Nurturing Hip Health: Motor Control, Posture, and Gait Retraining for Anterior Acetabulum and Labrum Support in Adult Hip Dysplasia
Adam Turnbull, Physiotherapist
The intricacies of the hip joint are particularly relevant for individuals dealing with hip dysplasia, a condition where the hip socket is insufficiently developed. In such cases, the anterior third of the acetabulum and the anterior labrum are often under increased strain, making them more susceptible to complications like labral tears. This blog post delves into the application of motor control, posture correction, and gait retraining as valuable tools in mitigating anterior hip load, with a specific focus on adults grappling with hip dysplasia.
Understanding the Anatomy in Hip Dysplasia
Adults with hip dysplasia face unique challenges due to the altered shape and stability of the hip joint. The anterior third of the acetabulum, responsible for housing the labrum, becomes a focal point for potential complications. By understanding the specific demands of hip dysplasia, we can tailor interventions to alleviate stress on the anterior hip structures.
Posterior Pelvic Tilt: A Common Culprit
Posterior pelvic tilt and a hip position in front of the midpoint of the trunk (when viewed from the side) is prevalent in hip dysplasia as it provides and feeling of support by “winding out” passive structures. Unfortunately, this behaviour or postural habit also over time exacerbates the strain on the anterior hip. The tilting of the pelvis backward can result in malalignment, leading to increased load on the labrum, anterior acetabulum, and the iliopsoas tendon. Addressing posterior pelvic tilt is crucial in the management of hip dysplasia, making motor control exercises, posture correction, and gait retraining valuable components of a comprehensive treatment plan.
Motor Control: A Cornerstone for Stability
In the context of hip dysplasia, motor control gains often require grading up to dynamic control type exercises where the goal is to recentre the femoral head in the acetabulum with appropriate fine control of deep hip stabiliser rather than superficial “prime mover” such as the hip adductors or the large gluteal muscles in a splinting or bracing fashion. Strengthening the muscles surrounding the hip joint, especially the gluteus medius, gluteus maximus, can be of assistance but in some cases these muscles are already over recruited and showing signs of tendinopathy and tears on scan. Appropriate motor control training is often focused on using these muscles in a more appropriate way, less static tone in postures and more specific recruitment during dynamic movements. Tailored motor control exercises become essential in supporting the compromised hip joint, promoting better control over movement patterns, and ultimately reducing stress on the anterior structures.
Posture Correction: A Key Element in Hip Dysplasia Management
Posture correction is pivotal for individuals with hip dysplasia, as the condition often goes hand in hand with altered lumbo-pelvic control. Increased awareness of where the body is in space and which muscles are being uses as well as balance training principles help to optimise posture and reduce not only anterior hip loads but also on the gluteal tendon and lumbar facet joint. Customised interventions can guide individuals with hip dysplasia toward optimal pelvic alignment and improved hip function.
Gait Retraining: Optimising Biomechanics for Hip Dysplasia
Gait retraining assumes a vital role in addressing hip dysplasia-related challenges. Individuals with this condition may exhibit distinctive gait patterns that contribute to increased stress on the anterior hip structures. Targeted gait retraining with part and whole practice of the aspects of the gait cycle as drills or exercises can help optimise biomechanics, promoting better hip and pelvic alignment during walking. This approach not only enhances gait efficiency but also minimises strain on the compromised hip joint, reducing pain and increasing endurance.
Clinical Applications and Personalised Approaches
Healthcare professionals, including physiotherapists are integral in crafting personalised interventions for individuals with adult hip dysplasia. A multidisciplinary approach, encompassing biomechanical assessments, targeted exercises, and patient education, is paramount in optimising outcomes. By addressing the unique challenges posed by hip dysplasia through motor control, posture correction, and gait retraining, we can empower individuals to manage their condition effectively and cultivate enduring hip health.
Graduating from the University of Sydney in 2000, Adam has always had a strong passion for gait kinematics and motor control and has worked with patients to improve their posture, endurance and function. Over his more than two decades working as a physiotherapist Adam has led a number of rehabilitation and pain management services across Melbourne. During the last 3 years he has been working as a physiotherapist at Advance Healthcare St Albans and Boronia as our clinical director of physiotherapy.