What is the recommended physiotherapy protocol for patients with hip dysplasia?

Physiotherapy Protocol for Hip Dysplasia

A comprehensive physiotherapy protocol for hip dysplasia should include structured exercise programs with clearly defined parameters, patient education, and individualized progression based on functional goals to improve pain and function.

Core Components of the Protocol

1. Exercise Program Structure

Exercise programs for hip dysplasia should be precisely defined with the following parameters 1:

• Load magnitude: Progressive loading appropriate to patient's tolerance
• Repetitions and sets: Typically 3 sets of 10-15 repetitions
• Program duration: Minimum 6 months for meaningful outcomes 2
• Contractile element duration: Specify concentric/eccentric/isometric timing
• Time under tension: Total time muscle is under load during each set
• Rest intervals: Between repetitions and sets
• Range of motion: Specific ROM targets for each exercise
• Session frequency: 2-3 times per week with appropriate rest between sessions

2. Strength Training Focus

Objective strength measurement is essential as patients with hip-related pain demonstrate lower strength in multiple planes 1:

• Target muscle groups:

  • Hip adductors
  • Hip abductors
  • Hip flexors
  • Internal rotators
  • External rotators

• Measurement methods:

  • Use objective methods like dynamometry (hand-held or isokinetic)
  • Either isometric or eccentric testing is acceptable
  • Account for potential measurement variability between testers

3. Functional Training Progression

Based on the feasibility study by Jacobsen et al. 2, include:

• Balance training: Y-balance test improvements from 70cm to 75cm (anterior), 104cm to 119cm (posteromedial), and 98cm to 116cm (posterolateral) were achieved
• Functional performance: Hop for distance test showed improvements from 37cm to 52cm
• Sport-specific movements: For active individuals, gradually introduce sport-specific tasks

Implementation Timeline

Phase 1 (Weeks 1-4)

• Focus on pain reduction
• Basic strength exercises at lower loads
• Education on hip dysplasia mechanics and joint protection
• ROM exercises within pain-free range

Phase 2 (Weeks 5-12)

• Progressive strength training with increased loads
• Introduction of functional movements
• Balance and proprioceptive training
• Core stabilization exercises

Phase 3 (Weeks 13-26)

• Advanced strength training
• Sport-specific or activity-specific movements
• Higher-level functional tasks
• Return to desired activities with modified techniques

Patient Education Component

Patient education is critical 1 and should include:

• Explanation of hip dysplasia biomechanics
• Relationship between pain and joint structure
• Realistic expectations of improvement
• Self-management strategies
• Activity modification techniques
• Joint protection principles

Monitoring Progress

Regular assessment using validated outcome measures:

• Hip and Groin Outcome Score (HAGOS) - expect improvements of approximately 11 points in pain subscale 2
• Strength testing - expect improvements of approximately 0.2 Nm/kg in hip abduction, flexion, and extension 2
• Functional performance tests (Y-balance, hop tests)
• ROM measurements

Clinical Considerations and Pitfalls

• Avoid excessive abduction: This can lead to complications including avascular necrosis in severe cases 3
• Respect pain: Exercise should challenge but not significantly increase symptoms
• Consider comorbidities: Adjust protocol for patients with other conditions
• Monitor for signs of osteoarthritis: Hip dysplasia is a leading precursor of OA, seen in 20-40% of hip OA cases 4
• Recognize limitations: Some patients may ultimately require surgical intervention if conservative management fails

Evidence Limitations

The current evidence has several limitations:

• Limited high-quality RCTs specifically for hip dysplasia physiotherapy
• Heterogeneity in classification of patients with hip-related pain 1
• Conflicting evidence on whether ROM differs between individuals with and without hip-related pain 1
• Lack of consensus on optimal measurement methods for hip ROM 1

Despite these limitations, the structured approach outlined above has shown promising results in improving pain, strength, and function in patients with hip dysplasia 2.