Articulation into internal rotation supine

Grip around the knee and you can partly protect the knee joint while you apply an internal rotation force to the hip.

Tips: Most useful where the knee joint may require some protection. Least useful where strong mobilizing is necessary as the lever is not very powerful. Extra considerations: Try using varied angles of flexion or abduction/adduction as necessary to reach the part of the hip capsule desired.

29.6 • (bottom left) Articulation into abduction and adduction sidelying Fix firmly above the greater trochanter to limit the movement to the hip joint and prevent movement into the lumbar spine. Hold the lower medial side of the thigh with the other hand to produce the abduction force. Varied degrees of flexion, extension and rotation can be introduced as required.

Tips: This position can also be used for muscle energy technique holds. To reduce any discomfort in this technique try varying the angle of flexion of the lower leg in the initial set-up of the technique. This will allow the lever to change the effect on the pelvis and lumbar spine.

29.7 • (bottom right) Articulation in external rotation and abduction sidelying This hold is similar to that in photograph 29.6 except that you can hold further round the thigh and it is easier to introduce the strong external rotation possible with this technique.

29.8 • Traction to hip supine Pull laterally against the padded upper, inner thigh at the same time as you create a fulcrum with your chest against the lateral aspect of the knee. The sum of these two forces will be to produce a true traction force that will tend to separate the head of the femur from the acetabulum.

Tips: Most useful in cases of degenerative hip disease where traction can allow greater circulatory interchange. The actual stretch on muscles is very small, but this technique can produce considerable symptomatic improvement. Extra considerations: Try varying the angle of flexion of the hip to find the optimum for the case.

29.9 • Traction sidelying Use a pillow over your anterior thigh to act as a fulcrum over which you place the patient's upper thigh. Fix down toward the table with the cephalic hand, and push toward the table with the caudal hand to produce a true traction effect on the hip. Note that the other leg has been flexed well out of the way.

Tips: Most useful in cases of degenerative disease where fairly strong traction may be needed. Extra considerations: Extension movement may be a problem in many cases of hip degeneration so that some flexion may be necessary to make the technique feasible.

29.10 • Traction and distraction supine Fold your arms and interlace your forearm under the patient's knee. The traction is produced simply by leaning back.

Tips: Most useful in cases of severe degenerative disease as the knee and hip are in considerable flexion, reducing the strain on them, but still allowing the effect to reach the hip. Extra considerations: Try varying the abduction and flexion range to find the optimum.

29.11 • Low velocity stress into internal rotation technique supine Place the patient's foot lateral to the other knee. Hold the hip into firm internal rotation for several seconds until a sense of 'give' is felt. This can be a multiple stage technique, as there may be more than one sense of release as different parts of the dysfunction release.

Tips: Most useful in almost all cases of hip dysfunction providing the patient can achieve the position; if not, place the foot medial rather than lateral to the other knee. This will, however, reduce the lever somewhat. Extra considerations: Try also varying the angle of hip flexion to find the optimum.

29.12 • Low velocity stress technique into external rotation supine Place the foot of the affected side on the thigh of the other leg. Hold down on the knee with the hip well abducted, while fixing on the other side of the pelvis to prevent lumbar rotation. After a few seconds there should be a sense of release in the hip. This may be a multiple stage technique. Release may be only partial if it is not repeated in slightly varied angles.

Tips: Most useful in almost all cases of hip joint dysfunction as stress techniques do not put undue strain on the articulation, but allow it to adopt its own path of free movement. Extra considerations: If the position is impossible due to severe limitation of movement, try placing the foot medial to the other knee. Try varied degrees of hip flexion to find the optimum for the case.

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