AN IMPAIRMENT BASED APPROACH TO THE TREATMENT OF NON-SPECIFIC
ANTERIOR HIP PAIN: A CASE REPORT
Manual Therapy Fellowship
Purpose:
This case report describes the
successful management of a
patient with a primary complaint
of six-month duration anterior
hip pain with secondary low
back and groin pain. The case
describes an impairment based
treatment approach focused on
manual physical therapy
interventions.
Subject:
33 year-old male with six month
duration of anterior hip pain
with secondary low back and
groin pain, possibly initiated by
a psoas strain when sprinting.
The Numeric Pain Rating Scale
(NPRS) at rest was 5/10, worst
8/10, least 4/10. The Modified
Oswestry Disability
Questionnaire (OSI) was 26%.
Significant examination findings
included limited hip flexion
bilaterally and hypomobility
throughout the lumbar spine.
Russ Overy, PT, DPT, Boulder Center for Sports Medicine, Boulder, CO
Regis University Manual Physical Therapy Fellowship Program
Procedures: Discussion:
The subject was treated for seven visits over a five-week period. Lumbar and hip Other diagnostic concerns
mobilization / manipulation was initiated during the second visit to address hip and lumbar necessary to rule out were
impairments identified in the initial examination. Posterior to anterior hip glides and osteitis pubis and inguinal
caudal glides were used for hip extension and flexion range of motion restrictions. Side hernia. No pubic bone
lying lumbar flexion mobilizations were also performed to improve lumbar flexion. abnormalities were found on
radiographs and inguinal
tenderness was limited. An
impairment based approach
was implemented focusing
on restoring hip and lumbar
spine mobility, increasing
hip and core strength, and
normalizing his gait pattern.
Follow-up treatments included manual muscle stretches,
exercises to address hip weakness and lumbar stabilization
exercises. Clinical Relevance:
In light of diagnostic
Numeric Pain Rating Scale
uncertainty, an impairment
Results: 9
based approach to the
Subject experienced immediate improvements in hip
8
treatment of anterior hip
7
extension and flexion range of motion after 2nd visit 6
Score
5
pain can be effective in
and a six point decrease in NPRS. Side lying 4
3
improving motion and
mobilizations improved pain-free flexion range of 2
1
strength and restoring
motion. His global rating of change at the 4th visit 0
function.
was “a great deal better”. Full resolution of symptoms
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was achieved by treatment 7 (NPRS= 0; OSW=0%).
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