Rehabilitation of hip joints

Dikul's Method of Hip Rehabilitation¶

What injuries to the pelvic bones and hip joints can be repaired with the Dikul Method?¶

The Dikul Method is a unique rehabilitation system based on kinesiotherapy (movement therapy) and special physical exercises. It was developed by Valentin Ivanovich Dikul, who was able to restore motor functions after a severe spinal injury. Today this method is successfully used to rehabilitate patients with injuries and diseases of the musculoskeletal system, including pelvic bones and hip joints.

Which pelvic and hip injuries can be treated with the Dikul method?¶

The Dikul's method is effective for various injuries and pathologies of the pelvis and hip joints, especially in cases where mobility restoration and muscle corset strengthening are required.

1. Pelvic bone fractures¶

Pelvic fractures are serious injuries that can occur with severe trauma, such as after a fall from a height, a car accident, or due to the fragility of the bones in osteoporosis.

These fractures range in severity from relatively mild, without displacement (e.g. a cracked pubic or sciatic bone), to complex fractures requiring surgery.

Important

Dikul's method helps to quickly return a person to a full life at the stage of rehabilitation after a pelvic bone injury.

Kinesiotherapy according to Dikul helps not only to restore mobility, but also to prevent many complications that often arise after long immobilisation. When a person lies down for a long time or moves little, muscles weaken, joints lose flexibility, and blood circulation deteriorates, and with pelvic bone injuries this fact is even more pronounced.

The special exercises developed by Diculus are designed to gradually, without overloading, restore strength to the muscles, improve tissue nutrition and restore normal joint function.

It is especially important that the method is suitable even for patients after complex operations, when the fracture was displaced and required fixation with metal structures. In such cases, the rehabilitation programme is built individually, taking into account the patient's condition, and includes not only physical exercises, but also breathing exercises, which helps to avoid congestion in the lungs.

The main thing is a systematic approach and gradual increase in the load, which makes recovery safe and effective.

2. Hip injuries¶

A. Fracture of the femoral neck¶

Fracture of the femoral neck is an extremely dangerous injury, especially for the elderly, whose recovery is complicated by age-related bone changes and concomitant diseases.

Dikul's method is successfully applied at different stages of rehabilitation: after osteosynthesis (when the fragments are fixed with screws or pins), during recovery after endoprosthetics (replacement of the joint with an artificial one), as well as during conservative treatment, if surgical intervention is contraindicated.

Specially designed exercises help not only to restore mobility, but also to prevent serious complications such as muscle atrophy, pressure sores and congestive pneumonia, which often develop due to prolonged immobility.

The emphasis is on the gradual restoration of the leg's supporting function - first with support, then with increasing loads, as well as strengthening the thigh and buttock muscles, which is essential for stabilising the joint and regaining independent walking.

The individualised approach and dosed loads allow even weakened patients to achieve significant improvements without the risk of overloading.

B. Hip dislocations and subluxations¶

Hip stability disorders, including congenital hip dislocation (dysplasia) in adults, where residual effects in the form of limited mobility, muscle imbalance or chronic pain persist, can also be restored using the Dikul method.

In the case of traumatic dislocation, after joint repositioning, kinesiotherapy helps to restore normal biomechanics of movement, strengthen the ligamentous-muscular apparatus and prevent repeated dislocations.

Special exercises are aimed at gradually increasing the amplitude of movements, improving coordination and forming a correct motor stereotype, which is especially important for patients with long-term disorders.

C. Ligament and tendon ruptures¶

Rehabilitation after injuries and operations on the ligamentous apparatus of the hip joint, including complex injuries such as a rupture of the acetabular lip, the cartilaginous formation that provides stability to the joint, is also effective.

After surgery or in the case of conservative treatment, kinesiotherapy helps to restore microcirculation, prevent the formation of scar contractures and gradually restore full mobility to the joint.

