Treatment Changes

A step-up requires less posterior shift of the free hip than a full single-leg squat off a box. Step-ups and single-leg squats sit on a continuum defined by posterior rotation and free-hip shift. Disease activity measured by DAS28-4 using erythrocyte sedimentation rate was not significantly correlated with treatment changes. The median time until the next treatment change shortened with each successive change, from 207 days before the first change to 165 days before the fourth. Keeping the free leg in front during a step-up drives the working-side hip forward and creates opening. Intolerance was the strongest predictor of any treatment change, with a hazard ratio of 4.43, followed by lack of efficacy with a hazard ratio of 3.30. Step-up or switch was the most common first treatment change, occurring in 38% of patients. Overall, 53% of patients experienced at least one treatment change during the 24-month study. Step-up progression can be used therapeutically for pelvic asymmetry by driving rotation and opening on a restricted side. The cross-back step-up is used when an athlete needs more rotation toward a restricted side through cross-body mechanics.