In this article we will talk, in detail, about congenital hip dysplasia, trying to understand how the instructor has the duty to behave in order to optimize motor therapy.
we are talking about a sport for everyone, a "non-class" sport, which does not oblige us to buy expensive equipment and commits us to join exclusive clubs.The goal of the trainer will therefore be to try to make sports practice as easy and functional as possible for the dysplastic subject, with a view to social and relational growth and in terms of improvement or at least not worsening of the pathology.
Finally, it must be said that the theoretical preparation of the trainer becomes fundamental also to know where one's work ends and to have the lucidity to rely on medical personnel and specialized therapists.
of the hip or coxofemoral joint, which joins the femur to the pelvis, is an "enarthrosis - the head of the femur moves into the" acetabulum (see figure 1).A smooth and soft tissue, the cartilage, covers the two surfaces. The cartilage has the main function of making the two articular surfaces slide over each other and of distributing the loads acting on the hip in the best possible way.
Muscles, ligaments and tendons surround the hip joint. Muscles attach to the bone via a strong tissue, the tendon. The two bones are linked to each other by fibrous ribbons called ligaments.
Inside the joint and around the ligaments there is a thin membrane that produces the lubricating synovial fluid.
During movement, the hyaline cartilage (the one on the articular bone surface) allows the two surfaces to slide over each other, the muscles impart strength to the movement, the ligaments and tendons support the muscles and the synovial fluid reduces friction .
of the femoral neck, anteversion of the femoral neck and delay in the appearance of the ossification nucleus of the head femoral.It affects 2 in 1000 newborns, mostly girls. The inheritance of this disease is often evident.
If the diagnosis is made early, it is possible to obtain a normal development of the joint thanks to the use of special braces in the first months of life. If, on the other hand, it is not treated, congenital hip dysplasia inevitably leads to an important picture of osteoarthritis, with subversion of the normal anatomy of the hip (see figure 2).
Two conditions can occur in adults, depending on whether the hip is dislocated or not:
- In the first case, the problems are more often borne by the spine (hyperlordosis) and the knee (valgus), which are forced to a functional compensatory overload;
- In the second case, a "sub-dislocated or centered hip but with a shallow acetabulum (residual dysplasia) may develop early" severe osteoarthritis, which differs from the primary one due to the severe limitation of external rotation and the "important shortening of the" limb.
In the vast majority of cases the cause is not known (idiopathic coxarthrosis), in other cases the arthrosis can be the consequence of trauma to the hip or of congenital alterations such as congenital dysplasia of the hip. In the primitive form it affects aged subjects. over 65 years old.
Arthrosis is characterized by a progressive damage to the articular cartilage, up to the loss of the free space between the two bones of the joint.
These, no longer protected by cartilage, undergo wear.
; that is, towards what is defined as self-realization (actualizing tendency).According to this principle, the client is in the same position as the trainer. The peculiar characteristic of this approach is that it places the experience of the client, the trainer and the immediate present of their relationship at the center of attention in every meeting.
The trainer tries to place his work as close as possible to the client's experience in the present relationship. The individual's experience is taken seriously without any preconditions, but simply as it is in the immediate: how the person has become and is through his relationships, what he is in the present and how he is capable of becoming in the near future. This includes the becoming of the person, how he is in relationships, how he is at the present moment and how he manages to develop further in his future.
In this approach, trust is given to the client's ability to be able to live his own life and to face problems relying on his own resources, in the event that he can live a relationship where certain facilitating conditions are present. All this involves breaking with the traditional image and function of the trainer as an expert on the client's problems. On the contrary, the trainer sees himself as a collaborator and companion who grows with the client in a person-to-person encounter process.
The most evident essence of these assumptions is that there is no preconceived theory to which one must adapt, to which one must try to correspond. There is no objective truth to which one must refer, the only truth is the person's experience in difficulty. According to this thought, each individual is the only one who possesses the key to himself, that is his awareness of himself and therefore the answers to his questions and the solutions of his problems. In this perspective, the focus of attention is centered on the dimension. existential of the relationship that is established between two or more people. And it is precisely the intensity of the quality of the relationship that allows people and groups to communicate effectively, develop, evolve, solve problems, express their full potential, grow.
In order to establish a good relationship with a view to improvement and growth, the trainer's empathic understanding of the client's inner world and its communication is necessary. Empathy is the ability of the trainer to see the client's experience as if it were the client same. However, it is important that the condition of "as if" is not lost because empathy is the ability to listen, to read the emotions of the other and not to identify the therapist with the client.
of a dysplastic subject will consider the improvement of joint mobility, muscle tone and all conditional and coordinative skills, so as to be able to guarantee daily activities without particular problems or limitations.The extensor muscles of the lumbar region of the torso, in particular the square of the loins and sacrospinalis, if excessively toned and "shortened", tend to rotate the pelvis in anteroversion, thus accentuating the lumbar lordosis, a very common situation in a dysplastic person.
On the contrary, the flexor muscles of the torso (rectus abdominis, internal oblique, external oblique) and the extensor muscles of the thighs (piriformis, gluteus maximus, hamstring, semitendinosus, semimembranous, adductor major) balance the action of the torso extensors by acting in the retroversion of the pelvis.
We will therefore focus on bodyweight and machine exercises that affect the aforementioned muscles.
Regarding the work on the buttocks we analyze the movement of extension of the thigh on the pelvis: the extension is the movement that brings the lower limb posteriorly to the frontal plane. As for flexion, its amplitude is different depending on whether it is active or passive and whether it occurs with the knee flexed or extended. Typical values for active extension are: 20 ° and 10 ° for extended knee and flexed knee respectively.
We will therefore prefer the extended knee extension to give more stability to the hip joint and allow us to work in greater safety.
As for the abdomen we will work with the legs stretched in support of the backrest (inclination> 45 °): this position will be assumed to allow a person with an untrained abdomen to tone the latter without "helping" with the " action of the muscles of the thigh and the iliac psoas which intervenes in the flexion of the thigh on the pelvis ("classic" position for the crunch).
The first exercises that can be performed will therefore be the following:
- Flexed foot extensions (contraction, triceps stretch of the sura, tibial, peroneal);
- With the leg extended, flex the knee and hip without lifting the heel off the ground;
- Femoral quadriceps isometric contractions. Maintain the contraction for 6 -10 "" with a 4-5 "" rest between repetitions;
- Contract the quadriceps muscle and keeping it contracted, lift the lower limb about 20 cm. Remain in this position for 8-10 "";
- Isometric contractions of the buttocks from the prone position. Maintain the contraction for 6 -10 "" with a 4-5 "" rest between repetitions;
- Abductions sliding on a smooth surface without detaching the lower limb from the ground leaning on a chair, armchair or bar on the wall;
- Hip flexions less than 90 °, maintaining the position for a few seconds,
- Hip extensions without arching the back, maintaining the position for a few seconds;
- Hip abductions keeping the knee and foot straight;
- Crunch on the ground with straight legs resting on the backrest;
- Crunch on obliques with straight legs resting on the backrest;
Later you can add to the workout: Hip extensions with elastic.
- Hip abductions with elastic;
- Hip flexions with elastic;
- Standing Leg curl;
You will then initially perform 12-15 repetitions for 2 sets, which will gradually be increased up to 4.
You can later replace the elastics with kilo anklets. It will be good in this period to perform 10 minutes of biking at the beginning and end of training, keeping the saddle very high or starting with the pedaling backwards.
Medical and Forensic Medicine - "congenital dysplasia of the" hip "Tommasos Vincenzo Bartolotta
