Hi there,

I`ve been thinking about treatment for typical expulsive coxarthrosis. (i hope this term is used in EN as well)

Specifically i would like to provide home exercise for ventral (+ lateral) instability of the Art. coxae in early stages of coxarthrosis (pain occurs ventral in maximum flexion). And i`d also like to find things other than training with which patients can effectively stabilize their Art. coxae.

My main issue is that the Art. coxae has no clearly posterior muscle insertios (in comparison to medial insertios of the short adductors + short abductors who will also prevent lateral instability) which are close to the joint and also that the Art. coxae is a heavily ligament dependet Art.

Obvious ideas are..
-hip extension exercise with flexed Art. genus for M. gluteus maximus pars inferior --> as mentioned before the insertio of this muscle is pretty much too far away from the Art. to effectively provide stability.
-training M. iliopsoas to increase volume and use the fact that its slung around the ventral part of the collum/caput femoris to effectively block the femur from sliding too far in ventral direction
-stretching for rectus femoris to decrease ventral pull on the pelvic girdle (which in turn increases the amount of space the femur has to glide ventral - on the other hand this would also decrease ventral overlap angle which seems counterproductive)
-change posture towards an increased hip flexion to increase ventral overlap angle (by "pulling" the pelvic girdle further posterior + compensating with increased thoracic columna vertebralis extension - especially in patients who typically hyperextend lumbal columna vertebralis+hip) ^this would also decrease constant stretch on ventral ligaments



I would appreciate if you`d voice your opinion/criticism/experience concerning patient self treatment in patients with ventral instability of the Art. coxae. (I am aware of self traction being useful but i cant see this helping the issue of ventral instability - its rather counterproductive in that regard)


Sincerely

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