Flexion contracture of hip

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Entdecke die Hip Auswahl bei ASOS, plus kostenlose Lieferung nach Deutschland! Starte in die neue Saison mit ASOS. Entdecke neue Styles für deinen Kleiderschrank Hip Flexion Contracture Biomechanics In the case with a hip contracture, the hip is in partial flexed position as the individual tries to stand up. The type of posture, unlike the normal upright posture, shifts the body weight anterior to the hip, thereby producing a hip flexion torque

Principles of Biomechanics in Hip Flexion Contracture

The mean angle of hip flexion contracture found on the Thomas test was 17± 11° (17° on the right side and 17° on the left side) A flexion contracture is a shortening of muscle tissues and tendons, forcing a joint into a flexed position and holding it there. A patient with this condition will have limited range of movement in the affected joint and may not be able to fully straighten it. This can cause discomfort and may make it difficult to complete daily tasks Sitting for long periods of time may lead to a condition called hip flexion contracture. A contracture is an abnormal shortening or contraction of a muscle due to spasm or fibrosis of the local soft tissue and inability to move the associated joint to its neutral position Bleck p.: for excessive hip internal rotation when walking; a recession of the iliacus and psoas tendon to anterior capsule of hip. Campbell p.: for abdominal and hip flexion contracture; excision of a part of the anterior ilium after a soft tissue release. Canale p.: for mild chronic slipped capital femoral epiphysis; cannulated screw fixation

The same is true for an above-knee (AK) amputee with a hip flexion contracture. A hip flexed beyond 15 degrees makes fitting a prosthesis difficult. If a prosthesis can be fitted, standing with a normally straight spine becomes impossible and even more fatiguing because the hip muscles also attach to the spine Custom fit knee & hip contracture braces with no tools or heat guns. Choose from a selection of knee flexion contracture braces, knee extension braces, & other knee splints. Shop & save at AliMed.com Hip Contracture Tests Ely's Heel to Buttocks Prone heel to buttocks Ipsilateral pelvis rising from table indicates hip flexion contracture or tight rectus femoris Hip Contracture Tests Ober's Test for TFL or ITB Ober's Test Failure to descend smoothly indicates a positive test for contracture of the TFL or ITB. Trochanteric Bursiti

Paraplegic flexion contracture of hip joints beyond 90° is a difficult condition to treat for any orthopedic surgeon. There is no fixed protocol of treatment described, by and large it is individualized Permanent fixation of the hip in primary positions, with limited passive or active motion at the hip joint. Locomotion is difficult and pain is sometimes present when the hip is in motion. It may be caused by trauma, infection, or poliomyelitis. (from current medical information & technology, 5th ed Hip flexion contracture is common with hip dysfunction, probably as a result of protective guarding and the positioning of the hip into flexion (i.e., the resting position) in response to pain Hip flexion contracture of the examined leg Ober test With the patient lying on the unaffected side and the knee flexed to 90 , the symptomatic hip is brought from abduction to adduction. Iliotibial band tightness Anterior impingement test (FADIR test) Hip flexion to 90 , with forced internal rotation and adduction FAI, labral tear, or. Figure 9.1 A hip flexion contracture in the left leg of a patient with paraplegia. This type of contracture can impede walking, especially if the patient also has paralysis of the hip extensor muscles. Figure 9.2 Patients with C6 tetraplegia can develop contractures of elbow flexors, wrist extensors and thumb adductor muscles

Dynamic implications of hip flexion contracture

Hip flexion contractures accompanying various orthopedic and neurologic conditions not only limits the physical activities of the patients but also distorts their postures and gait patterns o Hip flexion contracture (functionally short) Gait • Trendelenburg/abductor lurch (Affected side stays up, contralateral side goes down, body leans to the same side) • Weak abductors, hip OA • Gluteus maximus lurch (extension of the trunk on heel strike) Inspection.

