Complete Guide on Hip Dislocation Physiotherapy

A hip dislocation happens when the joint connecting your leg to your pelvis gets dislodged from the hip socket. This phenomenon is just as painful as it sounds, requiring immediate medical attention and extensive hip physiotherapy for complete recovery.

This article provides a comprehensive guide to hip dislocation symptoms and diagnosis, and how physiotherapy treatment helps. Look out for practical post-operative tips to fully recover from a traumatic hip dislocation.

How Does a Hip Get Dislocated?

Hip dislocations can be traumatic, caused by a sudden, high-force impact like a car accident or a fall. Traumatic hip dislocations often involve a femoral head fracture (the ball of the femur bone) or femoral neck. Alternatively, a hip joint might be malformed in rare congenital cases, increasing the risk of dislocation even with minor stress.

Physical therapy and manipulation techniques are typically the first line of treatment for managing hip dislocation. This is because they are often effective and less invasive than any surgical intervention. In fact, hip replacement procedures in Singapore are generally reserved for more chronic hip problems like hip dysplasia, inflammatory arthritis, and osteoarthritis.

Before diving into treatment, it's important to understand what type of hip dislocation you are dealing with.

Classifications of Hip Dislocations

There are various types of hip dislocations depending on the direction the femoral head dislocates. Posterior dislocations are the most common. Anterior dislocations are less frequent. Central dislocation is the rarest, often from severe accidents. Let's dive deep into hip dislocation classifications below.

Posterior Hip Dislocation

This occurs when the femoral head dislocates backward out of the socket. High-impact events like car accidents (any traumatic injury targeting the hips) or falls with the hip flexed and internal rotation often cause it.

Anterior Hip Dislocation

This is a rare condition where the femoral head dislocates forward. It typically happens due to forceful hyperextension (straightening) and external rotation of the hip.

Central (Superior) Hip Dislocation

This is a serious injury where the femoral head dislocates into the centre of the hip joint, often accompanied by a fracture of the acetabulum (socket).

Here are less common hip dislocations.

Congenital Hip Dislocation

This is a birth defect where the hip joint doesn't develop properly, causing the hip to be dislocated from the start.

Inferior (Obturator) Hip Dislocation

A rare dislocation where the femoral head dislocates downwards into the obturator foramen (opening) of the pelvis.

Lateral Hip Dislocation

This rather uncommon dislocation happens when the femoral head dislocates outwards, away from the socket.

Symptoms of a Dislocated Hip Joint

The hallmark symptom of a dislocated hip is severe pain and an inability to bear weight on the affected leg. The leg might appear deformed, shortened, or externally rotated. Other symptoms may include the following due to possible sciatic nerve involvement:

• Numbness or tingling down the leg
• Restricted hip mobility
• Bruising and swelling
• Hip stiffness

Diagnosis of Hip Dislocations

An orthopaedic surgeon will diagnose a hip dislocation through a clinical examination and imaging tests like X-rays, CT scans, and MRI scans to confirm the dislocation and assess for associated fractures.

During a clinical evaluation, the doctor will look for several signs and symptoms and assess your hip mobility, pain, and alignment.

Treatment of Hip Dislocations

The initial treatment focuses on "reducing" the dislocation, meaning putting the femoral head back into the socket. This can be done through closed reduction (manipulation with traction) or surgery in severe cases with loose bone fragments in the joint space or a trapped sciatic nerve. After reduction, pain management and protecting the joint with a brace or splint are crucial.

Why Physiotherapy is Essential for Hip Dislocations

While the initial treatment focuses on relocating the joint, hip physiotherapy is vital for long-term recovery. Even after closed reduction, soft tissue damage surrounding the joint is likely. Physical therapy providers in Singapore like Phoenix Rehab support this healing process by incorporating personalised techniques to reduce pain and inflammation. Below are just a few examples of effective physical therapy treatments.

