7 of 12 Top Hip Papers of 2023 | APTA clinical guidelines for non-arthritic hip joint pain

Key Recommendations:

GRADES OF RECOMMENDATIONS: (see paper for levels of evidence)

S -STRONG M - Moderate W - Weak C - Conflicting T - Theory O - Opinion

 

1. Diagnosis - Clinical assessment and testing of non-arthritic hip pain 

W - FADIR & FABER tests may be used to identify those without FAIS, when these tests are negative.

W - Clinicians may include the ligamentum teres test to identify those with & without a ligamentum teres tear.

2. Examination - outcome measures for non-arthritic hip pain

S - Recommended Patient Rated Outcome Measures (PROMs): iHOT, HAGOS, HOS.

W - Clinicians may also use a PROM for depression, anxiety, low self-efficacy and kinesiophobia.

 

Clinical Practice Guidelines for Nonarthritic Hip Joint Pain: Weak recommendations for physical diagnostic tests, but strong recommendations for commonly used Patient Rated Outcome Measures: the iHot, HAGOS, and HOS.

 

3. Examination of physical impairments in non-arthritic hip pain

M - Clinicians should continue to assess hip range-of-motion and strength of hip IR, ER, flexion, extension, abduction and adduction.

4. Examination of activity limitation and physical performance 

M - Clinicians should include measures of function and postural control: Single Leg Stance Test; Star Excursion Balance Test, hop distance, single-leg sit to stand, and timed measures of function.

5. Interventions for non-arthritic hip pain - multimodal intervention 

M - Clinicians should use multimodal interventions:

• • activity modifications
  • strengthening for hip-specific muscles, trunk and lower limb
  • manual therapy
  • postural and movement correction
  • stretching
  • balance exercises

6. Intervention for non-arthritic hip pain - movement pattern training 

W - Clinicians may provide movement pattern training to optimize lower limb movement patterns associated with hip pain during activities of daily living

 

Clinical Practice Guidelines for Nonarthritic Hip Joint Pain: Moderately strong recommendations for use of objective measures of impairments and multimodal treatment approaches. Weak recommendation for movement pattern training.

 

7. Interventions for non-arthritic hip pain - therapeutic exercise 

W - Clinicians may use therapeutic exercises and activities to address individual deficits in joint mobility, muscle flexibility, and muscle strength.

8. Interventions for non-arthritic hip pain - patient education and counseling 

W - Clinicians may use patient education and counseling to modify aggravating factors and manage pain associated with FAIS.

9. Interventions for non-arthritic hip pain - Bracing

C - Unable to make recommendations for bracing as a single intervention, based on current evidence.

10. Interventions for non-arthritic hip pain - manual therapy

O - Joint mobilization may be used where capsular restrictions are suspected to be impairing mobility.

Soft tissue mobilization may be used where soft tissue restrictions are suspected to be impairing mobility in those with FAIS.

10. Interventions for non-arthritic hip pain - Neuromuscular re-education

O - Progressive neuromuscular re-education may be used to reduce identified coordination impairments.

 

Clinical Practice Guidelines for Nonarthritic Hip Joint Pain: Weak recommendation for exercise and patient education, conflicting evidence for bracing, expert opinion only for manual therapy and neuromuscular re-education.