I'm Brett DeGoyer, I'm a primary care sports medicine specialist and neuromusculoskeletal medicine specialist, practicing for Samaritan Healthcare in Moses Lake, Washington. So in this case we're dealing with hip osteoarthritis. There are some things to consider with the hip osteoarthritis, especially using manual treatment, and particularly that's the age of the patient, the frailty of the patient, and the bone density of the patient. Depending on all of those factors, you'll need to modify how you're going about your manual treatment. For now, we're going to use this patient who's got good bone structure and good bone density. And the age is, typically for osteoarthritis of the hip, it can be anywhere between the ages of 50 all the way until they're in their 90s. One of the things that I do with my hip osteoarthritis for osteopathic manipulative treatment is to treat the joint capsule. And there's different ways to do that, and I'm going to demonstrate about three of those today. The first one is to just take the leg with the knee in full extension, the hip a little bit externally rotated, and adding some traction, so I just pull back. Now this is a myofascial treatment, so I want to find that point where I feel the tissues are getting tight, and add maybe a little bit more force on my traction until I feel things relax, or I turn away from the tightness and just add the traction to where I can feel everything is in balance as far as internal, external rotation, flexion, and extension, and hold that for several seconds to about half a minute. I'll also do that with a little bit of internal rotation, just to get a different part of the hip capsule. So that's the traction method. The other is to do a compression, and that comes with bending the hip into flexion, the knee at flexion, and then through the knee and through the femur, directed into the acetabular joint space, I'll add compression, usually pushing the knee into my axilla, or the front part of my axilla, again, feeling that tightness, and either gently pushing into it, and then holding, or trying to push in, and then find where internal, external rotation is balanced, as well as flexion and extension. Sometimes I may have to go all the way into AD-duction of the hip, but that can also induce a lot of pain and tension in an arthritic hip. Sometimes I'll have to come all the way out into AB-duction, similar circumstances, depending on the condition of what the hip joint really is, it may cause more pain. So you want to be very aware of how the patient is tolerating this type of treatment. So those are two sections, or two ways of treating the hip. The other is to come in directly over the hip joint, both from the front and from the back. So I'll be grasping all along the anterior part of the hip, along that capsular region anteriorly, and then grasping as close as I can to the femoral head posteriorly. Now since I'm grasping in areas that are highly sensitive, I need to educate my patient about what I'm doing, where my hands will be placed, and the purpose of the motion that I'm inducing, and why it's important in treating hip osteoarthritis, making sure in addition to the education that I'm getting full consent from the patient to do this type of treatment. It is also a key to make sure that they are comfortable either having or denying a chaperone in the room when you're doing any type of treatment that is in a sensitive area. So I'm going to come in, flex the hip, I'm going to take one hand, the hand, if I'm standing in this direction, this will be my caudate hand, this will be, excuse me, my cephalate hand towards the head, my caudate hand towards the feet. I'll take my caudate hand and come in from the front, grasp right into the groin area, right along where the hip capsule is. And I may fold, put the fold or the webbing between my thumb and my index finger right along the adductor tendons that you can feel on the inside, and then compress my thumb down into that anterior hip joint while my fingers wrap around to the more inner part of the hip joint. My cephalate hand is going to come from underneath and grasp posteriorly along the hip capsule, and I'm going to grab and compress together my two hands. I'm going to put the knee, if I can, if I don't have a, you know, seven foot tall basketball player on my hand, I will put the knee there just so I can add in a little bit of compression. If I can't, then I'll just have them rest their foot on the table. As I'm grasping, I'm compressing my hands together, and then I'm inducing rotation or traction or compression even further. That's part of why you try to get the knee and the entire leg up into your armpit or to the front part of your arm to add in that compression. This gives a little bit more detail treatment into the hip capsule, which offers a little bit better specificity than when you're down at the ankle. Once I've completed with that, then I'll just bring them up again and do some gentle range of motion to articulate that joint and get that fluid, that synovial fluid moving around to help lubricate what remaining space is there from the degenerative process of osteoarthritis.

3rd Edition, CASE 25

3rd Edition

Hip

hip osteoarthritis

osteopathic manipulative treatment

myofascial treatment

joint mobility

patient education