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HIP ALIGNMENT AND REBALANCING STRATEGIES

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)

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HIP ALIGNMENT AND REBALANCING STRATEGIES

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  1. HIP ALIGNMENT AND REBALANCING STRATEGIES HIP ALIGNMENT AND RE-BALANCING STRATEGIES By: Scott Adams, BHK, MA, ATC, CES

  2. 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

  3. Scott Adams, BHK, MA, ATC, CES • Career Path • 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)

  4. 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

  5. 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

  6. ANATOMY REVIEW Source: www.medical-illustrations.ca

  7. ANATOMY REVIEW

  8. ANATOMY REVIEW • Prime Movers of Flexion • TFL • Pectineus • Sartorius • Gracilis • Illopsoas Courtesy of ImageRepository.net

  9. ANATOMY REVIEW • Prime Movers of Extension • Gluteus Maximus • Hamstrings • Adductor Magnus (posterior region)

  10. ANATOMY REVIEW • Prime Movers of Adduction • Adductor Longus • Adductor Brevis • Adductor Magnus • Gracilis www.medmeshop.com

  11. ANATOMY REVIEW • Prime Movers of Abduction • Gluteus Medius • Gluteus Minimus http://files.myopera.com/sanshan/blog/piriformis.gif

  12. ANATOMY REVIEW • Prime Movers of Inward Rotation • Gluteus Minimus • Tensor Fascia Lata

  13. ANATOMY REVIEW www.aroundhawaii.com • Prime Movers of Outward Rotation • Gluteus Maximus • Piriformis • Obturator Externus • Obterator Internus • Superior Gemellus • Inferior Gemellus • Quadratus Femoris • Gluteus Medius

  14. 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

  15. ANATOMY REVIEW

  16. CHRONIC CONTRACTORS • Muscles that are constantly contracted • Constant state of fatigue • May be the primary site of a breakdown leading to chronic injury

  17. 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

  18. CHEST MUSCLES • Pre and post treatment of releasing the chest muscles • Note: Hip position http://www.hellerworkstructuralintegration.com/assets/images/client_photos.jpg

  19. MOVEMENT DIFFERENCES

  20. MOVEMENT DIFFERENCES

  21. MOVEMENT DIFFERENCES

  22. ASSESSING HIP ORIENTATION • Athlete Supine • Hips and knees bent

  23. ASSESSING HIP ORIENTATION • Perform three bridges

  24. ASSESSING HIP ORIENTATION • Gently return the athlete to a supine position with the legs resting on the table

  25. ASSESSING HIP ORIENTATION • Landmark the ASIS • Compare left vs. right • Note variation in the height of each

  26. ASSESSING HIP ORIENTATION • Have the athlete move into a prone position • Landmark the PSIS • Compare left vs. right

  27. ASSESSING HIP ORIENTATION • Note leg lengths • Gives an insight if an up-shift has occurred • This will not show a true anatomical leg length

  28. ASSESSING HIP ORIENTATION • RESULTS • If ASIS and PSIS are even, the hips are in a balanced position

  29. ASSESSING HIP ORIENTATION • IF ASIS on one side is high, and PSIS on opposite side is high -> we have a rotation of the hips

  30. ASSESSING HIP ORIENTATION • If the ASIS and PSIS are elevated on the same side -> an up-shift has occurred

  31. 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

  32. CORRECTING HIP ORIENTATION • Rotation • Break arm method • Up-Shift • Distraction method • Flairs • Abduction contraction

  33. 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

  34. 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

  35. 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

  36. THANK YOU

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