Terry Rose PT, MS, DPT, FAAOMPT, Cert. MDT
Hando, Gill, Walker, Garber, “Short- and long-term clinical outcomes
following a standardized protocol of orthopedic manual physical therapy
and exercise in individuals with osteoarthritis of the hip: a case series”
Journal of Manual and Manipulative Therapy, 2012, Vol. 20, No. 4.
Objectives: Describe short- and long-term outcomes
observed in individuals with hip osteoarthritis (OA)
treated with a pre-selected, standardized set of bestevidence manual therapy and therapeutic exercise
interventions.

Results:
 “Numerical Pain Rating Scale (NPRS) scores improved from 4·3(±1·9) to
2·0(±1·9), hip flexion range of motion (ROM) improved from 99 degrees
(±10·6) to 127 degrees (±6·3) and hip internal rotation ROM improved
from 19 degrees (±9·1) to 31 degrees (±11·5).”
 “Improvements in HHS, NPRS, and hip ROM measures reached
statistical significance (P<0·05) at 8-weeks and remained significant at
the 29-week follow-up.”
 “Mean changes in NPRS and HHS scores exceeded the minimal
clinically important difference (MCID) at 8-weeks and for the HHS scores
alone at 29 weeks. The 8 and 29 week mean Global Rating of Change
scores were 5·1(±1·4) and 2·1(±4·2), respectively.”

Discussion:
 “Improved outcomes observed following a pre-selected, standardized
treatment protocol were similar to those observed in previous studies
involving impairment-based manual therapy and therapeutic exercise for
hip OA. Future studies might directly compare the two approaches.”
Manual Therapy Protocol
• Patient supine at the edge
of table
Hip Flexion With Caudal (inferior) Glide
• Therapist next to patient on
stool. Optional to place one
knee on plinth for leverage.
• Belt placed around proximal
femur of patient and around
ischial tuberosities of
therapist.
• Distract hip joint inferiorly by
shifting hips posteriorly
while using hand to bring
patient into hip flexion.
Improve Hip Flexion
Manual Therapy Protocol
• Patient in supine, may hold
onto table to avoid sliding
Long Axis Distraction
• Place hip in slight flexion/
abduction.
• PT grasps pt. with both hands
above the malleoli
• Impart distraction by shifting
weight posteriorly
Improve all Hip Motions
Manual Therapy Protocol
• Pt. prone with hip placed in
flexion/ abduction/ external
rotation
Posterior – Anterior Mobilization
• Place towel roll under pt.
knee
• PT kneels on table while
using left knee to prevent the
pt. LE from internally rotating
• Impart anterior mobilization
through greater trochanter
• Progress by bringing hip
further into flex./ abd./ ER
and repeat
Improve Hip Extension
Manual Therapy Protocol
• Place pt. supine with
buttocks at edge of table (in
Thomas test position)
Iliopsoas Stretch
• Flex pt. non involved hip
while extending the
involved side
• PT holds opposite LE in
flexion and while extending
other LE until stretch is felt
in the hip flexors
Improve Hip Extension
Manual Therapy Protocol
Piriformis Stretch
• Pt. in supine
• PT flexes and externally
rotates pt. involved hip until
stretch is felt in the buttocks
• Progress with increased
flex./ ER/ and adduction
Improve Hip Internal Rotation and Stretch Hip Joint
Capsule
Manual Therapy Protocol
• Pt. placed in supine
Internal Rotation with Distraction
• PT places belt around pt.
proximal femur and
therapists ischial
tuberosities
• PT flexes pt. hip to 90
• Impart lateral distraction by
shifting weight posteriorly
• Following distraction, using
AAROM internally rotate pt.
hip
Improve Hip Internal Rotation
Exercise Program
Lie supine
Knee to chest stretch
Grasp the front of your
knee as shown.
Pull your knee to your
chest until you feel a
stretch in your buttock
and posterior thigh.
Hold stretch for 30
seconds or more.
Perform every day for 3
sets of 30 seconds.
Glute Max and Hip Capsule Stretch
Exercise Program
Lie on your left side.
Hip Abduction
Use your right lateral hip
muscles to lift leg towards
the ceiling.
Do not let pelvis rotate
posteriorly.
Hold for 1-2 seconds at the
top and return to starting
position.
Perform every other day for 3
sets of 12 reps.
Strengthen Glute Med
Exercise Program
Hip Flexor Stretch
Lie with your buttock at the edge of
the table.
Grasp the front of your knee as
shown and pull your knee to your
chest
Let your opposite leg relax and fall
towards ground until you feel a
stretch in the front of your thigh and
groin.
Hold stretch for 30 seconds or
more.
Perform every day for 3 sets of 30
seconds.
Stretch Iliopsoas, Rectus Femoris, ITB
Selkowitz, Beneck, Powers “Which Exercises Target the Gluteal Muscles While
Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment
Using Fine-Wire Electrodes”J Orthop Sports Phys Ther. 2012 Nov 16
Background: Abnormal hip kinematics (i.e. excessive hip adduction and
internal rotation) has been linked to certain musculoskeletal disorders. The
TFL is a hip abductor but also internally rotates the hip. As such, it may be
important to select exercises that activate the gluteal hip abductors while
minimizing activation of TFL.
Conclusion: If the goal of rehabilitation is to preferentially activate the gluteal
muscles while minimizing TFL activation, then the clam, mini squat side-step
with band, unilateral bridge, and both quadruped hip extension (straight leg
and bent knee) exercises would appear to be most appropriate