Hip joint assessment & management

Overview:

• Subjective assessment
• Hip joint assessment
• Soft-tissue techniques
• Hip joint mobilisation
• Exercise program
• Education

Hip pain in ballet

Poulsen et al., 2005

Professional ballet dancers

• 96% anterior
• 20% posterior
• 16% lateral
• 18% isolated anterior
• All anterior +/- lateral & posterior, except for one isolated posterior

Hip pain in ballet

Poulsen et al., 2005

Professional ballet dancers

• 96% anterior
• 20% posterior
• 16% lateral
• 18% isolated anterior
• All anterior +/- lateral & posterior, except for one isolated posterior

OTHER SYMPTOMS

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Stiffness

Clicking

Catching

Locking

Giving way

Weakness

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Hip functional movements

Stance

Gait

Step up

5^th position

Grande plié

Retiré

Developé

Fondue

Arabesque

Ronde de jambe

Sauté

SL squat

Hop

Hip joint range of motion

Pelvic drop/hold –

double and single leg stance

Flexion

Internal rotation @ 90

Flexion & adduction

Flexion, adduction & internal rotation Flexion, abduction & external rotation

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External rotation @90

IR & ER @ neutral

O’Donnell test

Extension

Extension & external rotation

Extension, ER & abduction

Thomas test

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Hip strength/endurance

Iliopsoas

Hip abd:add

Hip extension

IR & ER rotation

Aims of treatment

Treat the dancer

& their physical deficits

NOT

Joint structural changes

Robyn Hendricks. Photographer: Georges Antoni

Manual treatment

• Key to management is strengthening
• Will Rx facilitate strengthening process?
• Treatment can reduce pain inhibition
• Do soft-tissues feel tight due to poor capacity?
• Will Rx change the outcome?

Manual treatment

Hip joint mobilising

Manual treatment & taping

Soft-tissue techniques:

• Hip flexors
• Hip abductors & adductors
• Superior gluteal region
• Deep rotators

Hip joint mobilisation

• Promote hip joint approximation
• Promote hip joint dissociation
• Minimise anterior joint forces
• Inhibit over-active muscles

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STABILITY not RIGIDITY

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Facilitate & improve function of stabilising muscles

Hip stability training

Joint proprioception

Iliopsoas

Dynamic stabilisers of the hip

iliacus

Local stabiliser of hip - medial fibres

Global mobiliser of hip - lateral fibres

Adapted Grimaldi, 2006

psoas major

Local stabiliser of hip & Lx – posterior fascicles

Global stabiliser of hip – anterior fascicles

Comerford & Gibbons, 2007

iliocapsularis

Local hip stabiliser Ward et al, 2000

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Ward et al, 2000

iliocapsularis

Iliopsoas

Dynamic stabilisers of the hip

Iliopsoas

Dynamic stabilisers of the hip

Iliopsoas

Dynamic stabilisers of the hip

Dynamic stabilisers of the hip

Deep rotators

Dynamic stabilisers of the hip

Deep rotators

Dynamic stabilisers of the hip

Deep rotators

Dynamic stabilisers of the hip

Deep rotators

Dynamic stabilisers of the hip

Adductor magnus

Dynamic stabilisers of the hip

Adductor magnus

Arabesque and penché prep

Arabesque and penché prep

• Pain free to avoid inhibition or spasm of muscles
• Reduce joint inflammation to prevent reflex inhibition
• Avoid complete rest to prevent disuse atrophy

Richardson, Jull, Hides, & Hodges, 1999

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Facilitate & improve function of stabilising muscles

Photo: Justin Smith

Education

Education

Does iliopsoas feel tight because it is weak?

�Consider kinetic chain�

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Plantarflexion force in gait

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peak hip flexor moment & forces

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Ankle dorsiflexion

pronation

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hip internal rotation

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Lewis & Ferris 2008

�Consider kinetic chain�

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Plantarflexion force in gait

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peak hip flexor moment & forces

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Ankle dorsiflexion

pronation

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hip internal rotation

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Lewis & Ferris 2008

Kemp et al 2016

Single leg heel raise

endurance

post-arthroscopy

Rehabilitation

Retrain posture & technique

Modify ballet/dance training

Improve cardiovascular fitness

Acknowledgements

Dancers and Staff of The Australian Ballet

Paula Baird Colt

Sophie Emery

Robyn Hendricks & Daniel Gaudiello

Photography: Branco Gaica

Acknowledgements