Leveraging independent LAT to help more patients
Clinicians are finding additional ways to leverage independent long axis traction with HipTrac to assist a wider range of patients facing or experiencing tightness and capsular restrictions, pre- and post-surgery, including:
- Hip Arthroscopy with microfracture, post-op rehabilitation
- Hip Arthroscopy without microfracture, post-op rehabilitation
- Pre-habilitation, before surgery for hip arthroscopy or THR
- Hip OA, FAI and labral tears
- Other conditions resulting in pain, tightness and/or capsular restrictions
HipTrac’s original genesis centered around patients with hip osteoarthritis, as HipTrac directly targets the capsular restrictions of the affected hip, mobilizing it and improving mobility while reducing pain. The patient-controlled, independent long axis traction can be used in the clinic or at home to provide traction forces of 0 – 1000N, gentle enough for sensitive hips and tough enough on the stiffest. Capsular deformation begins to occur at approximately 350 N and higher, decreasing the intra-articular pressure, mobilizing it and improving fluid movement around the hip joint and soft tissues. As clinicians have gained more experience with HipTrac, they have expanded its use into other areas where patients benefit from long axis traction.
Rehabilitation following Arthroscopy – with or without Microfracture
After hip arthroscopy with microfracture, patients are generally non-weight bearing (NWB) for about six weeks.
One of the most important goals following hip arthroscopy is to not allow any unwanted tightness or restriction to develop around the surgery. Of the many factors that may lead to an increased risk of abnormal stiffness, tightening or capsular restrictions, non-use and disuse are the most common. Being NWB, as in the case of microfracture, contributes significantly to the possibility of tightening and becoming restricted in an undesired way.
Movement encourages circulation and bathing of oxygen- and nutrient-rich fluids throughout the hip joint. It also keeps the joint capsule, muscles and fascia from abnormal stiffness. Clinicians often use the phrase, “Motion is Lotion” for just that reason.
Physical therapy begins with passive ROM movements, advances to HipTrac’s LAT
Physical therapy begins first day post-op with typically 2 weeks of passive range of motion movements. These movements can be applied by a caregiver at home and/or the physical therapist. Clinicians will typically start patients on HipTrac at 4 to 6 weeks post-op and continue use for 1 to 2 months depending on the patient.
Long axis traction to the hip joint has been proven to increase capsular mobility, muscular relaxation and fluid movement throughout the joint surfaces. HipTrac is like having a provider at the patient’s home. This is especially important in rural areas where a patient may live 30-50 miles away from physical therapy and cannot drive for the first few weeks.
For arthroscopy without microfracture, even though there is some weight-bearing, surgeons and physical therapists familiar with HipTrac still recommend its use following the procedure to prevent adhesions from developing.
Recommended protocol, hip arthroscopy post-op
The recommended protocol in cases of hip arthroscopy can vary slightly depending on the sensitivity of the patient, but generally starts at traction force of 25-35 PSI with the patient’s involved leg in 30 degrees flexion, available comfortable external rotation and slight abduction. The pull and relax times as well as duration and repetitions follow the standard protocol (details on all protocols at hiptrac.com/go).
The traction force is increased by 5 PSI each week, as tolerated, up to a recommended maximum of 50-75 PSI. In cases where more stubborn tightness sets in, the angle can be decreased from 30 degrees flexion down to as little as 0 degrees in supine and any degree of extension in side-lying for progressive stretching towards the close-packed position. If the hip is responding as expected, then keeping the flexion at 20-30 degrees is typically more comfortable for the patient but always cater the angle to patient’s greatest comfort.
THR and Arthroscopy Pre-habilitation (OA, FAI, Labral Tears)
Using HipTrac in combination with regular manual therapy and exercise consistently for at least 6-8 weeks prior to surgery gives patients the opportunity to go into that surgery in improved physical condition. The decompression of the hip via HipTrac creates greater capsular stretching and range of motion while lessening pain with daily activities. This enables patients to participate in healthy activities more often and perform pre-surgical exercises to increase strength, flexibility and cardiovascular endurance. Studies (here and here) show that patients in better physical condition recover faster and have less complications post-surgery when compared to individuals in worse physical condition.
Prior to surgery, each individual should be evaluated to discover their specific objective limitations and how these limitations may affect their biomechanics. While we can’t cure conditions such as osteoarthritis, CAMs, dysplasia and bone spurs, we can treat the secondary effects of these conditions. Treatment can be targeted toward either: 1) achieving a state of peaceful coexistence with the condition(s) in question or 2) better preparing them for the surgeon.
The recommended protocol can vary slightly depending on the presence of OA and the sensitivity of the patient, but generally starts at traction force of 30-50 PSI with the patient’s involved leg in 20-30 degrees flexion, available comfortable external rotation and slight abduction. The pull and relax times as well as duration and repetitions follow the standard protocol (details on all protocols at hiptrac.com/go).
There is one specific group of individuals who do not require the use of HipTrac, or similar manual joint mobilization techniques. Individuals in pre-op with excellent range of motion, bordering on hypermobility such as in the case of young dancers, who have a labral tear generally do not need strong long axis traction. In cases of significant pain, they seem to respond better to light traction and un-weighting such as in the case of a SuperBand or CrossFit Band. It is not dangerous or even uncomfortable to use HipTrac in these cases, just counter-productive as, if used strongly, can create hours of hypertonicity and discomfort following its use. To use HipTrac at the same low levels of a SuperBand would work great, but would just not make financial sense.