The hip joint can be a source and site of symptoms in itself although in most cases pain originating in the hip will be referred along the third lumbar nerve root down the medial side of the thigh to the knee. Hip disease, whether of an acute or chronic nature, can produce a characteristic discomfort deep in the groin, but not usually where the patient perceives the hip to be. Restoration of even a small part of lost mobility can be very successful in relieving many of the symptoms of hip disorders, even if the progress of the degenerative state has not been changed at all. Technical problems occur mostly due to the deep nature of the joint, and the need to use quite long levers to reach it. There is, therefore, a possibility of inducing a strain of the knee in the process. Harmonic techniques are particularly useful here in re-establishing normal movement patterns.
Precautions relate particularly to the possibility of undiagnosed fracture of the neck of the femur, which even though still allowing the patient to have movement, shows on X-ray as severe damage. Unexpected hip fracture in an inappropriate age group can be due to a secondary deposit from a cancerous growth elsewhere, and clearly the indications for osteopathic treatment must be carefully considered. The full implications of the possible ill-effects of treatment on possible diseased bone are considerable.
29.1 • Harmonic technique into rotation supine Roll the lower extremity harmonically into rotation as a unit. See earlier section referring to harmonic technique.
Tips: Most useful in cases where there is considerable stiffness and loss of 'dynamism' in the limb. Extra considerations: Try using varied degrees of preliminary abduction to produce the most useful angle of the hip.
29.2 • Harmonic technique pelvic hold supine Choose whether to fix on the pelvis and roll the leg, or fix on the leg and rock the pelvis. This hold will allow the peri-articular tissues of the hip to be reached. See earlier section relating to harmonic technique.
Tips: Harmonic technique is rarely going to be a complete treatment by itself, but is often a useful preliminary to other procedures to loosen the tissues.
29.3 • Harmonic technique both legs supine Roll both legs into rotation and apply alternating traction and abduction/adduction as required. See earlier section relating to harmonic technique.
Tips: This hold is useful in cases of bilateral dysfunction. Alternating traction and compression will also address a lumbar dysfunction that is restricting sidebending.
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