Treatment of Hip Flexion Contractures with Psoas Recession

  1. Hip Flexion Case Study. Although this is a dramatic depiction of a transfemoral patient with a significant hip flexion contracture, it is something many above knee amputees and their prosthetist deal with to various degrees.A Thomas test would show that this patient has a contracture of approximately 35 to 40 degrees
  2. Hip Flexion Contracture. By definition, a hip flexion contracture is a limitation of passive hip extension caused by lack of extensibility of the muscles or ligaments of the hip. Whether mild or severe, hip flexion contractures are relatively common impairments in persons with compromised mobility
  3. Hip flexion contracture in adult paraplegic patient is a relatively rare condition and a combined strategy of precocious preventive physiotherapy and local botox injections and tenotomies can avoid aggressive treatment in most of the cases. The key point of surgical treatment is the choice of the correct indication. Michaelis [ 1
  4. Test for contracture of hip flexors or anterior ligamentous structures.the test is positive if the opposite hip flexes during the test or the opposite knee a..
  5. hip flexion contracture. best initial intervention for shoulder impingement: postural correction, AROM, stretching, or modalities. correct postural alignment first. typical posture of a patient with Parkinson's. forward head and trunk hip and knee flexion. +81 more terms. esfnlk

Hip Flexion Contracture Treatment How To Unlock Your Hip

A progressive crouch gait and limping while walking leads to shortening of stride length, Other symptoms of flexion contractures are anterior knee pain, compensatory movements such as hip flexion deformity accompanied by lumbar lordosis. Changes which appear later are severe contracture of knee and hip and patella alta Hip Flexor Contracture Fai. As always, make sure to obtain normal check ups from an accredited chiropractic doctor. This is the very best method to keep your hips healthy. A chiropractic doctor will certainly be able to recognize any problems in your position or your hip flexor muscular tissues Discover a systematic approach to diagnosing knee osteoarthritis years and make a difference in your patient's care. This video demonstrates how to perform t.. Hip Contracture (Contractures Hip): Read more about Symptoms, Diagnosis, Treatment, Complications, Causes and Prognosis It is known that normal infants have an average hip flexion contracture of 28° that decreases to 19° at six weeks and 7° at three months of age.[10, 11] Hip flexion contractures of 50° to 120° and knee flexion contractures of up to 35° have also been noted in otherwise healthy newborn infants.[12

Dynamic Hip Flexion Contractures : American Journal of

  1. Contractures of elbows Elbow contracture Elbow contractures [ more ] 0002987 Hand clenching Clenched hands 0001188 Hip contracture 0003273 Knee flexion contracture 0006380 [rarediseases.info.nih.gov] Other positive prognostic factors for independent walking were active hips and knees, hip flexion contractures of less than 20 degrees and knee.
  2. al stance, the foot quickly moves into an equinas position21. The most pro
  3. 2- Flexion Contracture of the Hip. Avoid placing pillow under the knee after surgery. Walking backward helps stretch flexion contracture. Perform Thomas Stretch 30 times a days. The above mention Hip Replacement Rehabilitation Protocol should be tailored to individual patients need and performed in guidance of a physical therapist
  4. evaluates hip flexion contractures. Extension. 20-30 deg. Abduction. 40-50 deg. Adduction. 20-30 deg. Internal rotation. 30 deg. External rotation. 50 deg. Special Tests. FADIR test. hip F lexed to 90 deg, AD ducted and Internally R otated. positive test if patient has hip or groin pain. can suggest possible labral tear or FAI
  5. A contracture deformity is the result of stiffness in the connective tissues of your body. Find out all you need to know about contracture deformities
  6. Flexion contracture of knee / FFD hip with flexion attitude of knee; comment on contracture; unable to place legs straight because of fixed flexion of knee / hip; must place other leg in same position; flex unaffected knee over bolster to same degree; look below medial malleolus; measure leg length; Valgus knee; comment on contracture

Hip Flexion Contractures - LevelUpR

The Thomas test (or Hugh Owen Thomas well leg raising test) is a physical examination test, named after Dr. Hugh Owen Thomas (1834-1891), a British orthopaedic surgeon, used to rule out hip flexion contracture and psoas syndrome. Often associated with runners, dancers, and gymnasts who complain of hip stiffness and reported snapping feeling when flexing at the waist However, hip flexion contractures are poorly tolerated. Surgical correction of the contractures may be indicated. Control of Hip Joint. If the child is unable to control the position of the hip joint while walking (gait cycle), then it must be provided by an orthotic (brace) An Y, Gross R. Proximal femur extension osteotomy for treatment of flexion contracture of the hip. Paper #29304. Presented at the SICOT XXV Triennial World Congress 2011. Sept. 6-9

Paraplegic flexion contracture of hip joints beyond 90° is a difficult condition to treat for any orthopedic surgeon. There is no fixed protocol of treatment described, by and large it is individualized. A 20 year old female presented with paraplegia for last 15 years due to irrecoverable spinal cord disease with complete sensory and motor loss of both lower extremities and was admitted with. Thomas Test. In general it is used to check for hip flexion contractures; more specifically it tests for anterior or lateral capsular restrictions or hip flexor tightness. The patient is asked to lie supine. The examiner checks for lordosis which is a predictor of a tight hip flexor. The examiner then flexes one hip bringing the knee to the.

