My client has hip dysplasia and is reluctant to start an exercise program with me. Can you give me more info on hip dysplasia and what sort of exercises I should do?
As with any diagnosed condition, the first place to look for advice is from the physician that diagnosed your client. With that said, hip dysplasia is a complex entity and should be treated on an individual basis. Some of the questions that are crucial to the rehabilitation of the client have not been answered. One thing we should know is if the hip dysplasia is a congenital condition? Has she had surgery for the condition? Is she considering surgery for the condition? How functional is she in her current state? How often does the hip dislocate?
I will assume for this article that she has had hip dysplasia since birth, she wants to avoid surgery and is fairly functional currently. Hip dysplacia occurs when the cartilaginious substance around the acetabulum is not shaped correctly. The positions for her to avoid are hip extension with adduction. This can cause the hip to dislocate. Functional anatomy tells us that the muscles that create hip abduction are the same ones that decelerate hip adduction. We should probably start with those.
The first set of muscles I would try to strengthen eccentrically are the glutes. We know that the glute medius is mostly responsible for decelerating hip internal rotation and holding the contralateral pelvis stable when that leg is raised. In other words, it would be a good idea to have your client try doing exercises on one leg or at least on one leg with only a toe down on the other side. This will help to strengthen the glute medius and give a more stable support for the hip.
The goal of your program should be to tighten the musculature around the hip. There is laxity in the ligamentous structures that were intended to hold the hip in place. The laxity in the ligaments and abnormal shape of the acetabulum cause the hip to have less support. The trainer should try to strengthen all the muscles of the hip capsule to take up the slack for the ligaments and acetabulum.
There are at least 30 muscles that tie into the lumbo-pelvic-hip region. I think it is best to work those muscles as a group, in a closed chain environment, rather than try to isolate any one muscle. The trainer should focus on isometric and eccentric loading of the hip capsule. One set of exercises that have served us well in our clinic is Paul Chek’s horse stance series. Please refer to Paul’s articles in PTontheNET.com (Inner Unit and Outer Unit articles are a good place to start).
One part of the series I recommend is doing the 4 point or horse stance and then having the client abduct one leg while keeping the spine stabilized. This will place force not only on the hip that is abducting but also on the hip that is holding stationary. Concentrate on stabilizing the pelvis while the leg SLOWLY goes back to the starting position. Look at the picture below. The difference in your exercise is the raised leg should be kept at 90 degrees of hip flexion when it is raised. Remember to avoid hip extension and adduction because it can cause dislocation.
Raised knee and hip should stay flexed to 90 degrees
Good luck with your client. If she has had hip dysplasia since birth and is even thinking about getting a trainer, she will know her body well enough to know what feels right and wrong. Always take her recommendations and that of her physician.