Externally Rotated Coxafemoral Joints Part 1

Baby hips are often externally rotated. The femoral head is very small as a bony structure and has lots of cartilage around it so we treat these joints with smooth easy movements to avoid hurting the cartilage. The acetabulums are shallow at birth. They develop deeper when the baby starts to weight-bear with crawling and walking. The ball-and-socket joint act like moulds for each other as they develop so it is important to remove restrictions. Sometimes the sockets are formed too shallow in a newborn. This condition is called hip dysplasia. Check out this handy link and refer the baby to their pediatrician if you feel too much clicking or if you feel hypermobility in those joints. Babies are normally checked for this at birth but sometimes things get missed.

Step 1 - ASSESSMENT

In side-lying or supine, check the quality of movement into internal rotation while the hip is in flexion. Normally, the legs come fairly easily towards midline as a gross motion but always search deeper because minor restrictions can hold the sacrum and then the lumbars too. If the baby tries to kick her leg out, or if her body twitches during the testing, there is probably a deeper restriction. Go slowly and smoothly and watch the whole body for these signs.

Step 2 - TREATMENT

These restrictions are easily treated in side-lying but some babies might seem to prefer lying on their backs, so modify your hold.

THE HOLD - Have the baby facing away from you so Mom can soothe and entertain her. Then, stabilize the innominate bone with your non-dominant hand with a C-shaped hold using your thumb to hold the SI joint (a bit difficult to see in the video but you get the idea). Your first 2 fingers can stabilize at the ASIS. Allow the thigh to fall towards the table.

THE CORRECTION - Gently apply a force near the distal femur to provide a soft tissue stretch to the posterior capsule and external hip rotators and abductors. Whenever baby opts to kick out or fidget, allow her to do that, then resume. Go easy on the barrier and make slow, smooth changes. Then check the other hip (see the next video).

In this video, she didn't have much restriction in her right hip. You can tell because she is really calm and she smiles as she enjoys a gentle stretch. But in the next video (part 2) you will see how often she goes to kick. When she does, I "let her have her leg back". She also wiggles a lot more between my attempts to correct it. 

HINT: Normally I use the blanket to help slowly flip the baby over to her other side to assess and treat the opposite hip. But for the purposes of filming, I didn't. It is better to find tricks with blankets to reposition a baby and move slowly so as not to overstimulate the nervous system.