Question
Would you recommend the use of hip mobilization techniques on a patient that presents to you in their late twenties or early thirties with a congenital hip diagnosis?
Answer
When we think about hip dysplasias and the like, we need to have an understanding of the architecture of the hip. We also need to realize that manual therapy is not simply mechanically working on the hip joint; it is also working to stretch the soft tissues and has a neurophysiological effect from a pain inhibition standpoint. So, yes, I would use manual therapy on those patients. My goal is usually from a pain reduction standpoint more than from a range of motion gaining standpoint. In talking about dysplasia, this is a small part of the population where some of the tests like a Craig Ryder test (where you are looking at the orientation of the femoral head) can be of use, because you may be wondering if you are going to get 30 degrees of internal rotation on this person because they have significant retroversion. This is one instance where that information is going to be informative. To answer your question, manual therapy may still be indicated though your goal may be different.
To piggyback off of that, people who have Avascular Necrosis, and have hip resurfacing or replacement done earlier on, in my experience have done very well with hip mobilization. It's similar to the Crow study which showed that when people get a replacement, therapist tend to be very hands off, but those patients can respond very well to joint mobilization. It should be part of a comprehensive treatment plan for those patients. There obviously is some concern, but realize that the impacted tissue, for the most part, is good at this standpoint. People will ask about a timeframe with manual therapy concerning those patients. Obviously you want to be mindful of tissue healing time, but generally you can start feeling pretty comfortable in the normal 10 - 12 week time period and especially when you are getting out to 6 months for that really persistent mobility deficit. They will do really well, and you will have minimal contraindications. Always be observant of your patient's response. If you are doing something and they are getting apprehensive, you need to be very aware because they are going to tighten up and the treatment will have a less than therapeutic response. So, always be mindful of the patient's response.
