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Core Hip and Slings -Intelligent prescription
PRESENTED BY:Max MARTIN BAppSc (Hons) AEP
Prescription Paradigms
Movement is a behaviourDevelopmental and learned
Quality over quantity
Posture is a good baseline for movement
Posture is not the cause of dysfunction but a SYMPTOM
Such dysfunction corresponds to compromised activity of musclesStabilisers typically become hypotonic/inhibited – ‘allowing’ faulty posture
Gross movers typically become hypertonic/facilitated – ‘driving’ faulty posture
tightness weakness
antagonist
synergist
Why weakness?
Muscle inhibition due to pain/injury
Muscle susceptibility – eg. VMO vs VL atrophy post surgery
Muscle inactivity in chronic postures – eg. Sedentary behaviours
CNS driven protection
Why tightness?Joint ROM can be limited by the following factors
1. Joint constraints
2. connective tissue (40%) – protective, inactivity,
hypertonicity
3. Neurogenic constraints (voluntary and reflexive) -
protective
4. Myogenic constraints – overload protective
tightness?
Or
gaining stability??
tightness weakness
antagonist
synergist
Hamstrings
Glute max
Hip Flexors• Psoas• Iliacus• TFL• Rec femLumbar Erectors
Glute max
TrA (+core)
Clinical/Practical findings
Prescription Paradigms
Joint by joint approach
Ankle
Foot
Knee
Hip
Lx Spine
Tx Spine
Scapula
GH Joint
Mobile
Stable
Stable
Mobile
Stable
Mobile
Stable
Mobile
Stiff
unstable
unstable
Stiff
unstable
Stiff
unstable
Stiff
CORE Anatomy
The research journey1992: TrA found to exhibit anticipatory function (activation prior to activation of prime movers in arm movements) in healthy subjects (Cresswell)
1996-97: TrA disrupted in multi-directional arm movements in LBP subjects
1998: TrA also disrupted in lower limb movements among LBP patients
2001: TrA latency in LBP patients shown to increase with increasing task demand
2001: Experimentally induced pain causes disruption (hypoactivity) in the TrA
2002: TrA contraction shown to increase stiffness of the sacro-illiac joint to a greater extent than a more global abdominal contraction
2007: Pelvic floor shown to share the same pre-emptive quality as TrA and MU
2009: LBP patients shown to have greater lumbo-pelvic instability in simple open-chain stability exercises (eg Leg Loads) compared to controls.
Lumbar Vertebrae
Largest and strongest due to compressive load.Cortical bone shell with cancellous bone core (trabeculae). Vertical Column alignment.
Aids shock absorption quality of L1-5. Age and repetitious loading degenerate horizontal trabeculae ‘struts’
Lumbar facet joints
Bony articulations between vertebrae.
Synovial Joints- articular surfaces covered in hyaline cartilage.
Allow flexion and extension
Movement pumps fluid in and out of joint space. Fixed postures lead to joint dehydration and degeneration.
Constant compression caused by hypertonicity of paraspinals can accelerate degeneration.
Sacroiliac Joints
Junction point between spine and pelvis.
Synovial Joint- innervated by pain receptors.
Corrugated design to assist stability.
Allows forward and backward tilting of the sacrum.
Sublaxation possible, resulting in dull ache or sharp pain that may refer inferiorly.
Intervertebral Discs
Colloidal gel nucleus
Concentric rings of fibrocartilage (lamellae) form the annulus.
Outer third ONLY innervated by pain and mechanoreceptors.
Slight movement of the vertebrae helps rehydrate discs.
Repetitious torsion forces can derange annulus, allowing nucleus to seep out.
Late warning of this process due to lack of pain receptors amongst inner 2/3 of annulus.
Intervertebral Discs Cont’d
Discs are poor shock absorbers– Very little compressive potential– Nucleus facilitates movement rather
than compression
Thoracolumbar Fascia
Dense multilayered sheet of connective tissue.
Insertion point for many muscles
Overactive lats and/or glutes can cause excess collagen deposition, making TLF more stiff.
This can restrict the ability of TrA to slide freely as it pulls on deep layer.
Transversus Abdominis
Transversus Abdominis
Intra-abdominal pressure, thus making this area more stiff (less bendable).Increases the stiffness of thoraco-lumbar fascia and abdominal aponeurosis.Line of pull helps to align the ribs and pelvis in anatomically correct Fibres crossing the sacroiliac joints pull the Ilium and the sacrum closer together, decreasing laxity in these joints.
Gluteus Maximus
Primary hip extensor and external rotator*Important for maintaining upright postureStabiliser of SIJ via attachment to TLFSupports hip and knee via ITB attachmentFunctional role in stepping, running, climbing etc. and…DECELERATION
Gluteus MediusPrimary abductor and controller of rotation of the hip*Functionally supports pelvis during SL stance and gait Plays rotator cuff-like roleStrongest in neutral or slight adduction
Tensor Fascia Latae
Primary functions are hip flexion, internal rotation and abduction (via ITB)Works in synergy with glute max:
Tighten ITB to extend knee jointControl movements of pelvis on femur and femur on tibia when weight bearing
Iliotibial Band
Thick, lateral aspect of fascia lataAttachment point for glute max, TFL (and glute med)Indirect insertion onto patellaAnatomically impossible to stretch effectively
Piriformis & External Hip Rotators
Primarily lateral rotator of the hipIn hip flexion, will also abduct the hipSecondary phasic stabiliser of the SIJ Close relationship to sciatic nerve
Piriformis syndrome
Vastus Medialis & Lateralis
Primary action is knee extension in inner range- 15-20deg of knee flexionProvide medial and lateral stability to patella respectivelyPerform anticipatory roleOften dysfunctional (knee pain, pronation)
Single Legged Squat
Functional strength exerciseAssessment tool
SLSq Research (performance and strength)
Wilson et al (2006) Frontal Plane Projection Angle measured (FPPA) Women > FPPA Weakness in external rotators correlated most closely to
FPPA (predisposes to ACL injury & PFP)Claiborne et al (2006) Hip abductor strength most important for resisting
valgus alignmentCrossley, 2006 Glute med shown to be latent in poor SLQ Abduction strength and Trendelenburg test shows
correlation to SLSq
Slings
Superficial Front Line
Thomas Myers- Anatomy Trains
Superficial Back Line
Spiral Line
Correctives!!
Core exercises:Leg loads (ant oblique, ant superficial and Spiral)hip extension (post oblique and posterior superficial)Hip lifts/SL (post oblique and post superficial)Hip exercises:Squat (posterior superficial),SL DL (Lateral), hitches (lateral) and Rots (posterior and anterior oblique), SL SQ (lateral)