In 'secondary hip spine syndrome,' the hip and spine are not distinct entities, and dysfunction with one causes abnormalities with the other. This syndrome can arise from hip flexor contractures placing the spine in excessive hyperlordosis by forward rotation of the pelvis. This increased curvature affects the facet joints, with slippage of. The ICD-10-CM code M24.559 might also be used to specify conditions or terms like abduction contracture of hip, acquired fixed flexion deformity of hip, acquired fixed flexion deformity of joint of lower limb, adduction contracture of hip, contracture of abductor muscle of hip , contracture of adductor muscle of hip, etc. Unspecified diagnosis.

Dynamic Implications of Hip Flexion Contractures

A flexion contracture can be released by an anterior approach to the hip with release of sartorius, rectus femoris and the anterior hip capsule as necessary. The patient is draped so that a Thomas test can be performed while sequentially releasing the contractures, and release should be performed to reduce the contracture to 10-20° Hip examination... for a hidden flexion contracture of the hip - hip flexion contractures may be occult , due to compensation by the back Hip examination... for a hidden flexion contracture of the hip - hip flexion contractures may be occult , due to compensation by the back. Hip flexion contracture often occurs after femoral lengthening in patients with achondroplasia, but few studies have investigated its development in these patients. The purpose of this study was to analyze sustained hip flexion contracture in achondroplasia patients who underwent femoral lengthening and to identify contributing factors. This study included 34 patients with achondroplasia who. Abduction contractures, like hip flexion contractures, are not uncommon and are more prevalent in shorter residual limbs. This range of motion in the coronal plane should also be documented. The analysis and measurement of the ranges of motion of the femur in the sagittal and coronal planes are important in establishing the initial angular. If there is a flexion contracture in the ipsilateral hip it should be evident, as the hip will appear flexed. Normal range of motion. Internal rotation - 40° External rotation - 45° Flexion - 125° Extension - 10-40° Abduction - 45° Adduction - 30° Special maneuvers. Trendelenburg test/sign: Make sure pelvis is horizontal by palpating ASIS

Hip flexor contracture is linked to injury predisposition and postural anomalies. This research examined reliability for the Modified Thomas and Ely's Special Tests when evaluating hip flexor contracture, and its effect on dynamic exercise. Twenty adults were randomized in a study and analyzed for hip flexor contracture Hip flexor pain is often felt in the hip or groin and made worse by certain movements, such as kicking, pivoting at high speeds, or moving the knee towards the chest. The underlying cause of hip flexor pain may be: Hip flexor strain or tear. A strain or tear refers to the damage caused to a muscle or tendon when it is stretched too far Hip flexor strain is also known as Iliopsoas syndrome and is a common sports injury (3,5% of all sports injuries). It is the pain that appears on the front side of the hip and pelvis and is caused by sudden swinging or repetitive flexion in the hip joint Hip flexor contracture test. Thomas test: supine, both hips flexed, maintain one hip in flexion, +ve if unable to touch posterior thigh to table; K 0.6- 0.8 (fair- mod) For: hip flexion contracture; Modified Thomas test: sit on end of table, flex non-tested hip, roll back into supine position, measure degree of extension of hanging leg off bed

What is a Flexion Contracture? (with pictures

  1. This is known as flexion contracture. Flexion contracture of both the knee and hip was present in 25.5% of patients. Flexion contracture of the knee was present in an additional 31.5% of patients, and flexion contracture of the hip was found in another 15.5%. In total, flexion contracture of either the knee or hip or of both the knee and hip.
  2. contracture [kon-trak´cher] abnormal shortening of muscle tissue, rendering the muscle highly resistant to stretching; this can lead to permanent disability. It can be caused by fibrosis of the tissues supporting the muscle or the joint, or by disorders of the muscle fibers themselves. Improper support and positioning of joints affected by arthritis or.
  3. 2. November 1972-Stump has 45 deg. flexion contracture and a residual range of 10 deg. active motion. Hip has a 30-deg. flexion con- tracture and abduction is limited to 20 deg., possibly due to the knee- bearing crutch. 3. December 1972-Under close and careful measurements by Mr

