The Use of Manual Therapy Post–Hip Arthroscopy When an Exercise-Based Therapy Approach Has Failed: A Case Report

Abstract

A number of publications describe postoperative rehabilitation following hip arthroscopic procedures. 7,12,13,17,47,50 Manual therapy for the treatment of joint stiffness is often mentioned but not well described in these publications. While Hoeksma et al, 21 MacDonald et al, 33 and Howard and Levitsky 23 have all demonstrated significant improvements in hip range of motion (ROM), pain ratings, and Harris hip scores 22 when using a manual physical therapy approach to treat hip osteoarthritis, to the authors' knowledge, there are no published case reports or clinical trials demonstrating the effectiveness of manual therapy in patients following labral/FAI repair.The purpose of this case report was to describe a multimodal manual therapy approach used with a patient who had undergone labral repair with FAI decompression and initially responded poorly to an exercise-based treatment approach postsurgery. The approach described consisted of a combination of soft tissue and joint mobilization, trigger point dry needling, and specific neuromuscular rehabilitation to restore hip function, reduce pain, and improve functional outcomes. CASE DESCRIPTIONT he patient was a 30-year-old female surgical resident specializing in the ear, nose, and throat. She reported a 2-year history of anterior lateral hip pain with insidious onset. The patient denied having a history of low back pain or lumbar radiculopathy prior to onset of her hip pain. The diagnosis of labral tear was made by the third orthopaedic surgeon she had consulted. Magnetic resonance arthrography and fluoroscopy indicated a labral tear in the anterior superior aspect of the hip, with a focal cam lesion and reactive pincer lesion. After a lack of improvement with conservative care that consisted of activity modification and steroid injections, the patient underwent arthroscopic surgery for labral repair, acetabular trimming, and femoral osteochondroplasty.Postsurgical management for the first 3 weeks consisted of reduced weight bearing, bracing, and hip ROM exercises. Twenty days postsurgery, the patient returned to her highly demanding occupation, which required prolonged standing and walking with limited rest. At that time, she discontinued the use of her brace and progressed to a cane for ambulation.Upon her return to work, the patient reported an exacerbation of hip pain with the increased activity level. The physical therapy interventions she received at that time appeared to deviate from published protocols by progressing resistance exercise too quickly and not sufficiently addressing soft tissue and joint mobility deficits. She reported increased pain during and after physical therapy treatment. At her 6-week follow-up postsurgery, the surgeon noted being concerned about her elevated pain levels and limited recovery. Additional therapy was prescribed to address soft tissue tightness as a potential cause of her symptoms. The patient continued to perform her demanding duties as a surgical resident and to experience elevated pain levels, gait abnormalities, and...

Improvement of Hip Pain After Total Hip Arthroplasty With Dry Needling as an Adjunct to Conventional Physiotherapy: A Case Series

“…A case series of 14 patients found that DN led to significant improvements in pain, range of motion, and function in patients with chronic knee pain after TKA [ 6 ]. A case report described the improvement of hip pain and function with DN and strengthening and stretching exercises for a woman 13 weeks following arthroscopic labrum repair of the hip (without THA) [ 7 ]. Both studies reported no serious adverse events with DN in these patients, providing limited evidence that DN is safe when applied after lower extremity joint surgery.…”

Fisioterapia no pós-operatório de correção artroscópica do impacto femoroacetabular

“…Caso o paciente apresente dores miofasciais neste período, técnicas de pressão inibitória de pontos dolorosos 72 , terapia combinada 73 , massoterapia 13 , e calor 64 são boas opções terapêuticas e podem ser utilizadas. Os principais músculos que se apresentam hipersensíveis nesta fase são: tensor da fáscia lata e trato iliotibial, glúteos, pectíneo e iliopsoas 6 .…”

“…A mobilização dos tecidos moles através das técnicas de terapia manual é endereçada ao alívio da dor oriunda de pontos gatilhos miofasciais. Se não tratados, os pontos gatilhos miofasciais podem ser resposáveis por dor crônica persistente 72 . Um estudo randomizado controlado realizado por Renan-Ordine et al 74 , forneceu evidências de que a utilização conjunta de técnicas de terapia manual auxiliam no controle da dor musculoesquelética.…”

Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial

“…Our data suggest that DN is a noninferior treatment alternative to cortisone injections in this patient population. 7,10,16,[23][24][25]28,30,45 Evidence suggests that analgesic injection is not superior to DN in other regions of the body. 17,21,46 Therefore, it is possible that cortisone injection for GTPS is not superior to DN.…”