Clinical reasoning for anterior hip pain

Anterior hip pain can result from various structures. The clinical reasoning process acts as a filter whereby many possibilities are reduced to the most probable. Frequently, inexperienced clinicians use little information to reach a diagnosis. In contrast, the experienced clinician uses multiple impairment variables to establish clinical patterns which should correlate with the events leading up to pain as well as the consequences of the pain. By reducing the variables into pattern recognition the experienced clinician can use inductive & deductive reasoning to confirm their 'working hypothesis'. When the clinical features do not fit a known pattern, then deductive reasoning is used to examine the basics, correlate this with principles of patho-anatomy, biomechanics and neurophysiology to form a management strategy for the new clinical pattern. Importantly, the subjective examination and disability measures should correlate with the physical examinations impairment measures, which in turn should be used to assess the outcomes of treatment. In this manner the efficacy, and hence validity & reliability of each and every technique can be assessed. Traditional approaches to Maitland physiotherapy have discussed the importance of the reproduction of the pain. However, in the subacute and/or chronic scenarios any treatment which has an immediate effect on the impairment measure or the disability becomes a valid method of treatment.

Ideally, the condition should be defined by the following categories. This will further help define the goals of treatment.

Treatment options include

• muscle energy techniques to the hip, ilium, hamstrings, rectus femoris and lumbar spine
  
• joint mobilisations to the lumbar spine and hip
  
• soft tissue and dry needling techniques
  
• exercises for deep hip rotator stability
  
• exercises for lumbo-pelvic rhythm
  
• stretches for the Psoas Major & Rectus femoris
  
• strengthening of the low, medium and high threshold lumbo-pelvic-hip stabilizers (dynamic & static)
  
• integration of exercises into A.D.L. and perhaps a gym, yoga and/or physiocise programme

Through the clinical reasoning process the physiotherapist engages the client in their healing process by helping their cognitive processes to refine and filter confusing and conflicting information (e.g. referred pain, mal-aligned ilia, etc) 

see link to

muscle energy techniques

Last update : 24 September 2006