Exercises are aimed at gentle strengthening of periarticular muscles, which take on a part of the load, compensating for temporary weakness of ligaments, as well as at restoring sensitivity of the joint, disturbed after injury. Special attention is paid to smoothly increasing the amplitude of movements without the risk of re-injury, thus avoiding joint instability and the development of post-traumatic osteoarthritis.

Periarticular muscles

Periarticular muscles are muscle groups located around the joint. They play a role in stabilising the joint articulation, ensuring smooth movement and protecting the ligamentous apparatus from overload. In the context of the hip joint, they include:

Gluteal muscles (large, middle, small);
Deep thigh muscles (iliopsoas, pectoralis major, internal hindlimb);
Femoral ring muscles (tensor fascia major, tailor's muscle).

In case of injuries or surgeries (e.g. acetabular lip rupture), these muscles compensate for joint instability, so strengthening them is the basis of Dikul's method of rehabilitation.

3. Degenerative-dystrophic diseases¶

Dikul's method is highly effective in the treatment of chronic hip joint pathologies such as coxarthrosis (stage I-II osteoarthritis), when cartilage destruction has not yet reached a critical degree, and aseptic necrosis of the femoral head in the early stages while its anatomical structure is still intact.

In osteoporosis, where the main danger is bone fragility and the risk of fractures, kinesiotherapy has a dual function: it strengthens the muscular corset, reducing the load on the joint, and stimulates bone metabolism through dosed physical activity.

Specially selected exercises help to activate blood circulation and lymphatic flow, which improves the nutrition of joint tissues, reduces pain by relieving muscle spasms and restores range of motion.

Regular Dikul exercises not only slow down the progression of degenerative changes, but also allow many patients to avoid or delay the need for endoprosthetics, preserving the natural biomechanics of the joint.

4. Postoperative rehabilitation¶

Recovery after hip surgery is ensured by a step-by-step and safe rehabilitation programme.

After endoprosthetics, the programme focuses on the adaptation to the artificial joint: exercises help to restore the support function of the leg, prevent muscle atrophy and normalise gait.

In arthroscopic interventions (e.g. resection of damaged cartilage or removal of osteophytes), kinesiotherapy promotes tissue regeneration, improves mobility and prevents re-injury.

Arthroscopic interventions

Arthroscopic interventions are modern minimally invasive joint surgeries performed using an arthroscope (special endoscopic equipment) through minimal incisions (usually 5-10 mm).

Main Features:

Minimally invasive - surrounding tissues are preserved
High accuracy - visualisation through a mini-camera

Wide range of interventions:

Diagnostic arthroscopy
Therapeutic manipulations

In the case of the hip joint, it allows for:

Removal of free cartilage bodies
Acetabular lip plasty
Treatment of damaged cartilaginous surfaces
Resection of osteophytes

The method combines diagnostic and therapeutic possibilities and is the gold standard for many joint pathologies.

After correcting bone deformities to restore normal anatomy and joint function, when the anatomy of the femur is changed to distribute the load correctly, the Dikul method helps to strengthen muscles, stabilise the joint and gradually restore full range of motion. All programmes are individually tailored to the type of surgery, the patient's age and physical capabilities, minimising the risk of complications and speeding up the return to active life.

Physiological processes and neuroplasticity in pelvic and hip rehabilitation¶

Recovery from pelvic and hip injuries is a complex physiological process in which neuroplasticity - the ability of the nervous system to remodel itself to form new neural connections to compensate for lost function - plays a key role.

This mechanism is particularly important in rehabilitation, as injuries to bones, ligaments and muscles are often accompanied by impaired proprioception (joint sense) and motor stereotypes.

Positive examples of rehabilitation of pelvic injuries (when following Dikul's methodology):¶

Activation of neuromuscular control¶

After a femoral neck fracture in elderly patients, gradual muscle activation (through dosed exercises) stimulates the restoration of neuromuscular communication.

For example, balance training on a platform helps the brain to ‘re-learn’ how to control the limb.

