Abstract:

Background: Slipped Capital Femoral Epiphysis (SCFE) is the “separation of the ball of the hip joint, epiphysis, from the femur at the growth plate of the bone while the bone is still growing.”(1)  With a prevalence of 10.8 cases per 100,000 children, it is the most common hip disorder in adolescents.(2) SCFE is typically treated with in situ fixation with a single screw.(2)

Objective: This study is to determine what inequalities, possibly from SCFE, can be revealed through postural charting, and how manual therapy can aid in decreasing pain by returning the body to postural equilibrium.

Case Presentation: 33 year old male with bilateral hip surgeries secondary to SCFE. Client presented with lower back pain, pain in the left ankle and decreased range of motion and tenderness in his hips.

Intervention: Patient was treated for 10 sessions ranging from 1-2 hours each, over the course of 5 weeks. Treatment performed by student therapist, taking full postural assessments at the beginning of each session.(3)  Treatment with manual therapy techniques focused on diminishing lower back pain and ankle pain, using the postural assessments to identify inequalities. Progression of pain was rated using visual analogue scales and the Bournemouth Back Questionnaire.

Outcome: The most important part of the treatment was the introduction of a shoe lift for his lower limb-length inequality in order to balance the sacrum, which is indicated by level posterior superior iliac spine (PSIS) measurements.(4)  In leveling out the pelvis there was a decrease in Atlas Axis distortions. No clinically significant quantitive results were yielded in reference to the patients pain levels.

Keywords: Slipped capital femoral epiphysis; manual therapy; in situ fixation; postural assessment; visual analogue scale, Bournemouth Back Questionnaire, lower limb-length inequality