title: The use of manual therapy post-hip arthroscopy when an exercise-based therapy approach has failed: a case report.
abstract: METHODS
  Case report.
  
  
  BACKGROUND
  Although there is a growing body of literature on both surgical intervention and postsurgical rehabilitation of acetabular labral repairs and femoroacetabular impingement, there is a paucity of information on how to manage individuals who show a lack of progress postsurgery.
  
  
  METHODS
  A 30-year-old woman underwent surgical labral repair with femoroacetabular impingement osteochondroplasty. Postsurgery, she was initially treated with an exercise-based approach, but experienced an increase in hip pain and further decline in function. Her primary functional deficits were difficulty standing and pain (6/10) with ambulation. A combination of soft tissue mobilization and trigger point dry needling was used to address perceived muscle dysfunction, and nonthrust manipulation was used to address perceived hip joint hypomobility.
  
  
  RESULTS
  Following 12 therapy sessions over 120 days, the patient returned to her demanding occupation with minimal residual symptoms. By the end of the period of care, the patient's Harris hip score had improved from 56 to 96 and her Lower Extremity Functional Scale score had improved from 26 to 70.
  
  
  CONCLUSIONS
  This case describes a multimodal manual therapy approach and the health outcomes of a patient following labral repair with femoroacetabular impingement decompression who did not respond to an initial exercise-based postsurgical rehabilitation approach. Level of Evidence Therapy, level 4.
authors.affiliation: Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL.
authors.forename: Robert T
authors.initials: RT
authors.lastname: LeBeau
authors.forename: Shane J
authors.initials: SJ
authors.lastname: Nho
mesh_terms: D000077:Acetabulum / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D018771:Arthralgia / Q000209:etiology / Q000517:prevention & control; D001182:Arthroscopy; D005081:Exercise Therapy; D005260:Female; D057925:Femoracetabular Impingement / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D053580:Muscle Strength; D026201:Musculoskeletal Manipulations / Q000379:methods*; D011182:Postoperative Care; D016059:Range of Motion, Articular; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: dry needling; femoroacetabular impingement (FAI); joint mobilization; labral repair