In this episode, we dive into the highly anticipated 2025 revision of the Clinical Practice Guidelines for Hip Pain and Mobility Deficits—Hip Osteoarthritis, published by the APTA Academy of Orthopaedic Physical Therapy. Join us as we explore the latest evidence on how to best classify, examine, and treat patients living with mild-to-moderate hip OA. We break down the updated recommendations for manual therapy, specific exercise dosing, patient education, and a brand-new "Level A" recommendation for dry needling. Whether you are looking to optimize your conservative management strategies or understand when to use (and when to avoid) modalities like ultrasound and bracing, this episode covers the essential updates every physical therapist needs to know.

Key Show Notes & Takeaways:

• Manual Therapy Matters: Clinicians should utilize soft tissue and joint mobilization, including both high- and low-force long-axis distraction and mobilization with movement. These techniques are strongly recommended to increase range of motion, decrease pain, and improve overall function. Therapists are encouraged to modify their force amplitude based on the patient's specific bony hip morphology and tissue irritability.
• Exercise Prescription & Dosing: Individualized exercise programs (including aquatic therapy) are vital. The updated guidelines recommend a specific dosage: 1 to 5 times per week, lasting 30 to 120 minutes per session, over a duration of 5 to 16 weeks.
• New Evidence for Dry Needling: The 2025 CPG introduces a strong recommendation for dry needling. Targeting myofascial trigger points in the iliopsoas, rectus femoris, tensor fasciae latae, and gluteus medius/minimus provides short-term (3-week) improvements in pain, muscle extensibility, and force production for patients with Grades II and III hip OA.
• Patient Education & Weight Management: Education should go beyond just giving advice. Clinicians should integrate internet-based pain coping skills training alongside manual therapy and exercise. Additionally, for overweight or obese patients, physical therapists should actively collaborate with physicians and dietitians to support a targeted weight loss of 5%–7.5%.
• Modalities and Bracing – What to Avoid:
• Bracing should not be used as a first-line treatment, though it can be considered if exercise and manual therapy fail to improve activities requiring pivoting.
• Therapeutic Ultrasound has conflicting evidence regarding its efficacy. It may be used in shared decision-making, but patients must be informed about its questionable benefits and potential costs.

References & Resources:

• Koc, T. A., et al. (2025). Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2025. Journal of Orthopaedic & Sports Physical Therapy, 55(11), CPG1-CPG31.

• What it is: Otoconia displaced into a semicircular canal (ear crystals where they shouldn’t be).
• Classic signs: Brief vertigo (<60 sec), triggered by position changes, upbeating torsional nystagmus, no hearing loss.
• Rule-in test: Dix-Hallpike.
• Rule-out clues: Long-lasting vertigo, neuro deficits, hearing symptoms → think neuritis/Ménière’s.
• NPTE trap: Nystagmus >60 seconds = NOT typical BPPV (think cupulolithiasis).
• Best treatment: Epley every. single. time.
• Mock question included: Yes — test yourself before you move on.

Listen in and pass this question forever in under 3 minutes.

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• What it is:
• ACL failure from excessive anterior tibial translation — basically the tibia tries to run off and the ACL can’t hold the line.
• Classic signs:
• Pop
• Immediate swelling (1–2 hours)
• Pivot / cutting mechanism
• Instability
• Difficulty weight-bearing
• Rule-in test:
• Lachman test — NPTE’s #1.
• Rule-out clues:
• Slow swelling → Meniscus
• Posterior sag → PCL
• Medial pain → MCL
• NPTE trap:
• Delayed swelling means NOT ACL.
• Best treatment:
• Early ROM, quads, swelling control, gait normalized.
• Mock question included: Yes — test yourself before you move on.

Lock down ACLs in under 3 minutes. Hit follow for more NPTE wins.

• What it is:
• Injury to the medial or lateral meniscus — the knee’s shock-absorbing cartilage — often caused by twisting or deep flexion.
• Classic signs:
• Joint line pain
• Locking or catching
• Clicking
• Delayed swelling (24–48 hours)
• Pain with squatting/twisting
• Rule-in test:
• McMurray test (NPTE’s go-to)
• Rule-out clues:
• Immediate swelling → ACL
• Posterior sag → PCL
• Medial tenderness → MCL
• NPTE trap:
• Locking/catching = meniscus, even if the question tries to distract you.
• Best treatment:
• ROM, swelling reduction, quads/hip strength, progressive loading.
• Mock question included: Yes.

Lock down meniscus tears in under 3 minutes. Hit follow for more NPTE wins.

• What it is:
• Injury to the posterior cruciate ligament from excessive posterior translation of the tibia — often from dashboard impact or falling on a flexed knee.
• Classic signs:
• Posterior sag sign
• Posterior knee pain
• Difficulty descending stairs
• Instability (less dramatic than ACL)
• Dashboard injury mechanism
• Rule-in test:
• Posterior Drawer Test (NPTE’s favorite)
• Rule-out clues:
• Immediate swelling → ACL
• Locking/catching → Meniscus
• Medial tenderness → MCL
• NPTE trap:
• “Dashboard injury” = PCL. Never ignore it.
• Best treatment:
• ROM, quad strength, avoid early hamstring loading.
• Mock question included: Yes.

Lock down PCL injuries in under 3 minutes. Hit follow for more NPTE wins.

• What it is:
• Sprain/tear of the MCL from valgus force or lateral blow.
• Classic signs:
• Medial knee pain
• Pain with valgus stress
• Local tenderness
• Mild swelling
• Lateral blow mechanism
• Rule-in test:
• Valgus Stress Test at 30°
• Rule-out clues:
• Pop + immediate swelling → ACL
• Locking → Meniscus
• Posterior sag → PCL
• NPTE trap:
• Valgus force + medial pain = MCL. Full stop.
• Best treatment:
• ROM, quad/hip strength, bracing, progressive load.

Mock question included. Listen in and lock it down.

• What it is:
• Non-mechanical symptoms raising suspicion for malignancy.
• Classic signs:
• Night pain
• Unexplained weight loss
• Constant, deep ache
• No mechanical pattern
• History of cancer
• Rule-in test:
• None — this is a screening cluster.
• Rule-out clues:
• Pain that changes with movement or position.
• NPTE trap:
• Night pain + weight loss = refer immediately.
• Best treatment:
• Medical referral, not PT.

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