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Table 1 Manual therapy techniques: a semi-standardised approach

From: A phase II trial for the efficacy of physiotherapy intervention for early-onset hip osteoarthritis: study protocol for a randomised controlled trial

Manual therapy techniques
Technique Aim Description Dosage Timeframe
Soft tissue massage and trigger point release of iliopsoas, adductor group, gluteus minimus, gluteus medius, piriformis and tensor fascia latae Address soft tissue restrictions with the aim of reducing pain and increasing hip joint range of movement Sustained digital pressure to each trigger point, with the muscle positioned on stretch 30 - 60 seconds digital pressure per trigger point Session 1 - 8
Massage longitudinally along the muscle belly 2 - 5 minutes of massage per muscle
Mobilisation of lumbar spine To improve lumbar spine mobility and restore normal lumbo-pelvic movement Unilateral postero-anterior accessory glides, Grade III or IV 3 - 5 sets of 30 - 60 seconds Session 1 - 8
Correction of sacro-iliac joint asymmetries To optimise the position of the ilium and therefore the orientation of the acetabulum Massage to iliopsoas 2 - 5 minutes of massage Session 1 - 8
Mobilisation of sacrum
Manual traction if ligamentum teres is intact or ligated and patient is >3 months post-labral repair Increase hip flexion and/or IR/ER range of motion Seatbelt around patient's proximal femur and therapist's hips. Gentle inferior and/or lateral traction force applied. May include patient actively moving hip into flexion as traction is applied 3 sets of 10 seconds. If tolerated, increase by 1 set per treatment session to a maximum of 6 sets in total Session 1 - 8
  1. Legend: IR = internal rotation; ER = external rotation.