Three-Week Combined Manual Hip Mobilization and Progressive Weight-Bearing Training Improves Pain, Range of Motion and Functional Disability in Young Adults with Early-Stage Avascular Necrosis of the Femoral Head: A Quasi-Experimental Study

Abstract

Background: Avascular necrosis (AVN) of the femoral head is a progressive musculoskeletal condition characterized by compromised blood supply leading to bone tissue death, pain, reduced mobility, restricted hip joint range of motion, and functional disability. Early-stage AVN commonly affects young adults and may progress rapidly to femoral head collapse if left untreated.
Objective: To evaluate the effectiveness of manual hip mobilization combined with progressive weight-bearing training on pain, hip joint range of motion, and functional disability in young adults with early-stage avascular necrosis of the femoral head.
Methods: A quasi-experimental interventional study was conducted on 15 young adults diagnosed with radiographically confirmed early-stage AVN (Ficat–Arlet Stage I–II). Participants underwent a supervised physiotherapy intervention for three weeks consisting of Maitland Grade I, II and III manual hip mobilization combined with progressive weight-bearing training and routine physiotherapy exercises. Pain intensity, hip joint range of motion (ROM), and functional disability were assessed using the Numerical Pain Rating Scale (NPRS), universal goniometry, and Harris Hip Score (HHS). Statistical analysis was performed using paired t-test.
Results: Significant improvement in pain, hip joint range of motion, and functional outcomes was observed following the intervention. NPRS scores reduced from 6.2 ± 1.1 to 2.8 ± 0.9, while Harris Hip Score improved from 62.5 ± 6.8 to 84.2 ± 5.7 (p < 0.001). Hip joint range of motion was found to be restricted at baseline due to pain and capsular stiffness; however, following the three-week physiotherapy intervention, an increase in active hip range of motion was observed in all planes of movement as assessed using universal goniometry.
Conclusion: A three-week physiotherapy program consisting of Maitland Grade I,II and III manual hip mobilization combined with progressive weight-bearing training significantly reduced pain and improved hip joint range of motion and functional outcomes in young adults with early-stage avascular necrosis of the femoral head, suggesting its effectiveness as a conservative intervention to reduce disability and enhance hip function.