Fascial manipulation in post-surgical hip replacements
Total hip replacements (THR) have increased dramatically in the past decade as a result of an expanding elderly population. In order to keep pace with the increasing surgical numbers, rehabilitation continues to optimize its treatment protocols to accelerate functional improvements and shorten discharge timelines. Fascial manipulation (FM) is a manual therapy approach that focuses on mobilizing specific points of deep muscular fascia to improve outcomes of pain, range of motion and functionality. Due to the effectiveness FM has shown in other populations, the authors investigated its role as a post-operative treatment modality in patients who underwent a THR. The authors found that those patients undergoing a protocol that incorporated FM had a statistically significant improvement in functional mobility as well as pain.
51 patients were recruited following total hip arthroplasty (THA) and randomized into either the study group or the control group. A single-blinded, parallel-group, randomized controlled trial study design was used. Both study groups received a standard protocol exercise regime consisting of two 45 minutes sessions a day. In the study group, two of the total sessions were replaced by FM.
Due to the variability and complexity of individual patient profiles even in technically sound, well-performed surgeries patients are often limited by pain and loss of ROM impeding their functional independence. Manual therapy is a treatment modality that has been shown to provide rapid tangible outcomes in mixed populations. The present study reinforces its effectiveness in a post-op population by showing significant improvements in all outcomes. In those patients who received FM, there was a statistically significant improvement ROM including: flexion, abduction, extension and ER. Furthermore, the scores for the Harris Hip Score (23.3 vs 14.5) and verbal numerical scale (1.1 vs 0.5) also showed statistically signficant improvement. Despite the present study only including two FM sessions into its protocol, it appears to provide a tangible improvement in outcomes in post-op patients and should be strongly be considered as an additional treatment approach to enhance patient recovery.
> From: Busato et al., PM & R 8 (2017) 1142-1150(Epub ahead of print). All rights reserved to American Academy of Physical Medicine and Rehabilitation. Click here for the online summary.