Hip Clinical Pearls: #7 Hip Diagnoses and Conservative Treatment Goals |
|
Clinical Pearl #7: Hip Diagnoses: Conservative Treatment Goals
If you are seeing a surgeon, any of the previously listed diagnoses may be identified as fixable through surgery. For someone who has never heard of these terms (and you might be overwhelmed already), and listen to someone who says they can perform surgery to fix them, I suggest taking the opportunity to walk away and digest the information. FAI and torn labrums are things which surgeons “fix” in surgery. It is very important to learn what these are, how they impact you and your issues, and how any or all are interrelated in the “fixing” stage. We will discuss this concept later in the clinical pearl series.
Conservative Intervention Thoughts:
I will not claim to “fix” a torn labrum, or “fix” dysplasia through physical therapy, but as noted in the previous pearl, I can help improve mechanics through muscle activation, controlled mobility or stability to reduce stresses at the hip, thus lessen strain and pain. Will this always prevent surgery from being a likely next step? No, and I’d be deceptive to say anything but. Can it help your situation? It can, and what that means to each individual is different. Exhausting conservative options prior to undergoing surgical intervention may be worthwhile. Surgery “fixes” the internal problem, but it does not “fix” the accompanying issues related to muscle or movement dysfunction. Why not try to address this as best as you can first? I am a Physical Therapist, and will always look to optimize something conservatively prior to surgery.
How Do Numbers Effect Conservative Treatment?
When it comes to hip diagnoses, there are further numbers associated with the size of a labral tear or numbers associated with dysplasia identifying the extent of the dysplasia. It’s been interesting to speak with patients through the years who want to compare what kind of femoral acetabular impingement they have, what angles they have when it comes to measuring hip dysplasia, etc. Yes, all of these things are important. However, I am not going to dive into these as these do not specifically change how physical therapy intervenes. One important factor that comes into play with any of these diagnoses is how well the body adapts to anatomical “findings”. Someone might have greater issues with hip dysplasia on the x-rays, but pain may be much less or function much greater than someone with no dysplasia and a torn labrum. While I have treated many folks with numbers on the upper and lower end of the spectrum, I try not to get too caught up in this since numbers, function and pain intensity don’t always match.
There are many other factors related to the amount of pain and dysfunction related to the hip and diagnoses. Many of these I referenced in an earlier pearl. Longevity of these various issues should also be included in this discussion. This is why a comprehensive physical evaluation by healthcare providers will help in your guidance with your game plan, and not jump to the conclusion that “fixing” the anatomical finding is the only solution.
If you are seeing a surgeon, any of the previously listed diagnoses may be identified as fixable through surgery. For someone who has never heard of these terms (and you might be overwhelmed already), and listen to someone who says they can perform surgery to fix them, I suggest taking the opportunity to walk away and digest the information. FAI and torn labrums are things which surgeons “fix” in surgery. It is very important to learn what these are, how they impact you and your issues, and how any or all are interrelated in the “fixing” stage. We will discuss this concept later in the clinical pearl series.
Conservative Intervention Thoughts:
I will not claim to “fix” a torn labrum, or “fix” dysplasia through physical therapy, but as noted in the previous pearl, I can help improve mechanics through muscle activation, controlled mobility or stability to reduce stresses at the hip, thus lessen strain and pain. Will this always prevent surgery from being a likely next step? No, and I’d be deceptive to say anything but. Can it help your situation? It can, and what that means to each individual is different. Exhausting conservative options prior to undergoing surgical intervention may be worthwhile. Surgery “fixes” the internal problem, but it does not “fix” the accompanying issues related to muscle or movement dysfunction. Why not try to address this as best as you can first? I am a Physical Therapist, and will always look to optimize something conservatively prior to surgery.
How Do Numbers Effect Conservative Treatment?
When it comes to hip diagnoses, there are further numbers associated with the size of a labral tear or numbers associated with dysplasia identifying the extent of the dysplasia. It’s been interesting to speak with patients through the years who want to compare what kind of femoral acetabular impingement they have, what angles they have when it comes to measuring hip dysplasia, etc. Yes, all of these things are important. However, I am not going to dive into these as these do not specifically change how physical therapy intervenes. One important factor that comes into play with any of these diagnoses is how well the body adapts to anatomical “findings”. Someone might have greater issues with hip dysplasia on the x-rays, but pain may be much less or function much greater than someone with no dysplasia and a torn labrum. While I have treated many folks with numbers on the upper and lower end of the spectrum, I try not to get too caught up in this since numbers, function and pain intensity don’t always match.
There are many other factors related to the amount of pain and dysfunction related to the hip and diagnoses. Many of these I referenced in an earlier pearl. Longevity of these various issues should also be included in this discussion. This is why a comprehensive physical evaluation by healthcare providers will help in your guidance with your game plan, and not jump to the conclusion that “fixing” the anatomical finding is the only solution.