Front Matter

Chapter 15 Evaluation and Rehabilitation Options for Orthopedic Disorders of the Pelvic Limb 395

function. Normal musculoskeletal function
requires normal ROM, flexibility, strength, and
muscle recruitment in the absence of pain.
Rehabilitation treatment techniques address
one or more of the following conditions: pain
(inflammation), hypomobility, hypermobility,
and weakness or altered muscle recruitment.
There are many options for addressing each of
these conditions, thus skilled treatment lies in
the nuance of introducing and discharging the
most efficient treatment techniques according
to the stage of recovery and the individual
response. Keys to successful outcomes are:

(1) The ability to extrapolate the why behind
the abnormal findings
(2) The art of configuring the most effective
treatment elements for the particular stage
of recovery and patient needs
(3) The skillful delivery of manual techniques,
therapeutic exercise and modalities
(4) The ability to change or advance the treat-
ment plan in accordance with patient
response to ongoing reassessment
(5) Client education and home exercise pro-
gram design.

Prior to initiating treatment, a problem list is
developed consisting of the abnormal findings
uncovered in the examination. A working diag-
nosis is determined and clearly stated functional
goals are established. Treatment is directed
toward resolving the issues on the problem list
as they relate to the functional goals and the
working diagnosis. Success is measured by
achieving objective progress towards the goals.
As mentioned in Chapter 13, physical therapy
treatment employs the use of manual techniques,
therapeutic exercise, and modalities. Initially pain
should be addressed, allowing the patient to tol-
erate progression of the treatment plan. Pain
reduction may involve medical management,
modalities, or increasing ROM and/or flexibility.
Because the ultimate goal is to maximize function,
the therapist should walk the fine line of increas-
ing the difficulty of exercise without increasing
pain and inflammation. Speed of recovery often
depends on the efficiency with which the thera-
pist initiates and discharges elements of the treat-
ment. A reassessment at each visit is necessary to
determine the appropriate blend of modalities,
manual work, and therapeutic exercise for the

patient on that particular day. Every element of

the treatment plan must be justified for the

patient at the specific time of treatment.

As pain and mobility issues are resolved,

therapeutic exercise becomes the primary

focus. Important considerations for initiating

and progressing a strengthening program are

listed in Table 15.3.

Rather than offering treatment protocols for

the pelvic limb conditions listed below, it is the

author’s intent to highlight the clinical findings

and treatment rationale from a physical therapy

perspective. With this information, the thera-

pist can create an individualized treatment plan

on a per case basis. Detailed techniques and

exercises will be provided for the first diagnosis

only. Thereafter, additional techniques specific

to each disorder will be mentioned.

Hip dysplasia

This commonly diagnosed, multifactorial

disease is well described in Chapter  14. The

techniques for applying manual therapies,

physical modalities, therapeutic exercises, and

aquatic therapy are described in detail in the

respective chapters earlier in this text.

Common findings on physical therapist’s

evaluation

● Tenderness to palpation of hip musculature

● Overactive (hypertonic) pectineus muscle

● Decreased/painful hip extension

● Decreased flexibility—iliopsoas, pectineus

● Atrophy of gluteals and thigh muscles

● Altered transfers and gait

Table 15.3 Therapeutic exercise variables

Amount of weight

bearing

Type of contraction

Non-, partial and full weight

bearing

Isometric, concentric, eccentric

Treatment plane Sagittal, frontal, transverse

Effect of gravity Assisted, neutral, resisted

Surface Flat, unstable, uneven, inclined,

declined

Resistance None, weights, therapy band

Intensity, frequency

and duration

Number of repetitions, how

often, for how long