provides useful information on how to approach treating patients with hip dysplasia. The eight steps outlined can serve as a helpful guide for clinicians in developing treatment plans for their patients.

Investigating Hip Dysplasia

In this section, the speaker discusses the importance of early investigations in identifying hip dysplasia and shaping management.

Investigations

• X-rays are a starting point to identify hip dysplasia, but they provide a two-dimensional picture of a complex anatomical structure.

• CT scans can provide a 3D perspective of hip anatomy and areas of instability.

• MRI is considered the gold standard for diagnosing high-risk stress fractures like femoral neck stress fractures.

Shaping Management

• Early investigations can shape management, such as non-weight bearing for up to eight weeks for high-risk stress fractures.

• Patient education is important in helping them understand their condition and how to modify aggravating factors that contribute to pain.

• Onward referral may be necessary for nutritional advice, weight loss, or surgery in severe cases.

Reducing Loading on Unstable Hips

In this section, the speaker discusses reducing loading into end-of-range or unstable positions by modifying aggravating factors.

Modifying Aggravating Factors

• Yoga and static stretching can be provocative for those with anterior instability; modifying these activities can help reduce pain.

• Static postures like standing and sitting, walking gait, and other movements may need modification to reduce discomfort.

• Identifying which type of instability a patient has can help with activity modification.

The speaker emphasizes that modifying activities is not about correcting faulty movement but rather finding more comfortable and less provocative positions to reduce pain.

Patient Education and Understanding

In this section, the speaker discusses the importance of patient education in helping them understand their condition and how to modify aggravating factors that contribute to pain.

Educating Patients

• Educating patients early on can help alleviate fear and concern.

• Helping patients understand their condition and how to modify aggravating factors can put them in control of their symptoms.

The speaker also discusses the role of muscle strength and postural position in hip stability and comfort.

Overall Summary

The speaker provides an overview of investigating hip dysplasia, shaping management through early investigations, reducing loading on unstable hips by modifying aggravating factors, and educating patients on understanding their condition. Modifying activities is not about correcting faulty movement but rather finding more comfortable positions to reduce pain.

Symptom Modification Tests

In this section, the speaker discusses how to test symptom modification during aggravating tasks to reduce pain or sensations of instability. They suggest modifying pelvic tilt, hip flexion or extension, rotation positions, and core muscle contraction.

Modifying Pelvic Tilt and Hip Abduction/Adduction

• Altering pelvic tilt during a provocative task can help reduce symptoms.

• Contracting core muscles can create more stability around the pelvis and reduce symptoms.

• Modifying hip abduction or adduction position can create a wider base of support for patients with instabilities.

Anterior Instability

• Patients reporting anterior hip symptoms aggravated in positions of hip extension or rotation should have their hip extension and/or external rotation reduced.

• Shortening stride length in walking or running may help reduce symptoms.

• Adjusting posture slightly by bringing patients into a more neutral or slightly anterior pelvic tilt and less hip extension can be helpful.

Posterior Instability

• Posterior instability is aggravated by hip flexion and/or internal rotation.

• Limiting range of motion during deeper squats and lunges based on symptoms may be necessary.

• A slightly more posterior pelvic tilt might help alleviate pain.

Improving Strength

This section focuses on improving strength for people with dysplasia. The speaker suggests exercises that target specific muscle groups such as glutes, hamstrings, quadriceps, and adductors.

Exercises for Specific Muscle Groups

• Strengthening glutes can improve stability around the pelvis.

• Hamstring strengthening exercises are important for reducing anterior shear forces on the femoral head.

• Quadriceps strengthening exercises are important for reducing posterior shear forces on the femoral head.

• Adductor strengthening exercises can help improve stability around the hip joint.

Conclusion

In this section, the speaker summarizes the key points discussed in the video. They emphasize that dysplasia is a complex condition that requires individualized treatment and management. The speaker also encourages patients to seek out healthcare professionals who are knowledgeable about dysplasia.

Key Points

• Dysplasia is a complex condition that requires individualized treatment and management.

• Patients should seek out healthcare professionals who are knowledgeable about dysplasia.

• Treatment should focus on reducing symptoms, improving strength, and addressing any underlying anatomical abnormalities.

Strengthening and Control for Hip Dysplasia

In this section, the speaker discusses the importance of strengthening and developing control for individuals with hip dysplasia. They provide tips on how to modify exercises based on symptoms and co-existing pathologies.

Strengthening Exercises

• Strengthening exercises can benefit individuals with hip dysplasia by improving control of anterior/posterior pelvic tilts or contralateral pelvic drop.

• Weight-bearing exercises may be more likely to recruit deep hip stabilizers, so starting with non-weight bearing positions like sideline positions or bridges may be helpful.

• Consider the position of the exercise, as some positions like fire hydrants can be provocative in anterior instability.

• Side lying abduction is a good exercise for recruiting glute medius but doing it in an extended hip position can be provocative if there is anterior instability.

Developing Control and Proprioception

• Developing control and proprioception can help improve joint position sense and control.

• Modify movements based on functional requirements and symptoms. For example, reducing stride length during walking/running to reduce hip extension for anterior instability or having a more upright squat to reduce hip flexion for posterior instability.

• Modifying technique can also help improve control. For example, reducing ankle range during single leg squats to prevent excessive forward flexion at the hip.

Managing Co-existing Pathology

• Hip dysplasia often presents with other painful areas like muscle/tendon pain around the hips, iliopsoas-related pain, gluteal tendinopathy, or lower back pain.

• Reduce stretches if there is tendon pathology/pain and modify provocative positions in general.

• Strengthening the muscle and tendon can also help manage co-existing pathologies.

Treatment Options for Hip Dysplasia

In this section, the speaker discusses various treatment options available for hip dysplasia. The speaker emphasizes the importance of reducing stress on the joint and improving outcomes.

Encouraging Activity

• Encourage people to be active at a level that doesn't lead to flare-up in symptoms or pain during walking.

• Look at building activity from a manageable level gradually to where they want to be.

Sleep and Recovery

• Modify sleeping positions to help reduce night pain, which can be problematic for patients with hip dysplasia.

Mental Health Support

• Some patients may benefit from seeking support for their mental health as this condition can have a big impact on people's lives.

Hypermobility

• Hypermobility is common in hip dysplasia, and there are potential causes such as Ellis-Danlos syndrome.

• Keep a lookout for those bigger picture things that we may be able to help people with.

Conservative Management vs Surgery

• Changes take time, typically at least eight to twelve weeks of rehab is needed.

• Some patients may not improve as much as they'd like with conservative management and may benefit from surgery.

• Getting appropriate investigations and teaming up with an orthopedic surgeon who's experienced in this area can help ensure the patient has all their options available to them.

Additional Resources

In this section, the speaker provides additional resources related to running injuries and hip dysplasia research papers.

Running Injuries Video Series

• Check out free video series related to running injuries by following the provided link.

Research Papers

• The speaker will add extra research papers in the comments for those who want to delve in and find more information.