Exercise Interventions for the Hip
Stretches
Your lab packet has a pre-lab worksheet that extends your knowledge from PTA 132L and asks you integrate observation, knowledge of conditions, and possible modifications into your thinking. Be sure to complete the pre-lab packet and bring it to lab.
Principles of Strengthening
Last term, you applied kinesiology when selecting a basic, intermediate, and advanced exercise for the lower extremity. PNF for the lower extremity was introduced as an intervention to progress ROM into resistance using manual contact and verbal cues to facilitate a response.
Warm-up exercises should preceed any resistance exercise. Consider stretching prior to resistance training to optimize ROM while training. Resistive training is specific to the patient population. This includes age, comorbidities and surgical considerations. Here are some general age-specific recommendations for resistance training. A summary of major concepts is included below:
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Healthy Adults |
Children (6+) |
Older Adults (65+) |
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Move through full, available, pain-free range |
Close, continuous supervision; ergonomics suited for child |
Close supervision and medical clearance to participate; monitor vital signs |
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Include both concentric and eccentric |
Light weights (1-2#) |
Low resistance, low repetition; care with eccentric activities to minimize joint strain |
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At least 8-12 repetitions of moderate intensity; 1-3 sets, 2-3 times a week |
At least 8-12 to 12-15 repetitions with emphasis on multijoint motions; 1-2 sets, 2 times a week. |
At least 10-12 repetitions at low to moderate intensity x 6-8 weeks before progressing; 2-3 x week with 48 hrs rest in between |
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Slow to moderate speeds of motion; 2-3 minute rest intervals |
Low intensity, short duration, play-themed activities; 3 minutes rest during resistance intervals |
Movements should optimize joint protection; avoid high resistance in end-range; |
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Gradual increase in intensity for progressive strengthening |
Increase intensity by increasing repetitions first, then increasing resistance by small increments |
Increase intensity by increasing repetitions first, then increasing resistance by small increments |
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Modify or avoid exercises that strain or reinforce age-related postural changes |
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Consider strengthening in sitting to decrease risk of LOB |
Plyometrics
Plyometrics train muscles to rapidly produce force and quickly accelerate and decelerate in multiple planes of motion. A high degree of trunk control, soft tissue mobility, and dexterity is required to safely and effectively perform these exercises.
There are some examples of these advanced techniques in some of the linked web resources below.
What is the difference between general strengthening and exercise prescription?
Exercise prescription considers surgical and individual precautions and contraindications; skilled exercise instruction includes observing,and correcting compensation for under and over recruitment of synergists. Failure to provide adequate feedback, correction, and progression according to tissue healing parameters and surgical guidelines can result in repetitive strain to neighboring joints, soft tissue overuse syndromes, or surgical failure.
PTAs use their eyes and hands to monitor for a patient's ability to perform exercises correctly and safely within the parameters of their pathological conditions and comorbitities. PTAs understand considerations for progressing a patient safely toward rehabilitation goals.
Active Learning Exercise
Set up and safely apply exercises with elastic tubing or bands to strengthen major muscle groups of the upper and lower extremities. Include a dynamic open-chain, a dynamic closed-chain (if possible), and an isometric exercise for each muscle group.
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Hip joint |
Open Chain |
Closed Chain |
Isometric |
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Hip flexors |
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Hip extensors |
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Hip abductors |
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Hip adductors |
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Hip internal rotators |
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Hip external rotators |
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Now: Consider a patient who has the following restriction:
- total hip replacement - anterior approach, acute stage, using walker
- total hip replacement - posterior approach, subacute stage, using single point cane
- greater trochanteric pain syndrome - subacute stage, painful on stairs curbs
How will you modify the home exercise program for each condition?
What soft tissues are involved, and how can you use manual therapy (soft tissue mobilization) to help decrease pain and improve muscle performance?
Be prepared to answer these questions in lab
Considerations for Gait Training
Resisted walking with theraband at pelvis can progressively increase recruitment of hip and core muscle for stable gait. In addition to marching and forward/backward gait, you can challenge lateral stability by walking away from the anchor at a diagonal.
