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Case study 1: 70yo female with right hip osteoarthritis 

The goal of these case studies is not to create an extensive program for specific injuries. Rather, it is to provide examples with potential progressions with explanations to allow a physiotherapist/physiotherapy student to prescribe appropriate exercise by understanding core principles and clinical reasoning.

Step 1.

Subjective and objective assessment;

Subjective assessment;

  • Body chart

  • History of presenting condition​

    • Right anterior hip and groin pain

    • Gradual worsening of symptoms in right hip over last 18months 

  • Symptom behaviour

    • 24hr pattern: Morning stiffness for 30minutes​ then eases

    • Aggravated by sitting for >1hour, standing for >20minutes, traversing stairs

    • Eased with anti-inflammatory medications and heat pack

    • Average of 4/10 pain

  • Special questions

    • No unexplained weight loss​​

  • General health

    • High blood pressure​

  • PMHx

    • Fall four years ago

      • Right tibia fracture

      • Right colles fracture

  • Social and family history​

    • Lives in double story with husband with all amenities upstairs

​

Functional goals

  • Be able to go up and and down stairs without hip pain 5 times per day

  • Be able to stand for 30minutes while painting

  • Walking with grandchildren for 1hour

Consider;

WHO-ICF:

Participation limitations:

  • Unable to go to the zoo with grandchildren because of prolonged walking causing symptoms

  • Unable to paint in a standing position for >10minutes without pain in her hip

  • Unable to volunteer at local shelter as she is required to stand for >2.5hours

 

Activity limitations

  • Unable to go up/down stairs without pain

  • Unable to stand to paint for long periods of time

​

Physical assessment​;

  • 5/5 strength in knee extensors and hip extensors/abductors 

  • Decreased endurance in plantarflexors, quadriceps, and hip extensors/abductors

  • Right hip internal rotation 5degrees; Left hip internal rotation 15degrees 

  • Full knee ROM 

  • Full upper limb strength

​

Irritability;

  • High - symptoms last for 2hours if aggravated

Step 2.

Identify level of framework

It can be argued that this patient fits within the 'performance improvement' phase as she has a high level of strength throughout her lower limb. Therefore, her reported limitations should be analysed and determined which muscle performance type needs to be trained. 

Step 3.

Step 4: Consider Blanchard & Glasgow's model, identify patient goals and prescribe exercises based on tissue healing, optimum dosages and contextual factors

It is evident through the patient history, objective assessment and goals that the patient has decreased endurance and power throughout her lower limb, with what can be considered sufficient strength. Power training is not only for an athlete returning to sport! 

​

Functional goals:

  1. Be able to go up and and down stairs without hip pain 5 times per day

  2. Walk for >1hour with grandchildren on flat surface  

  3. Be able to paint in a standing position for 30minutes

​

Contextual factors:

The patient volunteers for long hours which aggravates her hip, so changing exercise variables on days that she volunteers rather than increasing volume should be considered.

Step 4.

Step 5.

Step 5: Consider most appropriate motor learning principles for each exercise 

Practice, feedback, instruction, modelling or manual guidance.

Understanding the concomitant demands of a rehabilitation:

  • The multicoloured triangles represent the integration of multiple aspects of the rehabilitation combined into single exercise to more closely replicate the demands of the sport

Goal C

Increase power throughout lower limb

Patients should have sufficient strength before progressing to power based activities!

Goal A

Increase endurance in quadriceps 

Goal B

Increase endurance in hip abductors

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