Front Matter

Chapter 15 Evaluation and Rehabilitation Options for Orthopedic Disorders of the Pelvic Limb 397

Increase strength

● Neuromuscular electrical stimulation (NMES):
gluteals, quadriceps, hamstrings
● Therapeutic exercise: gluteals, quadriceps,
hamstrings, core stabilization
● Starting with low-level, low-impact exercises
for short periods of time (such as partial
sit-to-stands or isometric therapy band exer-
cises), increasing intensity of the exercise as
tolerated
● Aquatic therapy (see Chapter 9).

Increase joint proprioception

● Joint compressions: emphasis on the hip
joint in non-weight-bearing and weight-
bearing positions
● Proprioception exercises: wobble board exer-
cises or walking over ground poles, increasing
the difficulty level as strength permits.

Reach functional goals per individual
patient’s needs

Rehabilitation programs vary greatly according
to the specific needs and goals of the individual
patient and the patient’s response to therapy.
Long-term functional goals are broken down
into their integral components and addressed
in small increments. For instance, if the long-
term goal is to walk up four steps to get into the
house, the therapist should consider the amount
of ROM and the particular muscle flexibility
required at each joint to accomplish the task.
Additionally, the specific muscular demands of
key muscle groups should be analyzed and
addressed. In this case, the gluteals and quadri-
ceps must contract concentrically as the patient
lifts the body-weight onto a step. Accordingly,
the therapist will design a program that empha-
sizes concentric use of these muscles in an envi-
ronment that is less challenging. An example
would be sit-to-stand exercises on level ground
with the assistance of NMES, followed by sit-
to-stand exercises on an incline, followed by
walking uphill and performing small step-ups.

Weight management

This is a common issue with this patient group.
Techniques for weight management are dis-
cussed in Chapter 4.

Home program

Client education will include lifestyle manage-

ment information such as weight management

and activity counseling (no jumping up, no

standing up on pelvic limbs, no jogging until

growth plates have closed, and minimizing

stair climbing). Other recommendations would

include providing a soft surface for sleeping

and creating surfaces with traction (carpeting)

to prevent falls.

An HEP is designed for each patient. Pictures

and written instructions of the HEP are pro-

vided for the client. It is extremely important

for the therapist to not only instruct the client

in the home program, but to observe them

practicing the program while still in the reha-

bilitation facility.

Femoral head ostectomy

Common findings on physical therapist’s

evaluation

● Atrophy throughout the gluteal muscles,

hamstrings, and quadriceps

● Decreased and painful hip extension PROM

● Decreased flexibility (iliopsoas, sartorius,

hamstrings)

● Altered gait (PWB, decreased stance phase

of gait, difficulty with circle walking).

Treatment rationale

● Encourage immediate postoperative weight

bearing

● Emphasize hip extension ROM, propriocep-

tive training, and hip and core strengthening.

Treatment goals

● Decrease pain

● Promote weight bearing

● Increase hip PROM

● Improve proprioception

● Increase strength of hip musculature

● Increase core stabilization.

Treatment by goal

● Decrease pain: as for hip dysplasia