Stretching a Hip Flexion Contracture Woman - The Nes

  1. The worse the flexion contracture, the more rapidly the symptoms appear. But even mild flexion contractures can cause disability if they are left untreated. One study by Riddle found that over three years, for every degree of flexion contracture present, the risk of having a knee replacement increased 6%. Treatment of Flexion Contractures
  2. - check hip abduction in both extension and flexion (less than 45 deg indicates contracture, and less than 30 deg abduction indicates a significant contracture); - Treatment: - usually requires both a bony and a soft tissue procedure
  3. However, hip flexion contractures are poorly tolerated. Surgical correction of the contractures may be indicated. Range of Motion. Motions of the lumbosacral spine and the hip are essential for functional walking. Motion of the knee is less important and is useful only in clearing the swing leg. Mobility of the spine must allow the center of.
  4. Hip flexion contracture beyond 90° in adult paraplegic patient is a relatively difficult condition to treat because of the marked contracture of hip flexors in addition to blood vessels and nerves anterior to hip. There is no definite consensus on the type of treatment to be offered

Hip flexion contracture/deformity Ankle equinus (true vs apparent) or calcaneus (calf weakness) Planovalgus foot (lever arm dysfunction) Previous Next: Pathophysiology. Normal sagittal alignment includes the ability to lock the knee in full extension, stabilized posteriorly by the cruciate ligaments, posterior capsule, hamstrings, and. Christopher: Knee Pain, Severe Crouch Gait, & Hip Flexion Contracture Case Study 1. Case Study: Christopher Conditions Treated Anterior Knee Pain, Severe Crouch Gait, & Hip Flexion Contracture Age Range During Treatment 23 Years to 24 Years David S. Feldman, MD Chief of Pediatric Orthopedic Surgery Professor of Orthopedic Surgery & Pediatrics NYU Langone Medical Center & NYU Hospital for Joint.

Hip Contracture - an overview ScienceDirect Topic

  1. A concomitant knee flexion contracture will impair the patient's ability to place the leg flat on the table. Again, this may trick you into thinking that a contracture exists in the hip. To overcome this, move the patient down the table to let their knees and lower legs hang over the edge of the bed
  2. Patients with cerebral palsy and fixed hip extension are often unable to sit and therefore lose social and educational opportunities. At Texas Scottish Rite Hospital (Dallas, TX, U.S.A.), 29 patients had hip extension-abduction contractures. Eleven patients with mild involvement were managed with physical therapy
  3. Fixed flexion deformity at knee is common in osteoarthritic knee and is a combination of bony deformity, capsular and ligamentous deformity. It affects knee biomechanics in terms of increased forces at the patellofemoral and tibiofemoral joint. This in turn makes carrying out of routine daily activities like walking or use of staircase very difficult
  4. Main types of contracture of hip flexor muscles, and their effect on posture: a. Bilateral hip flexion deformity will be combined with increased lumbar lordosis. b. Unilateral hip flexion contracture will be often combined with hip abduction and external rotation. Dr. Olfat Ibrahi
  5. Children with spina bifida develop a wide variety of congenital and acquired orthopedic deformities. Among these are hip deformities such as contracture, subluxation, or dislocation. Patients may also have problems with the knee joint, such as knee flexion or extension contracture, knee valgus deformity, or late knee instability and pain
  6. Knee flexion contracture (FC) and crouch gait are challenging to treat in children with cerebral palsy (CCP), and recurrent knee FC after surgery is a severe complication. The aim was to identify factors associated with recurrent knee FC after surgery. The records of 62 CCP (age 10.6±2.6 years) who underwent surgery and were followed for > six months were reviewed

