Treatment of Hip Capsule Tightness - Kristin B., Physical Therapist

I have a patient in my clinic currently, who I have been working with since the beginning of the summer. He was injured as a result of a motorcycle accident which caused several upper body injuries and a crush type injury to the right side of his pelvis. When he arrived in sub-acute rehab he was in severe pain and had non-weightbearing restrictions for both legs and was only able to bear weight through one of his elbows. His recovery has been a long road, but after several months, this patient is home and is getting back to his regular life. He is walking independently and without an assistive device and could possibly be discharged from therapy at this point due to his high level of function. He is however not back to his true prior level of function and he is still working with me as an outpatient due to pain and tightness in his right hip and a limp in his gait pattern.

Initially, I was approaching this patient like any other patient with hip pain. We were doing stretches for his hip musculature and core stability exercises, but it wasn't working. He was still experiencing pain and stiffness and the limp endured. I started to realize that he was experiencing these feelings right in his hip joint capsule and not in the surrounding muscles, which seemed unusual to me. I have dealt with capsular tightness in other parts of the body, but had not addressed it as directly in the hip in a while.

I began brainstorming treatments for capsular tightness and realized I would need to find a way to deep heat the tissues in this patient's hip. Ultrasound and diathermy were out of the question due to metal plates currently implanted in this patient's pelvis, so I began using moist hot packs in the clinic before treatment.

We then completed range of motion exercises with and without joint mobilizations focusing on the capsular pattern of the hip which is internal rotation, abduction and flexion. By using this treatment technique, my patient found that he was experiencing less pain and tightness and through improved range of motion in the hip, the patient achieved a more normalized gait pattern, which we have reinforced with treadmill walking to encourage equal step length.

I have also given this patient an extensive home exercise program with exercises and stretches that focus on maintaining muscular stability surrounding the pelvis and increased muscular and capsular range of motion. The patient uses moist hot packs or takes a hot shower before completing the stretches at home to improve the efficacy of the treatment.

Through hard work, perseverance and some novel treatment approaches this patient has returned to his prior level of function after a devastating injury.