Hip mobility exercises include joint mobilization techniques and soft tissue stretching techniques.
In a single-blind, randomized study investigating interventions for hip osteoarthritis, 109 participants were randomly assigned to either hip mobility exercises or active exercises to improve strength and range of motion over a five-week period, with nine visits. The success rate after five weeks was 81% in the manual therapy group and 50% in the active exercise group. Furthermore, patients in the manual therapy group showed significantly better results in terms of pain, stiffness, hip function, and range of motion (ROM). The effects of manual therapy on improving pain, hip function, and ROM persisted after 29 weeks.
Hip mobility exercises are usually performed with sustained stretching to reduce capsular restriction of the hip joint, with the stretch being determined by the direction of the restriction rather than the concave-convex rule.
For example, if hip extension is restricted, the distal femur is shifted in the direction of hip extension. The joint is initially in its neutral position and is gradually moved closer to the end of the range of motion. A belt can also be used for this technique. Rotations can be combined with any sustained stretch performed in a cardinal plane. Distraction or compression techniques can be used alone or in combination with rotations.
Hip distraction mobilizations are indicated in cases of pain and any hypomobility of the hip joint, for example, when the patient reports pain before the physician feels tissue resistance. The lateral distraction technique can be used to increase the range of motion of the hip joint in adduction and internal rotation.
Inferior distraction can be used for the temporary relief of joint pain, to increase the range of motion in hip abduction, and to stretch capsular adhesions that are pronounced in the lower part of the joint capsule. Leg traction
Quadrant mobilizations involve flexion and adduction of the hip, combined with simultaneous joint compression by the femur. The flexed and adducted thigh is guided through a 90–140-degree flexion arc while maintaining joint compression. This arc of movement should feel smooth and be painless. In an abnormal joint, pain or restriction of the arc will occur during movement. In selected non-acute cases, the procedure can be used as an effective mobilization technique, with Grade II to III mobilizations performed perpendicular to the arc throughout.
Posterior gliding mobilization serves to increase flexion and internal rotation of the hip.
The anterior glide is used to increase hip extension and external rotation.
The inferior glide is used to increase hip abduction.
Here's how to restore internal hip rotation:
This technique is used when the patient shows early signs of hip joint degeneration, indicated by minor capsular symptoms and slight degenerative changes on X-rays. The technique requires a length-adjustable belt.
The patient is positioned supine with the affected hip and knee flexed and the foot just above the edge of the bed. The physician stands on the affected side, facing the patient's head. A belt is placed around the physician's back, just below the hip joints, and as proximally as possible around the patient's thigh, so that the belt runs approximately horizontally.
With the hand closest to the patient's head, the clinician grasps the lateral iliac crest on the affected side, with the elbow resting in the clinician's groin to stabilize the pelvis during the maneuver. The clinician places the other hand around the mid-thigh of the patient. From this position, the clinician slowly extends their own hips to apply a distraction force to the patient's hip joint while maintaining fixation of the iliac crest.
If the maneuver causes pain, it should be stopped. This is distinct from discomfort that may be caused by improper belt placement.
Here's how to restore hip flexion:
The technique for restoring hip flexion is identical to the one described above, except that during distraction, the clinician passively flexes the patient's hip by laterally bending the waist.
The effectiveness of manual techniques for improving hip range of motion has been reported in the literature. Crosman and colleagues investigated the effects of patellar tendon massage (effleurage, petrissage, and friction) on hip flexion in healthy individuals and observed a significant improvement in range of motion after the soft tissue massage.
Godges and colleagues reported improved hip flexion and hip extension ranges in normal individuals after applying manual stretching exercises to muscle groups that resist the respective movement, combined with training of agonistic muscles.
The patient is positioned in the lateral decubitus position. The patient is instructed to flex the non-involved hip and maintain this position by using their arms to help stabilize the lumbar-pelvic region. While the clinician monitors the movement of the lumbar pelvis with one hand, they passively extend the thigh with the other arm/hand. The advantage of the psoas muscle stretch technique is that varying degrees of hip adduction/abduction and knee flexion/extension can be controlled. The disadvantage is that the technique is more physically demanding for the clinician.
Although a number of exercises are recommended to stretch the iliopsoas and rectus femoris muscle groups, the standing/kneeling position is preferred due to their potential to increase the anterior shear of the lumbar vertebrae either directly or indirectly.
A cushion is placed on the floor, and the patient kneels on it with the other leg extended forward in a typical lunge position. The patient is asked to tilt their pelvis backward while maintaining an upright posture in relation to their torso. From this starting position, the patient slides their torso forward, keeping it in a near-vertical position. A stretch should be felt in the top of the front thigh of the kneeling leg. The rectus femoris can be further stretched from this position by grasping the ankle of the kneeling leg and lifting the foot toward the buttocks. This stretch targets the iliopsoas and rectus femoris.
The patient lies supine with legs extended. The foot of the leg to be stretched is placed on the table on the outside of the unaffected, extended leg. The patient grasps the knee of the affected leg and pulls it over the extended leg. Both shoulders should be flat on the table. Once the stretch is felt, the position is held for approximately 30 seconds. The TFL stretch is repeated 10 times.
