1. How to work with children who have hip problems?
Gabriella Papp – Conductor, Hungarian Trained Physiotherapist
Bence Kun – Conductor - Teacher

2. In our presentation we’d like to delve into the anatomy and the function of the articulatio coxae to get a better view of the treatment and our options in working with children who have hip issues.

3. ABOUT THE HIP JOINT
ball and-socket type joint
connects the lower extremity and the trunk
usually works in a closed kinematic chain
What can cause hip subluxation, dilsocation?
Dysplasia of the hip (congenital)
General connective tissue looseness
Developmental disorder
Secunder hip dysplasia (adductor spasm)
Teratological hip dysplasia

4. COMPOSER BONES Femur – Caput femoris: 2/3 sphere surface
Collo-dyaphiseal angle: 125° →childhood °.

5. Acetabulum
synostosis of 3 bones – os ilium, os ischii, os pubis.
half- sphere shaped
inferior tilt → 30° in adulthood → smaller in newborns and children → decreases joint stability → risk of superior dislocation
anterior tilt (anteversion) → 18-22° →increase → risk of anterior dislocation

6. JOINT CAPSULE AND LIGAMENTS
The joint capsule is stabile.
The ligaments surrounding the joint are very strong.

7. Movements in the hip joint
STAND UP, PLEASE!

8. Main muscles Movement Flexion Extension Abduction Adduction
M. iliopsoas, M. rectus femoris, M. tensor fasciae latae, M. sartorius
Extension
Gluteus maximus, Hamstring
Abduction
Gluteus medius et minimus
Adduction
M. Adductor magnus/longus/brevis, M. Gracilis, M. Pectineus
Inward rotation
Gluteus medius/minimus, Tensor fasciae latae, Adductor magnus, pectineus
Outward rotation
M. piriformis, M. quadratus femoris, M. obturator internus/externus, Mm. gemelli
Circumduction
Combining all the above

9. OPEN PACKED AND CLOSED PACK POSITION
Closed packed position: Full extension, internal rotation, abduction
E.g.: W sitting
Open packed position: flexion, slight abduction, slight extarnal rotation
E.g.: Crossed legs sitting

10. THE TWO MOST COMMON CASES IN CP
Spastic Hip Dysplasia
Developmental Dysplasia of the Hip
SIGNS AND SYMPTOMS OF HIP ABNORMALITIES
Possible pain, limping
Assymetric posture
Abduction is decreased more on the affected side
External rotation of the hip
Difference between the length of the two legs between the ASIS and the medial malleolus (true leg length)

12. Studying hospital discharge summaries and medical papers
WHAT SHOULD WE DO AS CONDUCTORS TO PROVIDE THE BEST TREATMENT TO OUR KIDS WITH SHD OR DDH?
Studying hospital discharge summaries and medical papers
Positioning (pillow between the knees, turning the leg in a neutral position, knee block, posterior tilt of the hip, position of the hip)
Strengthening the abductor and adductor! muscles
Stretching the adductor muscles

14. WHAT WE SHOULDN’T DO?
Avoid to flex the hip more than 90degrees (pull up the leg to the stomach, crouching down too low, W sitting)
Avoid to (either passively or actively) extend the hip (for instance; do not lift the knee up in prone)
Carefully select exercises considering the directions and angle of the movement in the hip joint

16. THANK YOU FOR YOUR
KIND ATTENTION!