Preventing Contractures - Amputee Coalitio

Knee & Hip Contracture Braces Knee Extension Braces AliMe

For example, one should avoid placing pillows under the knees while supine to prevent knee flexion contractures, and prone lying can force the hip into extension to prevent hip flexion contractures. Shoulder range of motion can be preserved with 30 minutes of positioning using a sling attached to the bed, holding the arms in maximal external. Hip Flexor Function — and Why The Hip Flexor Is Important. The hip flexors are a group of muscles in the pelvic region and upper thighs that help drive up the knees and keep the pelvis and thighs aligned, which is a key running tip for beginners and can help prevent knee problems. But you don't have to be a runner or athlete to need healthy hip flexors R. hip 50 flexion contracture. L. hip extension full. H.J. June 1957 R. hip40°flexion, I5° abduction Sept. 1959 Thepatient walks well. Nolumbar L. hip 300 flexion, I00 abduction Dec. 1959 lordosis. Hip extension full. D.T. Aug. I954 R. hip 450 flexion Feb. I960 The patient walks well without L. hip 450 flexion March I960 compensatory lumbar.

Hip Range of Motion • Flexion - Most pts > 90 • Flexion Contracture - Maximally flex opposite hip to fix pelvis - Thigh will not lie flat on the table Hip Range of Motion • Hip Rotation • Check in several positions: - Supine with hip flexed - Supine with hip extende Tag Archives: hip flexion contracture. 0 I'm Stuck! Managing tight muscles and contractures in growing children. July 11, 2014 | georginaleigh. Physiotherapists have a wide range of roles and one of the really important ones is to maintain range of movement. Children with a range of conditions, most notably Cerebral Palsy, can develop tight. If a flexion contracture is present, particularly of the iliopsoas, the affected hip moves with the increasing flexion at the con-tralateral hip instead of remaining flat on the ex-amination table. The angle formed by the flexed leg with the examination table allows estimation of the amount of fixed flexion contracture at the hip (9,10) The Thomas test is used to rule out hip flexion contracture and psoas syndrome. Often associated with runners, dancers, and gymnasts who complain of hip stiffness when flexing at the waist. The hip flexor is a group of muscles that allow us to lift our knees and bend at the waist. Hip flexors perform various functions, and where some cross over. Orthopedics Today | PRAGUE — Flexion contracture in the hips of pediatric patients due to spastic cerebral palsy, arthrogryposis and other conditions can be challenging to treat. However, a team.

Implies no fixed contracture at MP or PIP joint, but deformity increases on wt bearing. Consider isolated tenotomy of the FDL tendon. Flexor tendon transfer: may or may not be appropriate indicated for a young adult with a mild deformity. This procedure may cause the base of the toe to remain swollen (or fat) giving a poor cosmetic appearance Hip flexion contractures: a comparison of measurement methods. Bartlett MD, Wolf LS, Shurtleff DB, Stahell LT. Archives of Physical Medicine and Rehabilitation, 01 Sep 1985, 66(9): 620-625 PMID: 4038029 . Share this article Share with email Share with twitter Share with linkedin Share. The hip must also be examined because correction of hamstring contractures without addressing concomitant hip flexion contractures will lead to increased hip flexion and forward lean during gait . Furthermore, distal femoral or proximal tibial deformities may create or exaggerate a knee flexion deformity Treatment of Hip Flexion Contractures. Canale and Beaty . Operative Pediatric Orthopedics . 1991. Psoas lengthening at the Pelvic Brim. Hip Subluxation & Dislocation. Hip Subluxation. Acetabular Dysplasia. Hip Subluxation & Dislocation Indications for Treatment: • Hip subluxation in any conditio


Comfy Multi-Podus Contracture AFO with Adjustable Strap keeps heel in floating position to prevent pressure areas while the anti-rotation bar controls hip and leg rotation. Dorsiflexion straps prevent plantarflexion and an ankle strap secures to prevent ankle flexion. Adjustable toe post accommodates all foot sizes. Antimicrobial surface protector shields against mold, mildew, stains, bacteria. The purpose of this study was to examine possible effects of hip flexor contractures on changes in pelvic anterior tilt during the squat. Twenty recreationally active subjects were evaluated for hip contracture using the Modified Thomas test. Eight subjects were foun Position of comfort for the hip joint is flexion, abduction & external rotation; as it allows maximum distension of the capsule. If the joint is moved it can be brought to neutral position. In deformity; there is a fixed contracture of the joint which will prevent the joint from being placed in the neutral position

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Paraplegic flexion contracture of hip joints: An

