Hip Dysplasia, also known as developmental dislocation of the hip joint; developmental hip dysplasia; DDH; congenital dysplasia of the hip; congenital dislocation of the hip; CDH, is generally something that is picked up by the child’s physician in the early months of the infant’s life. In infancy, positioning with a device to keep the legs apart and turned outward positions the joint properly. Or a cast may be placed on the child’s leg and altered as the child grows. Surgery maybe necessary especially if the defect is detected in an older child. Recently one of my sons baseball teammates had this surgery. The boy was 11 years old. It was detected due to complications that arose when playing baseball and that had not been noticed beforehand. If it is undetected in youth it will lead to arthritis and deterioration of the hips as an adult. It can be severely debilitating and cause major problems throughout the entire body.
To answer your question it would be good to know if your client had treatment in infancy and what kind of symptoms she/he is experiencing currently. Are there movement limitations? What are their daily activities and workouts? Are they in pain daily, occasionally or only when they work out? These are all important things to consider and know. Here are a few guidelines to work with:
Because the affected side may seem or actually be shorter, work with something under the foot to help align the legs during footwork or even standing exercises. If this adaptation and correction causes pain it should be monitored and slowly introduced. It may not work at all. It works well for those individuals who are already using a lift in their shoes to align the legs and hips.
Leg alignment of the knee, ankle and foot position may be asymmetrical with corresponding poor biomechanics. You can work for symmetry on the reformer and other closed chain positions. Again, monitor your success and if what your doing causes pain, ease off.
Muscular development will most likely be different from one leg to the other so working to strengthen the weaker side with specific muscle strengthening exercises is important. The high chair and low chair are good for this. Be cautious!
With congenital aliments the body adapts to accommodate them and over time poor movement patterns are adopted. This causes problems in other areas of the body which a sound Pilates practice can benefit. For instance, an individual with hip dysphasia may over use the unaffected leg more often to take the load off the affected leg. These seemly simple adjustments will cause trouble in the spine, hip of the unaffected leg, knees and feet of the unaffected leg and scores of other problems.
Keeping with Joseph Pilates’ philosophy that movement heals and a flexible and aligned spine are paramount to a healthy mind, body and spirit, work through the basic systems and take care of the entire body. Work to help the client understand and be aware of their dally movement patterns outside the session and, encourage them to adjust them as much as possible. Adjusting daily functional activities is one of the most important things your client can do. Work them out the best you can in your session and check in regularly with them. If you do not feel comfortable working with this client then I suggest you refer them out. It’s best to be honest and work within your scope of practice and knowledge.
We can continue this conversation if you provide more information, however, it would be more beneficial for you to network with this clients’ doctor and other support individuals. Good luck!