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HIP MALTRACKING
 LOWER EXTREMITY CASE
45 year old female enters the clinic with non-specific pain
and/or “tightness” in anterior hip and thigh and at times lateral
hip pain. Her script states “hip bursitis” eval and treat.
The pain is starting to go distally, now. She has no numbness or
tingling in her leg.

Where do you start?

What are your first thoughts?
 Hip Case
• Weightbearing Tests Palpate the greater trochanters bilaterally
• Upon squat or forward bend feel early unrestrained femoral anterior and
internal rotation compared to the other side, single leg stuff may have some
knee valgus
• Non- Weightbearing Tests
• Limited IR with block
• With hip tracking you will feel some resistance and the hip will track off into
abduction/ER Joint Play
• Decreased ER strength
 – Hip Maltracking (Tests)
• Gail Malloy/Fred Stoot

• Hip Maltracking
• Repetitive microtrauma from postural hip extension or psoas driven 🡪
anterior displaced femoral head (loss of neutral zone)

• Hip Maltracking Tests

• Stiff posterior hip
• ROM hip IR loss in 90 deg flexion but not in extension (hip LR stiff)
• ROM into flexion – see abduction/ER pattern = maltracking
• Weak posterior hip
Keep them in a shortened position (neurological test)
“Keep your foot towards me”… come on, Push it
• MMT Hip in ER- inhibition (weak) from lumbar or SIJ
Hip Manipulation Assessment
Gail Malloy/Fred Stoot

High Velocity Manipulation to the Femur due to Unrestrained Femoral

Internal Rotation (UFIR)
• Presentation:
– Non specific pain and/or tightness in anterior hip and thigh,
lateral hip pain (including bursitis-type symptoms, ITB pain,
lateral trunk pain, medial and lateral knee pain, deep buttock
pain, SIJ and sciatic pain)
• Occurs due to:
– Laxity
– Subluxation
– Motor strategy
 Hip Manipulation Assessment
Weightbearing Tests
• Palpate the greater trochanters bilaterally
• Have the patient:
– Actively forward bend
– Perform a small squat
Looking for early unrestrained femoral internal rotation compared to the
other side
Non- Weightbearing Tests
• Supine:
– Limited IR with block
– With hip tracking you will feel some resistance and the hip will track off
into abduction/ER
Hip Manipulation Assessment
Joint Play
•Pt is sidelying in loose pack position
•Stabilize the ASIS with cranial hand
•With wide palmar grip on greater trochanter, rock
the trochanter anterior and posterior
Did you say manipulation?
Treatment – Hip Maltracking: Malloy/Stoots
•Velocity Manipulation for
posterior glide of the femoral
head
•Used for Femoral anterior glide
with IR - Unrestrained Femoral
Internal Rotation (UFIR)
•Follow with rebalancing hip
lateral rotators
Contact point posterior to greater trochanter

Impact thumb on posterior GT 🡪 posterior glides

femoral head (NM reset)
POST MANIPULATION TREATMENT
Phase I after Hip
Manipulation
• Client is asked to think of turning the knees
outwards and pulling against therapist’s
fingertips
• Hold for 3-5 seconds and then relax and
repeat.
• Client will notice with cueing that the
motion travels all the way down to the foot
and ankle with the arches lifting up as the
legs rotate out.
• Therapist may palpate the larger gluteals
(after communicating with client about
intention and purpose) to ensure they are
not activated with the effort.
Phase III after Hip
Manipulation
• Phase III: Weight Shifting with Single Limb
Stance --
• Once the external rotation can be maintained
with a weight shift
• Have the patient pick up the opposite foot
partially and eventually all the way without
losing the external rotation control.
• Progress to being able to hold for 30-60
seconds with good control during single limb
stance.
 • Single Leg Semi-Squat --
Once control can be
maintained with single
limb stance, the client
then adds a mini squat
with the knee tracking in
Phase IV and line with the mid-foot
and the trunk centered
V after Hip over the stance leg. Cue
neutral lumbopelvic
Manipulation alignment and leg
alignment

• Phase V: Single Leg Hop

-- Progress to hopping
without loss of the
tracking or rotation
control.
Follow Up Treatment

• Follow up with soft tissue treatment such as trigger

point, dry needling, soft tissue mobilization,
stretching
Home Exercises:
• One that you are pretty sure they won’t mess up
☺
• Theraband around knees with knees bent- one
leg at a time…. Fast out and slow in