9/14/2015 3 most common deformities hip flexion contractures knee flexion contractures equinus adult problems lower extremity edema pressure sores ischium low lumbar level hip flexors- strong knee extensor- strong medial hams- strong gluteus medius- 2 or less gluteus maximus- 2 or less gastrosoleus- 0 low lumbar walk with afo an Read on for 10 expert-approved hip flexor stretches to ease pain and tightness. Safety and Precautions . Before we talk more about how to loosen up your hips, an important distinction needs to be made. Complaints of 'tightness' or 'pain' in the hip flexors is something I commonly hear in the clinic, but before I ever prescribe hip. Lower extremity joint contractures have negative effects on gait in children with Duchenne muscular dystrophy (DMD). Thus, contracture prevention is essential for maintaining a patient's functional ability and an acceptable quality of life. This study investigated hip flexion (HF), knee flexion (KF), and ankle joint plantar flexion (APF) contractures among male patients with DMD, based on.

2021 ICD-10-CM Diagnosis Code M24

Patients with ankylosing spondylitis and severe hip flexion contracture treated between 2011 and 2017 were assigned to either an experimental group or an age-matched control group (n=12 each) based on receiving, respectively, soft tissue release of the hip joint, femoral osteotomy, and supracondylar bone traction (stage I) and THA (stage II) or. may lead to worse function if it leads to a hip flexion contracture because flexion deformities worsen the patient's gait. Knee Contractures. Treatment. operative. soft tissue releases (especially hamstrings) indications. flexion contracture >30 degrees. best performed early (6-9 months of age Inability to maintain fully extended hip on the other side indicates hip flexor contracture. Rectus femoris stretch test. Patient lies supine with lower leg hanging off table at 90 degrees. Patient pulls knee of other leg up toward chest. Positive test is when the hanging limb extends in response to contralateral hip flexion

Flexion Contracture - an overview ScienceDirect Topic

Flexion contracture (ie loss of terminal extension) is the least tolerated limitation in motion because >5-8 ° affects the gait pattern and prevents patients from locking out their knee while standing, leading to increased muscle fatigue bc the quad never gets a chance to relax Contracture is the most common cause of deformity, such as: • Plantar flexion contracture: ¾In stance: blocks progression of the limb over the supporting foot ¾In swing: inhibits floor clearance (increased hip flexion is needed BACKGROUND:: Hip flexion contracture (HFC) in the ambulatory child with cerebral palsy (CP) may impair function and lead to deteriorations in health-related quality of life. Furthermore, increasing HFC may lead to increasing disability. However, the association between passive range of motion and the measures of function and well-being is unclear Hip flexion deformity or spasticity is a cause of the abnormal gait observed in cerebral palsy patients. Hip flexor spasticity was reported to cause dynamic restriction of hip extension in the terminal stance and become fixed hip flexion contracture with age in those patients [1-3].The psoas muscle is a primary cause of hip flexion contracture [4, 5] and has been known to be associated with. Prone position to prevent flexure contracture of hip (20-30min, several times a day) Legs kept together to prevent abduction deformity Overhead trapeze Tourniquet at the bed side: bleeding may happen No elevation to stump on pillows (to prevent flexion contracture of hip) Not sitting for long periods (to prevent flexion contracture of hip).

Toe Out - physical therapy should rule out hip external rotation contracture, hip abductor weakness, and poor trunk stability as contributors to this compensatory pattern Drop Off - a prosthetist should be consulted when drop off is observed and there is little to no evidence of a knee flexion contracture or substantial quadriceps weaknes flexion contracture does not necessarily prevent ambulation with a prosthesis. Does the patient also have a hip flexion contracture? ***** I use the Monodos (static, not dynamic joint), Becker Orthopedic. It's pretty slick: the joint only goes in one direction, unless released flexion instability include too little distal femoral resection in a preexist-ing flexion contracture (Figure 1), overly aggressive posterior condylar resection with undersized femoral im-plants (Figure 2), excessive posterior slope on the tibia (Figure 3), or over-release of the PCL in the CR knee. 6,11 Mid-flexion Instabilit Hip flexion contracture in crouch gait is mostly com-pensation of the knee flexion contracture and ankle equines. The psoas muscle is the primary reason for the hip flexion contracture and is known to be associated with increased anterior pelvic tilt, crouching gait, hip instability and lumbar lordosis