Mr. C., 57 years of age, is a mail carrier; he has walked his mail route for 32 years and is proud “that he has no heart problems.” Over the past year, he has noticed that his hip hurts after sitting for more than 1 hour and that there is a marked increase in pain when first getting up out of a chair and walking. He also has noticed that there is increased discomfort in his hip and knees near the end of each workday. The medical diagnosis is osteoarthritis. Strength testing reveals generally 4/5 on manual muscle tests except the gluteus medius, which is 3+/5. There is mild tightness in the hip flexors, including the rectus femoris and tensor fasciae latae. Mr C. wants to avoid being a “candidate for total hip replacement surgery.”

■ Explain why the patient’s job would perpetuate these symptoms.

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â–  Outline a plan to manage the symptoms; identify measurable goals and interventions you would use to reach the goals.

â–  What can the patient do to protect his hip joints?


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