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We are staying with finding Gold Nuggets from the the Australian Physiotherapy Conference for this week and next (even though all the Physios have actually long gone home by now!)…. Our material this time comes from an extremely highly regarded and Specialised Musculoskeletal Physiotherapist I know, who works for the Australian Cricket Team: Dr Kevin Sims. So let’s focus in on why Kevin thinks it is so critical to have 10 degrees of Hip Extension, and secondly how to easily assess if its lacking in your client (including a short video from conference of him teaching a simple test):
  • Why is Poor Hip Extension mobility (10 degrees) so important?
Some scary statistics help us to realise that this small ingredient of mobility is a critical signature for Osteoarthritis: 1. A massive 12% of hip pain sufferers will end up having a Total Hip Replacement within 3 years! (Lievense et al 2007) 2. Poor Hip Extension, particularly in walking (gait) has been shown to be a possible marker for presence of and greater severity of Osteoarthritis (OA) of the Hip. (Voucher, Schlink et al 2012 ). [Gait only requires a small amount of true Hip Extension (10 degrees), but this is critical for the upright functioning of the human body.] 3. A full high level review of land-based treatments for symptomatic Hip OA has demonstrated that therapeutic exercise programmes can reduce pain and improve physical function. So all those involved in Hip Rehab even for OA are NOT wasting their time!
  • How can I quickly Assess on a bench or bed if my client is lacking this?
See the video below for his demonstration from the conference – this is actually a simplification of the classic “Thomas Test”. In a nutshell, as you flex your client’s Right knee and hip to their chest, their lumbar spine will flatten (approximately 10 degrees of posterior tilt). To assess if the problem Left hip has the required 10 degrees of extension, look at the Left thigh to see if it is hovering in the air, or if it is still lying flat on the bed. If its hovering, it has insufficient hip joint extension and needs this incorporated into their rehab-programme. If it still lies on the bed like in the video, then you have sufficient hip extension. Simple.
Here’s to your more effective management of hips! Ulrik
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