MANUAL THERAPY pada HIP

Overview hip joint/coxofemoral joint

Sendi yang stabil, dipengaruhi oleh :

 Acetabulum : dibentuk oleh os illium, os ischium, os pubis. Dari bahasa latin venegar cup
 Labrum : memperdalam acetabulum dan meningkatkan articular congruence/ kesesuaian
bentuk sendi
 Ligamen : lig yang paling kuat, beradaptasi secara baik mentransfer beban antara spine dan
lower exremity
 Otot : dipengaruhi oleh otot abdominal, otot erector spine yg mempengaruhi pelvic tilting
dan sendi hip. Otot paha atas dan juga adductor juga mempengruhi stabilisasi hip.

Dibutuhkan keseimbangan antara mobilitas dan stabilitas. Gaangguan satu atau keduanya ataupun
ketidak seimbangan anatara keduanya dapat menyebabkan :

a. Cidera jaringan lunak

b. Impingement syndrome
c. Joint dysfunction

Anatomi fungsional

 The hip joint is an anatomically and mechanically simple, triaxial ball-and-socket joint
(unmodified ovoid).
-> Ball n socket
 The convex articulating surface is formed by the head of the femur (caput os. femoris).

The head of the femur is about two-thirds of a sphere on the neck of the femur (collum ossis
femoris), which is itself approximately five centimeters long.

The neck of the femur forms an angle of approximately 1260 with the longitudinal axis of

the femoral shaft (angle of declination) and an angle of approximately 120 with the frontal plane
(angle of femoral torsion).

The head of the femur faces the acetabulum in a medial, cranial, and slightly ventral direction.

The ilium contains the acetabulum (a lunate-shaped, concave articular surface) and the non-articular
floor of the cavity, the acetabular fossa.

The acetabular fossa is occupied by an articular fat pad (pulvinar acetabuli, or corpus adiposum
fossae acetabuli), which can be pushed out or sucked in through the acetabular notch by variations
in pressure.

Palpasi Tulang

a. Ventral
b. Hip joint
c. Anterior superior iliac spine (SIPS)
 d. Anterior inferior iliac spine (SIAI)
e. Iliac crest (crista iliaca)
f. Symphysis pubis (simpisis pubis)
g. Lesser trochanter (trochanter minor)

Lateral

a. Iliac crest
b. Greater trochanter (trochanter mayor)

Posterior :

a. lebih sering karena referred pain degenerative disk disease, facet atrhopathy, spinal
stenosis
b. Sacroiliac disorder, ggn ektensor hip, external rotator
c. Aortoiliac vascular occulsive disease (jarang)

Ligamen

a. Ligamentum capitis femoris

b. Iliofemoral ligament (ventral)
c. Pubofemoral ligament (caudal)
d. Ischiofemoral ligament (dorsal/cranial)
e. Zona orbicularis
f. Ligament of the head of the femur (lig. capitis femoris)

EXAMINATION- history

 Dapatkan Keluhan utama dan mekanisme cidera, lokasi keluhan.

 Nyeri biasanya karena local hip pathology, tapi bisa juga kondisi yang bebahaya seperti
inflamatory arthitides.

EXAMINATION- history

Penyebab nyeri lokal pada hip diantaranya :

1. Hip strain, tears, rupture dan tendinitis sering karena overuse injury
2. Bursitis (subtrocanter dan ischiogluteal
3. Contusio
4. Snapping hip
5. Loose body within the joint : ada hub dgn kedutan , nyeri saat gerakan hip
6. Dislokasi & fraktur dislokasi
7. Fraktur Hip & pelvic
8. Fraktur pubis
9. Femoral neck stress fracture
10. OA hip
11. Septic athritis
12. Osteoid osteoma
13. Reiter’s syndrome
 14. Synovitis
15. Avascular necrosis of femoral head
16. Iliopsoas abses
17. Iliofemoral venous thrombosis
18. Lumbal disc herniation
19. Obturator, femoral, & inguinal hernia
20. Osteomielitis
21. Osteomielitis pubis
22. Compartment syndrome
23. STD
24. Muscle strain
25. Lateral femoral cutaneus nerve entrapment
26. labral tears
27. Stress fracture of femoral neck
28. Subluxation /dislocation of hip

Lokasi nyeri

 Anterior : hip pathology i.e degenarative arthitis, hip flexor strain/tendonitis, bursitis
 Lateral : nyeri trochantor mayor, ITB syndromes, meralgia

Kerakteristik nyeri

 Mendadak atau perlahan

 Gerakan dan posisi dan aktivitas yang menambah dan mengurangi nyeri
 Efek berjalan dan weight bearing
 Resting pain ?

