The 2017 revision of the clinical practice guidelines for hip pain and mobility deficits related to hip osteoarthritis were recently published in the Journal of Orthopaedic and Sports Physical Therapy with important recommendations for manual therapy.
The 2017 guideline recommendations include criteria to classify adults over the age of 50 years with hip pain and mobility effects, criteria for differential diagnosis and patient referral as well as advice on the use validated outcome measures including for hip pain, falls risk, body function impairment, activity limitation and treatment outcomes for hip osteoarthritis.
Importantly, clinicians are recommended to provide patient education combined with exercise and/or manual therapy. Education should include educating patients how to modify activities, exercise and support of weight reduction when necessary. The strongest level A evidence grading for treatment interventions was given to manual therapy and exercise therapy.
Manual therapy is advised for “mild to moderate hip osteoarthritis and impairment of joint mobility, flexibility, and/or pain. Manual therapy may include thrust, non-thrust, and soft tissue mobilisation. Doses and duration may range from 1 to 3 times per week over 6 to 12 weeks in patients with mild to moderate hip osteoarthritis. As hip motion improves, clinicians should add exercises including stretching and strengthening to augment and sustain gains in the patient’s range of motion, flexibility, and strength.”
Exercise therapy is advised using “individualised flexibility, strengthening and endurance exercises to address impairments in hip range of motion, specific muscle weaknesses, and limited thigh (hip) muscle flexibility. For group-based exercise programs, effort should be made to tailor exercises to address patients’ most relevant physical impairments. Dosage and duration of treatment for effect should range from 1 to 5 times per week over 6 to 12 weeks in patients with mild to moderate hip osteoarthritis.”
Clinicians are reminded to revise their diagnosis and care plan and consider referral in circumstances where patients are not consistent within the diagnosis and classification section of the guidelines.
For more detailed information you can go to the guidelines by clicking here
Summary by Dr Craig Moore