ideas for treatment of a patient with stenosis and bilateral THA (Full Version)

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Kaden -> ideas for treatment of a patient with stenosis and bilateral THA (May 13, 2008 11:34:46 AM)

I have a colleague who is seeing a patient with signs and symptoms of lumbar stenosis.  This patient also has bilateral THA.  These were done over 2 years ago but per patient report she still has typical precuations.  The whole precautions things and how long they last is probably best held for another topic.

My main question is...any treatment ideas for this gal to relieve symptoms without violating precautions?  How would you alter your typical approach to stenotics but still be effective?

I have thrown some ideas back and forth with my co-worker but thought I would throw it out to the forum.



SJBird55 -> RE: ideas for treatment of a patient with stenosis and bilateral THA (May 13, 2008 12:53:14 PM)

If she still has those precautions, the precautions are supposedly to avoid hip flexion greater than 90 degrees, right?  If she doesn't have severe osteoporosis, you can mobilize the spine (there might have even been a study that included manipulating the spine).  Flexion of the spine is recommended for stenosis - she can perform spinal flexion in standing and not go against the hip precautions.  I believe there have also been studies on unweighted ambulation.



Kaden -> RE: ideas for treatment of a patient with stenosis and bilateral THA (May 13, 2008 4:32:04 PM)

She has tried spinal flexion within precautions without much benefit.  I had the same suggestion about trying mobilization to restore end range flexion since with precautions she may not be able to get there.

Thanks for the advice, I'll see how the mobs work.



Tom Reeves DPT ATC -> RE: ideas for treatment of a patient with stenosis and bilateral THA (May 13, 2008 6:02:27 PM)

hips might be lacking in extension.  I would assess iliopsoas flexibility and stretch them, they are probably tight.  abdominal ex.  I don't think I would do anything differently than a regular stenosis patient except avoid big hip flexion.



Alex Brenner PT MPT OCS -> RE: ideas for treatment of a patient with stenosis and bilateral THA (May 14, 2008 7:43:00 AM)

Dr. Julie Whitman has completed some published work on the effectiveness of manual therapy and lumbar stenosis. Do a pubmed search for her studies, they are excellent. Like SJ mentions, I would try some treadmill unweighted training as this has shown to be effective. If you don't have this equipment in your clinic then I would consider getting it.

Tom, right on with the hip flexor tightness. With stenoic patients I have also noticed anterior hip capsule restrictions. I personally would not be afraid to get in there and mobilize the hip a year after the surgery.



Kaden -> RE: ideas for treatment of a patient with stenosis and bilateral THA (May 14, 2008 12:08:25 PM)

Thanks for the replies everyone.

Alex I agree that mobes should be fine one year out.  I read an article in JOSPT lately detailing some mobilization for the hip with a similar time frame.  I will try to locate it for my colleague. 

I think she was being fairly gentle due to the hips and I was pushing her to be a little more aggressive but I will show her some of these replies to see if more than just my opinion will help.

Thanks again.



pwrandall -> RE: ideas for treatment of a patient with stenosis and bilateral THA (May 14, 2008 1:26:26 PM)

I just completed a course /c Dr. Wainner of EIM who suggests much of what has already been discussed above as options for these patients.  A lot of the focus was on hip mobility, l/s mobilzation/manipulation and focusing on LE impairments.  As for the PBWS T-mill intervention he suggested that it wasn't as effective as Dr. Whitman initially demonstrated, but may still be worth a try if walking tolerance is a cheif complaint of the patient.  I'm not sure I'd shell out the bucks for the gear just yet if you don't already have it...unless you also see a large number of CVAs who may benefit as well.  Hope this helps.

Pete



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