In stage I-II coxarthrosis, strengthening the gluteal muscles reduces stress on the joint, and proprioceptive exercises (on unstable surfaces) improve coordination.

Bone adaptation (in osteoporosis)¶

Dosed loads (e.g. exercises with rubber bands) stimulate osteogenesis (bone growth), preventing recurrent fractures.

Prevention of contractures¶

After endoprosthetic replacement, early muscle activation (hip flexion-extension) prevents scarring and preserves mobility.

Negative effects (if technique is ignored):¶

Muscle atrophy and contractures¶

Patients with pelvic fractures who refuse Therapeutic exercises develop joint stiffness due to soft tissue fibrosis (example: ankylosis of the hip joint after prolonged immobilisation).

Progression of degenerative changes¶

In coxarthrosis, lack of movement accelerates cartilage destruction - the joint ‘hardens’ (ankylosis), requiring endoprosthetic replacement.

Chronic pain syndrome¶

After acetabular lip arthroscopy without rehabilitation exercises, joint instability persists, leading to re-injury.

Physiology and Tissue Regeneration in Pelvic and Hip Reconstruction: Scientific Mechanisms¶

Bone, cartilage, and soft tissue repair after injury or degenerative disease is a complex biological process regulated by cellular, molecular, and biochemical mechanisms.

1. Bone tissue regeneration (osteogenesis)¶

The regeneration process consists of the following phases:

Inflammation phase (0-7 days):
- After a fracture or osteotomy, cytokines (TGF-β, BMP, PDGF) are released, attracting osteoclasts that resorb the damaged bone.
- A haematoma is formed which serves as a framework for regeneration.
Repair phase (1-6 weeks):
- Mesenchymal stem cells (MSCs) differentiate into osteoblasts under the action of the Wnt-signalling pathway and bone morphogenetic proteins (BMP-2, BMP-7).
- Soft bone callus (fibrous cartilaginous tissue) is formed, followed by hard callus (osteoid mineralising into hydroxyapatite).
Remodelling phase (months to years):
- Osteoclasts and osteoblasts remodel bone along load lines (Wolff's law).

The Role of the Dicul's Method:¶

Mechanical loading stimulates the piezoelectric effect in bone, activating osteoblasts through mechanotransduction.

This fact is supported by research

According to Frost (2003), dosed exercise increases bone mineral density by 5-15% in osteoporosis.
Robling et al (2006) showed that cyclic exercise increases the expression of RUNX2, a key gene for osteogenesis.

2. Cartilage repair (for coxarthrosis and injuries)¶

Cartilage regeneration process:

Limited regeneration:
- Hyaline cartilage is avascular, so it is regenerated by:
  - Chondrocytes (divide weakly, synthesise type II collagen and proteoglycans).
  - Mesenchymal cells from synovial fluid.
- Osteoarthritis is dominated by catabolism: MMP-13 degrades collagen, ADAMTS-5 degrades aggrecan.

Role of kinesiotherapy:¶

Dynamic compression during walking and Therapeutic exercises increases synovial fluid diffusion, delivering nutrients to chondrocytes (Grodzinsky, 2016).

Moderate exercise suppresses NF-κB (inflammatory mediator) and stimulates SOX9 (chondrogenesis factor).

This fact is confirmed by research

According to Roos et al (2011), exercising 3 times a week reduces coxarthrosis pain by 40% (WOMAC scale).

3. Muscle and Ligament Regeneration¶

The process of muscle and ligament regeneration:

Muscle tissue:
- Atrophy activates satellite cells that differentiate into myoblasts (regulation of myostatin and IGF-1).
Ligaments/tendons:
- Type I collagen is synthesised by fibroblasts but slowly (up to 12 months).

Role of Exercise:¶

Exercise increases growth factor by improving blood flow.
Stretching stimulates tenogenesis through activation of tenogenic factor.

