Transcript Hip Alignment and Rebalancing Strategies - PHATS

HIP ALIGNMENT AND
REBALANCING STRATEGIES
HIP ALIGNMENT AND RE-BALANCING
STRATEGIES
By: Scott Adams, BHK, MA, ATC, CES
Scott Adams, BHK, MA, ATC, CES
• Educational Background
– University of Windsor - Bachelors of Human
Kinetics (Kinesiology)
– University of Nebraska Omaha - Masters in
Athletic Training
– Corrective Exercise Specialist
– Survival Operating Systems – Level I
Scott Adams, BHK, MA, ATC, CES
• Career Path
•
•
•
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LaSalle Physiotherapy and Rehabilitation Centers
St. Clair College
Accelerated Rehabilitation Centers
Windsor Spitfires Hockey Club (Ontario Hockey
League)
• Johnstown Chiefs (East Coast Hockey League)
• Pittsburgh Penguins (National Hockey League)
HIP ALIGNMENT AND RE-BALANCING
STRATEGIES
• Topics to Review
–Review Hip Anatomy
–Assessment of alignment
–Un-Balancing of the Hips
–Re-Balancing of the Hips
Courtesy of www.stonetemplesanctuary.com
ANATOMY REVIEW
• Hip Joint
– Multi-axial ball and socket synovial joint between the
head of the femur and the acetabulum
– Fibrous Capsule – capsule incomplete posteriorly
– Ligaments – illiofemoral, pubofemoral, ischiofemoral
– Intracapsular – ligament of the head of the femur
(very weak)
– Retinacula
ANATOMY REVIEW
Source: www.medicalillustrations.ca
ANATOMY REVIEW
ANATOMY REVIEW
• Prime Movers
of Flexion
– TFL
– Pectineus
– Sartorius
– Gracilis
– Illopsoas
Courtesy of ImageRepository.net
ANATOMY REVIEW
• Prime Movers of
Extension
– Gluteus Maximus
– Hamstrings
– Adductor Magnus
(posterior region)
ANATOMY REVIEW
• Prime Movers of
Adduction
– Adductor Longus
– Adductor Brevis
– Adductor Magnus
– Gracilis
www.medmeshop.com
ANATOMY REVIEW
• Prime Movers of
Abduction
– Gluteus Medius
– Gluteus Minimus
http://files.myopera.com/san
shan/blog/piriformis.gif
ANATOMY REVIEW
• Prime Movers of
Inward Rotation
– Gluteus Minimus
– Tensor Fascia Lata
ANATOMY REVIEW
• Prime Movers of
Outward Rotation
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Gluteus Maximus
Piriformis
Obturator Externus
Obterator Internus
Superior Gemellus
Inferior Gemellus
Quadratus Femoris
Gluteus Medius
www.aroundhawaii.com
ANATOMY REVIEW
• Reference Points for Rotation
– ASIS and PSIS
– We are going to use these two
reference points to determine
the athletes current resting
position
ANATOMY REVIEW
CHRONIC CONTRACTORS
• Muscles that are
constantly contracted
• Constant state of
fatigue
• May be the primary site
of a breakdown leading
to chronic injury
UNDERACTIVE MUSCLES
• Muscles that are “lazy”
• They don’t need to
work because
something is working
for them
• Compensation
patterns formed
• Leads to chronic injury
CHEST MUSCLES
• Pre and
post
treatment
of
releasing
the chest
muscles
• Note: Hip
position
http://www.hellerworkstructuralintegration.
com/assets/images/client_photos.jpg
MOVEMENT DIFFERENCES
MOVEMENT DIFFERENCES
MOVEMENT DIFFERENCES
ASSESSING HIP ORIENTATION
• Athlete Supine
• Hips and knees bent
ASSESSING HIP ORIENTATION
• Perform three
bridges
ASSESSING HIP ORIENTATION
• Gently return the athlete to a supine
position with the legs resting on the table
ASSESSING HIP ORIENTATION
• Landmark the ASIS
– Compare left vs. right
– Note variation in the
height of each
ASSESSING HIP ORIENTATION
• Have the athlete
move into a prone
position
• Landmark the PSIS
– Compare left vs. right
ASSESSING HIP ORIENTATION
• Note leg lengths
• Gives an insight if an
up-shift has occurred
• This will not show a true
anatomical leg length
ASSESSING HIP ORIENTATION
• RESULTS
– If ASIS and PSIS are even, the hips are in a
balanced position
ASSESSING HIP ORIENTATION
• IF ASIS on one side is high, and PSIS on
opposite side is high -> we have a rotation
of the hips
ASSESSING HIP ORIENTATION
• If the ASIS and PSIS are elevated on the
same side -> an up-shift has occurred
ASSESSING HIP ORIENTATION
• If the PSIS or ASIS on the same side are a
different distance away from the midline ->
an out-flair or in-flair has occurred
CORRECTING HIP ORIENTATION
• Rotation
– Break arm method
• Up-Shift
– Distraction method
• Flairs
– Abduction contraction
CORRECTING HIP ORIENTATION
• Perform corrective strategy
• Have patient remain supine, hips and knees
bent as in starting position
• Perform 3 reps of isometric contractions and
different angles (adduction and abduction)
• Perform 3 bridges
• Return to original position and re-assess in
supine
CORRECTING HIP ORIENTATION
• Focus on lengthening “chronic contractors”
– Massage, myofascial stretching, etc
• Awaken “underactive” muscles
– Isolated muscle strengthening
• Integrate into movements
– Squats, lunges, rotational movements
• Integrate into sport-specific movements
CORRECTING HIP ORIENTATION
• REMEMBER
– The role fascia plays
on chronic muscles > the hip flexor may
not be the true
source of dysfunction
-> look up and down
the movement chain
THANK YOU