EXAMINATION- System review

 Referred pada hip disebabkan oleh sbb :

 Lumbar spine
 Peripheral nerve entrapment
 Sacroiliac joint
 Visceral pain di abdomen\

Keluhan referred pain

 Nyeri daerah paha depan : lumbar radiculophaty

 Nyeri berkurang saat berjalan dan naik tangga : lumbar spine stenosis, terutama saat nyeri
meningkat di permukaan datar
 Nyeri saat duduk : lumbar disk lession, ischial bursitis (weaver’s bottom)
 Nyeri malam hari yang tdk berhubungan dengan gerak dan posisi : suspect cancer !!!

Demam, malaise, berkeringan malam hari, weight loss, night pain, drug abuse intravena, riwayat
cancer , ggn imunitas yg tk jelas : tumor, infeksi (i.e , septic atrhritis / osteomielitis), inflamatory
arthritis
Weight loss, fatigue, tk nafsu makan: penyakit sitemik polymyalgia rheumatica, TA, lupus, sepsis.

EXAMINATION- Test & measurement

a. Observasi
b. Screening test
c. Palpasi
d. Active, passive, resistive test
e. Test khusus

Test & measurement- Observation

 Scars
 Bruising
 Swelling
 Observasi : epan belakang dan samping, general alignment hip, pelvis, spine dan LE lainnya(
knee, ankle, toes)
 Pelvis cross syndromes
 Swelling di trocanthor mayor bursitis
 Bulk TFL , shortened

Test & measurement-screening test

 Gait analysis : stance n swing phase !!

 Joint loading test : hight step, unilateral standing, squat

Test & measurement-palpasi

Struktur anatomi spesifik

Perhatikan : warmth, tenderness, deformitas, krepitasi

1. Aspek anterior hip n groin : SIAS, pubic tubercle, adductor magnus, rectus femoris, iliopsoas
bursae, femoral triangle, inguinal ligamen, adductor longgus
2. Aspek lateral hip : -> posis side lying Krista iliaca, trochantor mayor, trocantor minor,
piriformis attachement, psoas
3. Aspek posterior hip : quadratus lumborum, tuberositas ischidikum, n. Ischiadikus

Test & measurement-active, passive, resisted

Fleksi , ekstensi, abduksi, adduksi, intenal-eksternal rotasi

Test & measurement-active, passive, resisted

Otot yang attach di trochantor mayor

1. Piriformis
2. Gluteus medius
3. Gluteus minimus
4. Obturator internus
 5. Gemellus superior
6. Gemellus inferior

Test & measurement-fungsional assesment

Tes fungsinal dengan menggerakkan hip dengan repetisi tertentu, lalu dilakukan skoring

Test & measurement- passive accesory movement

Congruency hip sangat ektrem sehingga tes in sulit dilakukan, karena hanya dilakukan lateral
distraksi. Tes positif jika dideteksi adanya gerak berlebih

Test & measurement- tes khusus

a. Articular test

 Active SLR
 FABER
 FAIR
 Torque test

b. Muscle n tendon test

 Thomas test
 Modified ober test
 Tredelenber test

c. Other test : craig’s test, sign of buttock

Intervensi

1. Hip stretching

 Hip extension stretch

 Internal rotation stretch
 External rotation stretch
 Flexion stretch

2. Muscle energy technique

 Hip extension muscle energy

 Internal rotation muscle energy
 External rotation muscle energy

3. Mobilizatian n traction

 Indirect traction
 Direct traction
 A-P glide
 P-A glide n modification
 L glide

4. Mobilization with compression

 Passive IR with compression

 Passive flexion with concurrent compression
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