Hip Joint Examination and Treatment Continuing Education

Learn from the Expert Michael P. Reiman, PT, DPT, OCS, SCS, ATC, FAAOMPT, CSCS

Michael P. Reiman, PT, DPT, OCS, SCS, ATC, FAAOMPT, CSCS is an assistant professor of physical therapy at Duke University Medical Center. As a clinician Dr. Reiman has over 20 years of experience in assessing, rehabilitating, and training athletes, clients, and patients at various levels of ability. He received his doctoral degree in physical therapy from MGH Institute of Health Professions in 2007. In addition to his certifications as an athletic trainer and strength and conditioning specialist, Dr. Reiman is a manual therapy fellow through the American Academy of Orthopaedic and Manual Physical Therapists (having completed a 2 and one year fellowship program), is a USA Weightlifting level 1 coach and a USA Track and Field level 1 coach. Dr. Reiman has co-written the only textbook on functional testing, Functional Testing in Human Performance, written eight book chapters on orthopedic examination/intervention and training for strength, power, and endurance. He has also written multiple articles in such journals as the American Journal of Sports Medicine, Journal of Orthopedic and Sports Physical Therapy, and Journal of Sport Rehabilitation, as well as having served as special guest editor for a special issue on the hip joint in the Journal of Sport Rehabilitation. Dr. Reiman currently serves on the editorial board for the Journal of Sport Rehabilitation and is a reviewer for multiple orthopedic and sports related journals. Dr. Reiman presents on various levels of assessment and treatment methods at national, regional, and local conferences and actively participates in research regarding various testing methods for orthopedic examination-intervention and human performance. His current research and presentation interests focus on performance enhancement, low back/hip pain, and evidence based examination-intervention of the hip joint. He continues to practice clinically on various sports and orthopedic-related injuries. He is a member of the American Physical Therapy Association, National Athletic Trainers Association, National Strength and Conditioning Association, USA Weightlifting Association, and USA Track and Field Association

Course Objectives

• Identify how to perform a Differential Diagnosis examination to rule out the Lumbar Spine, SI Joint and stress fractures when assessing for specific hip diagnosis.
• Discuss the definitions of diagnostic accuracy when reviewing the efficacy of specific examination and treatment approaches in relation to the hip joint.
• Identify how to enhance examination skills by performing differential diagnostic tests to determine the underlying mechanisms of hip dysfunction and pain. Ruling out: poor alignment, hip intra-articular pathology, hip intra-articular/instability pathology, impingement labral tears, muscle dysfunction and gluteal tendinopathy.
• Describe the steps to perform appropriate joint mobilization techniques for the hip joint dysfunction.
• Develop evidence based rehabilitation programs for specific dysfunctions that are based on current scientific literature.
• Identify how to utilize the information in research articles to perform the most effective tests and develop evidence based rehab programs.

Rule out the Lumbar Spine, SI Joint and Stress Fractures

• Repeated Motions (Flexion and Extension) of Lumbar Spine
• Posterior-Anterior Glide Assessment for Facet Joint Dysfunction
• Extension Rotation Test for Facet Joint Dysfunction
• Thigh Thrust Test

Ruling out poor alignment, hip intra-articular pathology, hip intra-articular/instability pathology, impingement labral tears, muscle dysfunction and gluteal tendinopathy

• Fracture/Stress Fracture Tests
• Fulcrum Test
• Patellar-Pubic Percussion Test
• Fracture/Stress Fracture Tests
• Fulcrum Test of Femur
• Hip Range-of-Motion (ROM)
• All ranges of hip motion are assessed
• Hip IR < 15 degrees and flexion < 115 degrees is suggestive of hip osteoarthritis
• Assess Hip Alignment - Craig’s Test
• Hip Intra-Articular Pathology - Heel Strike Test, Resisted Straight Leg Raises (SLR) Test, Hip Scour Test, FABER (Flexion-Abduction-External Rotation) Test

Ruling out poor alignment, hip intra-articular pathology, hip intra-articular/instability pathology, impingement labral tears, muscle dysfunction and gluteal tendinopathy

• Assess for Capsular Laxity - Dial Test, Log Roll Test, Abduction–Extension–External Rotation Test
• Test for potential labral pathology - Flexion–Adduction–Axial Compression Test, Flexion–Internal Rotation Test, Internal Rotation–Flexion–Axial Compression Test
• Hip impingement - FADDIR (Flexion–Adduction–Internal Rotation) Test
• Assess for tight hip flexors and/or tight quads - Thomas Test
• Assess for IT band flexibility - Ober’s Test
• Piriformis syndrome - FAIR (Flexion–Adduction–Internal Rotation) Test
• Gluteal tendinopathy - Resisted Hip Abduction Test
• Trendelenburg Sign
• Resisted External Derotation Test

Treatment of the Hip

• Hip Lateral Distraction Mobilization
• Hip Longitudinal Distraction Mobilization from Knee Purchase
• Hip Longitudinal Distraction Mobilization from Ankle Purchase
• Hip Mobilization Direct Distraction
• Hip Posterior Glide Mobilization from Knee Purchase

Treatment of the Hip

• Hip Posterior Glide Mobilization from Anterior Hip Purchase
• Hip Anterior Glide Mobilization from Posterior Hip Purchase I
• Hip Anterior Glide Mobilization from Posterior Hip Purchase II
• Hip Anterior Glide Mobilization in Prone Crawl Position
• Hip Mobilization with Belt for Flexion
• Hip Mobilization with Belt for Internal Rotation
• Indirect Mobilization Technique for Hip Internal Rotation

Master Exercises and Stretches to Improve Hip Function

• Posterior Hip Self Stretch–Mobilization
• Self Hip Flexor/Anterior Capsule Stretch (Standing
• Self Hip Flexor/Anterior Capsule Stretch (Tall Kneeling
• Clam Exercise
• Hip Abduction Exercise
• Bilateral and Unilateral Bridge Exercise
• Bilateral and Unilateral Bridge Exercise–Lying on Physioball
• Bilateral Bridging on Physioball–Knees Straight
• Bilateral Bridging on Physioball–Knees Bent

Master Exercises and Stretches to Improve Hip Function

• Bird Dog Exercise
• Lunge Exercise Variations
• Unilateral Mini–Squat Exercise
• Single Limb Squat Exercise
• Single Limb Deadlift Exercise
• Forward Step–Up Exercise
• Side–Bridge Exercise
• Hip Hike