4. Neuroplasticity and proprioception¶

Scientific mechanisms of how neuroplasticity and proprioception work:

After injury, the brain forms new neural connections (BDNF-dependent synaptic plasticity).
Proprioceptive training (balance, unstable platforms) activates the cerebellum and sensorimotor cortex.

BDNF

How is BDNF related to hip rehabilitation?

Physical exercise (especially aerobic and coordination exercise) increases BDNF levels in the blood and brain (Cotman, 2007).

This accelerates:

Recovery of proprioception (joint sense).
Adaptation of motor areas of the cortex to new movement conditions.

Example: In post-endoprosthetic patients, balance training increases BDNF, improving muscle control (Mang et al., 2016).

Factors that decrease BDNF:

Hypodynamia, chronic stress, sleep deficiency.

BDNF is the molecular basis of neuroplasticity, which explains why the Dicul's method is effective in restoring motor function.

Scientific reasons for strict adherence to the timing and stages of Dikul's rehabilitation programme¶

From a physiological point of view, shortening the rehabilitation period or disrupting the sequence of stages of the Dikul's programme leads to an imbalance between the mechanical load and the biological capacity of the tissues.

Bone regeneration, for example, requires a strictly defined time for bone callus formation: premature increase of load (e.g. early axial load after a pelvic fracture) provokes micro-mobility of the fragments, activating osteoclasts and slowing down mineralisation.

Research

Research (Marsell, 2011) shows that disruption of this process increases the risk of a false joint by 23%.

Similarly, in cartilage in coxarthrosis, the accelerated introduction of strength training exercises without prior training increases the expression of matrix metalloproteinases (MMP-13) that degrade type II collagen.

Neuromuscular consequences of stage failure¶

Dikul's method is based on the principle of gradual neuroadaptation, where each stage corresponds to a specific task: firstly, restoration of blood flow and range of motion, then muscle strengthening, and only then - functional loads. Skipping the stages disrupts the formation of new motor stereotypes.

For example, when patients move early to strength training after endoprosthetics without restoring proprioception, they compensate for muscle weakness with incorrect movement patterns (e.g., claudication), leading to joint overload and chronic pain syndrome.

EMG experiments confirm: these patients have 40% reduced gluteal muscle activity compared to those who followed the programme.

Risks of long-term complications¶

Disruption of the rehabilitation sequence triggers a cascade of pathological changes:

Muscle imbalance → asymmetric loading of the joint → accelerated osteoarthritis.
Soft tissue fibrosis due to insufficient early mobilisation → contractures.
Central sensitisation (hyperexcitability of the nervous system) by forcing loads through pain.

Clinical studies

Clinical data (Dijkstra et al., 2020) demonstrate: patients who have shortened rehabilitation after hip arthroscopy have a 2-fold higher risk of reoperation.

Important

Physiological processes of regeneration are non-linear and require an exact match of the load to the capacity of the tissues. Dikul's method is scientifically based: it takes into account its stages:

Time for angiogenesis (3-4 weeks),
Period of bone remodelling (3-6 months),
Neuroplasticity (6-12 months).

Failure of this logic negates the benefits of kinesiotherapy and increases the risk of disability.

Welcome to our Dikul's Method Rehabilitation Centre!¶

If you or your loved ones have experienced pelvic or hip injuries or degenerative diseases, we are here to help you regain mobility and quality of life!

Our centre offers:¶

✅ Individual programmes - tailored to your diagnosis, age and physical condition.
✅ Specialist supervision - rehabilitation therapists, neurologists and orthopaedists accompany every stage of recovery.
✅ Scientifically based approach - strict adherence to the physiological timing and stages of rehabilitation.
✅ Modern equipment - mechanotherapy equipment, balance training and adaptive loading systems.

Don't delay your recovery!¶

After surgery (endoprosthetics, arthroscopy)
For arthrosis, osteoporosis, fracture consequences
For prevention of complications and return to activity.