Pain Management

Techniques like manual therapy, electrical stimulation, and therapeutic ultrasound can effectively reduce pain and inflammation after dislocation. This method also applies to physiotherapy for hip labral tear.

Regaining Range of Motion

Gentle stretching exercises progressively improve hip joint mobility, allowing for a wider range of movement without discomfort.

Strengthening Exercises

Targeted exercises strengthen the surrounding muscles in the hip joint, improving stability and reducing the risk of future dislocations. This may involve using resistance bands, weights, or bodyweight exercises. Hip impingement physiotherapy may involve similar methods.

Balance and Gait Training

Balance exercises and gait training help restore proper walking mechanics and prevent falls, which can further complicate the healing process.

Proprioception Exercises

These exercises retrain the body's awareness of the hip joint's position in space, improving stability and coordination. Activities may include wobbleboard exercises or single-leg standing.

Similar to hip fracture physiotherapy or physiotherapy for hip osteoarthritis, a tailored programme complements the severity of the dislocation and any associated fractures or injuries. A physical therapist will gradually progress the exercises as strength, flexibility, and balance improve.

Eventually, home exercise programmes can help to ensure continued progress outside of therapy sessions. These methods help hip patients address pain, regain strength, restore movement of muscles around the hip, and prevent potential complications.

Tips for Post-Operative Recovery at Home

Following surgery for a hip dislocation, your physiotherapist will guide you on specific exercises and stretches to perform at home. Make sure to follow weight-bearing restrictions as instructed by your orthopaedic surgeon before taking these steps. Here's a breakdown of key strategies:

General Safety Measures

• Maintain a Healthy Weight: Excess weight puts extra stress on the hip joint. Maintaining a healthy weight through a balanced diet and exercise can significantly reduce the risk of dislocation.
• Minimise Hip Strain: Avoid activities that involve repetitive or forceful movements that strain the hip joint. If your job requires prolonged standing or awkward postures, consider using ergonomic equipment or taking regular breaks to stretch and rest your hips.
• Address Underlying Conditions: Certain medical conditions like loose ligaments (laxity) or hip dysplasia can increase the risk of dislocation. Talk to your doctor about managing these conditions to promote hip stability.

Safety in Sports and Activities

• Protective Gear: When participating in high-impact sports like football, hockey, or rugby, wear appropriate protective gear like padded shorts or hip guards to absorb impact and cushion the joint during falls.
• Technique Training: Proper technique is essential in activities like gymnastics, dancing, or martial arts. Work with a qualified coach to learn movements that minimise stress on the hip joint.
• Know Your Limits: Pushing yourself beyond your physical capabilities increases the risk of injury. Listen to your body, avoid excessive force or strain, and gradually increase intensity in any new activity.

Maintaining Hip Health

• Regular Exercise: Regular physical activity, including exercises that strengthen the muscles around the hip joint, improves flexibility and stability, reducing the risk of injury.
• Proper Nutrition: A healthy diet rich in calcium, vitamin D, and other essential nutrients promotes strong bones and healthy muscles, both crucial for hip health.
• Adequate Hydration: Staying hydrated helps maintain joint lubrication and flexibility, reducing the risk of stiffness and strain.
• Avoid Sudden Movements: Avoid sudden, forceful movements that can stress the hip joint. When lifting objects, bend your knees and keep your back straight to avoid straining your hips.

These tips plus maintaining a healthy lifestyle can significantly reduce your risk of hip dislocation and keep your hips strong and mobile for years to come.

Conclusion

Hip dislocation is a serious injury that can lead to long-term complications like avascular necrosis (loss of blood supply to the femoral head) if not treated promptly and followed by thorough physiotherapy. Hip physiotherapy plays a critical role in regaining a full range of motion, strengthening the joint, and preventing future dislocations.

Complete recovery takes time and dedication to the physiotherapy programme designed by your healthcare team. Don't hesitate to seek medical attention if you experience persistent pain, limited mobility, or any unusual symptoms after a hip injury.