Long Axis Distraction

Body Region: Hip

Technique Name: Long Axis Distraction non-thrust mobilization/thrust manipulation

Indications: hip osteoarthritis, hip pain, knee osteoarthritis, lumbar spinal stenosis, lower back pain

Instructions:

Patient Position:

• Supine

Clinician Position:

• Standing at feet of patient

Technique Description:

• Grasp the patient’s ankle with both hands just above the malleoli and position your feet in a walk stance
• Position the hip in slight flexion and abduction
• Apply a distraction force to the hip by shifting your weight to your back foot and pulling with both arms
• The technique may be performed as a graded mobilization into resistance or as a high-velocity thrust at end range
• Progress the technique by positioning the hip in further abduction and internal rotation prior to performing the mobilization or thrust manipulation

Key Points:

• Use a belt in a figure-8 to aid in gripping force and increased patient comfort
• You may also have another person provide proximal stabilization through the pelvis with downward pressure on the patients bilateral anterior / superior iliac spines
• Ensure the hip is not brought into adduction as this may risk injury to the acetabulum

Manual therapy interventions for the hip have been associated with improvements in pain, function and disability in individuals with hip osteoarthritis (OA).

Hip Osteoarthritis (hip Oa):

Research into the effectiveness of manual therapy interventions for patients with hip OA has been limited but initial studies have yielded promising results for both short and long term effectiveness. In a recent systematic review (2011), French et al reported that there is silver level evidence that manual therapy is more effective than exercise over the short and long-term.

Hoeksma et al. compared the effectiveness of manual therapy versus exercise therapy in patients with hip OA. Subjects were randomized into two groups: an exercise therapy group and a manual therapy group. Exercise therapy was administered by a physical therapist. Manual therapy, also administered by a physical therapist, consisted of aggressive manual stretching of hip musculature followed by a traction manipulation technique to the hip joint. The treatment period for both groups consisted of nine sessions over a duration of five weeks. Subjects receiving manual therapy demonstrated greater improvements in hip function, range of motion, and pain at the conclusion of the five week treatment period. The majority of these improvements were maintained at three and six-month follow-up.

MacDonald et al. reported clinical outcomes in a case series of seven subjects with hip OA following a median of five treatment sessions of OMPT combined with therapeutic exercise. Interventions consisted of thrust and non-thrust mobilization/manipulations and an exercise program targeted at improving hip joint mobility and muscle strength. Following a median of five treatment sessions, all subjects demonstrated significant reductions in pain and clinically meaningful improvements in function.

Wright and colleagues conducted a prognostic study to identify a set of factors that could help to identify individuals with hip OA who were likely to respond to PT interventions.  PT interventions included manual therapy interventions as well as exercise interventions (note: subjects were randomized to receive either treatment).  Five variables were identified as predictors of success:

1). Unilateral hip pain

2). Age <59 years

3). Pain > 5/10

4). 40-m self-paced walk test time of <26 seconds

5). Duration of symptoms

<

 1 year

Subjects who were positive for 3 or more of these factors had a 99% probability of success with a physical therapy intervention program of exercise + manual therapy or exercise alone.  Although this CPR was developed with a randomized controlled trial which strengthens the findings; this study must be validated in subsequent trials prior to implementing this rule in widespread clinical practice.

• Hoeksma, 2004, Arthritis Rheum
• MacDonald, 2006, J Orthop Sports Phys Ther
• French, 2011, Man Ther
• Wright, 2011, Phys Ther

Other Clinical Evidence:

• Howard, 2007, J Orthop Sports Phys Ther
• Crow, 2008, Phys Ther

Other Relevant Evidence:

• Harding, 2003, J Orthop Sports Phys Ther
• Hoeksma, 2005, Rheumatology
• Makofsky, 2007, J Man Manip Ther