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    Hip Maltracking

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    SMS Printing

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    Hip Maltracking

    Uploaded by

    SMS Printing
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    Hip Maltracking.pptx

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    Copyright:

    © All Rights Reserved
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    18 views16 pages

    Hip Maltracking

    Uploaded by

    SMS Printing

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Welcome

    HIP MALTRACKING
    LOWER EXTREMITY CASE
    45 year old female enters the clinic with non-specific pain
    and/or “tightness” in anterior hip and thigh and at times lateral
    hip pain. Her script states “hip bursitis” eval and treat.
    The pain is starting to go distally, now. She has no numbness or
    tingling in her leg.

    Where do you start?


    What are your first thoughts?
    Hip Case
    • Weightbearing Tests Palpate the greater trochanters bilaterally
    • Upon squat or forward bend feel early unrestrained femoral anterior and
    internal rotation compared to the other side, single leg stuff may have some
    knee valgus
    • Non- Weightbearing Tests
    • Limited IR with block
    • With hip tracking you will feel some resistance and the hip will track off into
    abduction/ER Joint Play
    • Decreased ER strength
    – Hip Maltracking (Tests)
    • Gail Malloy/Fred Stoot

    • Hip Maltracking
    • Repetitive microtrauma from postural hip extension or psoas driven 🡪
    anterior displaced femoral head (loss of neutral zone)

    • Hip Maltracking Tests


    • Stiff posterior hip
    • ROM hip IR loss in 90 deg flexion but not in extension (hip LR stiff)
    • ROM into flexion – see abduction/ER pattern = maltracking
    • Weak posterior hip
    Keep them in a shortened position (neurological test)
    “Keep your foot towards me”… come on, Push it
    • MMT Hip in ER- inhibition (weak) from lumbar or SIJ
    Hip Manipulation Assessment
    Gail Malloy/Fred Stoot

    High Velocity Manipulation to the Femur due to Unrestrained Femoral


    Internal Rotation (UFIR)
    • Presentation:
    – Non specific pain and/or tightness in anterior hip and thigh,
    lateral hip pain (including bursitis-type symptoms, ITB pain,
    lateral trunk pain, medial and lateral knee pain, deep buttock
    pain, SIJ and sciatic pain)
    • Occurs due to:
    – Laxity
    – Subluxation
    – Motor strategy
    Hip Manipulation Assessment
    Weightbearing Tests
    • Palpate the greater trochanters bilaterally
    • Have the patient:
    – Actively forward bend
    – Perform a small squat
    Looking for early unrestrained femoral internal rotation compared to the
    other side
    Non- Weightbearing Tests
    • Supine:
    – Limited IR with block
    – With hip tracking you will feel some resistance and the hip will track off
    into abduction/ER
    Hip Manipulation Assessment
    Joint Play
    •Pt is sidelying in loose pack position
    •Stabilize the ASIS with cranial hand
    •With wide palmar grip on greater trochanter, rock
    the trochanter anterior and posterior
    Did you say manipulation?
    Treatment – Hip Maltracking: Malloy/Stoots
    •Velocity Manipulation for
    posterior glide of the femoral
    head
    •Used for Femoral anterior glide
    with IR - Unrestrained Femoral
    Internal Rotation (UFIR)
    •Follow with rebalancing hip
    lateral rotators
    Contact point posterior to greater trochanter

    Impact thumb on posterior GT 🡪 posterior glides


    femoral head (NM reset)
    POST MANIPULATION TREATMENT
    Phase I after Hip
    Manipulation
    • Client is asked to think of turning the knees
    outwards and pulling against therapist’s
    fingertips
    • Hold for 3-5 seconds and then relax and
    repeat.
    • Client will notice with cueing that the
    motion travels all the way down to the foot
    and ankle with the arches lifting up as the
    legs rotate out.
    • Therapist may palpate the larger gluteals
    (after communicating with client about
    intention and purpose) to ensure they are
    not activated with the effort.
    Phase III after Hip
    Manipulation
    • Phase III: Weight Shifting with Single Limb
    Stance --
    • Once the external rotation can be maintained
    with a weight shift
    • Have the patient pick up the opposite foot
    partially and eventually all the way without
    losing the external rotation control.
    • Progress to being able to hold for 30-60
    seconds with good control during single limb
    stance.
    • Single Leg Semi-Squat --
    Once control can be
    maintained with single
    limb stance, the client
    then adds a mini squat
    with the knee tracking in
    Phase IV and line with the mid-foot
    and the trunk centered
    V after Hip over the stance leg. Cue
    neutral lumbopelvic
    Manipulation alignment and leg
    alignment

    • Phase V: Single Leg Hop


    -- Progress to hopping
    without loss of the
    tracking or rotation
    control.
    Follow Up Treatment

    • Follow up with soft tissue treatment such as trigger


    point, dry needling, soft tissue mobilization,
    stretching
    Home Exercises:
    • One that you are pretty sure they won’t mess up
    ☺
    • Theraband around knees with knees bent- one
    leg at a time…. Fast out and slow in

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