The Effects of Hip Mobilizations on Patient Outcomes: A Critically Appraised Topic.

Clinical Scenario: Hip osteoarthritis currently affects up to 28% of the population, and the number of affected Americans is expected to rise as the American population increases and ages. Limited hip range of motion (ROM) has been identified as a predisposing factor to hip osteoarthritis and limited patient function. Clinicians often apply therapy techniques, such as stretching and strengthening exercises, to improve hip ROM. Although traditional therapy has been recommended to improve hip ROM, the efficiency of the treatments within the literature is questionable due to lack of high-quality studies. More recently, clinicians have begun to utilize joint mobilization and the Mulligan Concept mobilization with movement techniques to increase ROM at the hip; however, there is a paucity of research on the lasting effects of mobilizations. Given the difficulties in improving ROM immediately (within a single treatment) and with long-lasting results (over the course of months), it is imperative to examine the evidence for the effectiveness of traditional therapy techniques and more novel manual therapy techniques. Focused Clinical Question: Is there evidence to suggest manual mobilizations techniques at the hip are effective at treating hip ROM limitations? Summary of Clinical Findings: 5 Randomized Controlled Studies, improved patient function and ROM with the Mulligan concept, high velocity low amplitude improved. Clinical Bottom Line: We found moderate evidence to suggest favorable outcomes following the use of hip mobilizations aimed at improving hip ROM and patient function. Strength of Recommendation: Strength of the studies identified are 1B.

AN EXPLORATORY CASE SERIES ANALYSIS OF THE USE OF PRIMAL REFLEX RELEASE TECHNIQUE™ TO IMPROVE SIGNS AND SYMPTOMS OF HAMSTRING STRAIN.

BACKGROUND/PURPOSE: Hamstring strain (HS), a common condition found among the injured physically active population, is often treated with rest, stretching, and modalities. Primal Reflex Release Technique™ (PRRT™) is a manual therapy technique used to treat pain caused by over-stimulation of the body's primal reflexes. The purpose of this case series was to explore the immediate effects of PRRT™ for treating hamstring strains. DESCRIPTION OF CASES: A multi-site case series approach was used to report on the treatment of six patients with HS using PRRT™. The Numeric Pain Rating Scale (NPRS), Patient Specific Functional Scale (PSFS) and range of motion (ROM) measurements were collected, as well as evaluation of symmetry of the sacroiliac joints, reported as sacroiliac dysfunction(SJD). OUTCOMES: Primal Reflex Release Technique™ (PRRT™) was an effective treatment for subjects with HS. Subjects reported a significant decrease in pain on the NPRS, averaging five points over the course of the treatment (95% CI of 3.374, 6.626). Functional measures on the PSFS were significantly improved following treatment (post-treatment mean = 7.8 ± 1.84, pre-treatment mean = 4.8 ± .97, p < .001; CI: -2.1, -3.9). The mean change on the Passive Knee Extension Test (PKE) (mean = 8.20 ° ± 3.96 °) and ASLR (mean = 10.333 ° ± 8.98 °) indicated statistically significant improvements of post-treatment ROM (mean change = 8.20 ° ± 3.96 °, p = .01). The presence of SJD was observed in all subjects prior to treatment and resolved in all subjects when reassessed after treatment. DISCUSSION: In this case series, the use of PRRT™ resulted in decreased pain, increased function, and increased range of motion, as well as resolved SJD. The Primal Reflex Release Technique™ may be useful in decreasing symptoms of HS acutely, but long-term effects are unknown at this time. Clinicians should consider using a treatment which targets the autonomic nervous system when addressing pain associated with HS. LEVEL OF EVIDENCE: Level 4 - case series.