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Clinical Pearl Details

September 2013

Monica Sasaki, PT, MPT, OCS, FAAOMPT, CSCS -
Halima Ahmadu, PT, DPT, OCS, FAAOMPT -

Technique:	Long axis distraction of the coxofemoral joint with a strap
Indication:	This technique can be used to improve passive hip range of motion and to decrease pain at rest, with motion, and at end range. Crow et al. utilized long axis joint distraction along with exercise to address severely restricted hip motion and saw a significant increase in total passive range of motion. The authors theorized that manual therapy including long axis distraction improved the extensibility of the ligament-capsular tissue, broke up adhesions, realigned collagen and decreased pain by stimulation of mechanoreceptors. The reason for submitting this clinical pearl is to provide clinicians with an alternative home exercise that may reinforce manual techniques that address hip range of motion limitations and pain, performed in the clinic.
Positioning:	Patient assumes a supine position in front of a doorway. The involved foot is placed in a looped strap anchored in the door jamb. The involved foot should be resting on a bolster that places the lower extremity in approximately 30 degrees of flexion, 30 degree abduction and in slight external rotation. The uninvolved foot is placed on a foot stool supported against the door.
Instruction:	A downward force is applied through the uninvolved foot resulting in a caudal glide or long axis distraction through the involved hip. The pelvis should remain level for the duration of the stretch. Increased force through the uninvolved foot will increase the vigor of the mobilization. Stretch discomfort is acceptable but should subside quickly upon completion of the exercise.
Dosage:	Amplitude of motion may vary depending on the goal of treatment. For restricted accessary motion with pain through or at end range a sustained force may be beneficial.
References:	Crow JB, Glefand B, Su EP. Use of joint mobilization in a patient with severely restricted hip motion following bilateral hip resurfacing arthroplasty. Phys Ther. 2008;88:1591-1600.
Figure 1