4/21/2008

Outline

MarkMcKean k
Dip.T(HPE/Sc),CSCS,Level2ASCA, MAAESS,AEP,PhDCandidate

IdealPostureofthehips AssessingHipconditions Dealingwithspecifichipconditions

PalpationBony
Iliaccrest Anteriorsuperioriliac spine(ASIS) Anteriorinferioriliac spin(AIIS) Posteriorsuperioriliac spine(PSIS) Pubicsymphysis Ischialtuberosity Greatertrochanter Femoralneck Posterinferioriliac spine(PIIS)

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Observation
Symmetry hips,pelvistilt(anterior/posterior)
Lordosisorflatback

Sagittalplane SideView
Alignment
Centrelinepassesjustanterioroflateralmaleolusof ankle Centrelinepassesjustinfrontofthecentreofthe kneejoint Centrelinepassesjustbehindthecentreofthehip C li j b hi d h f h hi joint Centrelinepassesthroughthecentreofthelumbar vertebraebodies

Lowerlimbalignment
Knees,patella,feet Knees patella feet

Pelviclandmarks(ASIS,PSIS,iliaccrest) Standingononeleg
Pubicsymphisuspainordropononeside

Observations
Lumbarspinenormalcurveslightlyconvextofront Pelvisinneutral ASISandSymphysisPubisin verticalalignment Hipjointsneutral notflexedorextended Kneejointsneutral notflexedorhyperextended

Ambulation
Walking,sitting painwillresultinmovementdistortion

FrontalPlane
Alignment
Centrelinepassesthroughumbilicus Centrelinepassesthroughsymphysispubis Centrelinefallscentrallybetweenkneesandankles

NormalRangesofMotion
Hip Flexion 1250 Extension 100 Abduction 450 Adduction 100 Lateralrotation 450 Medialrotation 450 Knee Flexion 1400 Extension 00 Ankle PlantarFlexion 450 DorsiFlexion 200

Observations Fronton Observations

Hipinneutral notadductedorabducted ASISlevelLR Kneecapsfacingfront Footslightlyturnedout

Observationsfromrear
Lumbarspinestraight PSISlevelLR Legsstraight notbowedorknockkneed Tendonofgastrocnemiusstraightintocalcaneus

2AcceptedStructuralVariations
LowpositionofASISinwomenoftenmisinterpreted asanteriorpelvictilt 2. Flatbackinmenwithatallpelvismisinterpretedas posteriortiltwhenASISishigherthanbeltline
1.

Horizontalangleofupto150 differencebetweenASIS andPSISwhenASISandSymphisusPubisaligned verticallyhasbeenfound.

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2Outof3RuleforPelvicTilt
Becauseofthesepotentialsourcesoferrorinassessing pelvictilt,youshouldusethe2outof3rule. Youneedtofindatleast2ofthese3conditionspresent beforeyoucansaythatthepelvictiltisacquiredandnot structural l
Anincreaseordecreaseinnormaldepthoflumbarcurve Ananglegreaterthan200 betweentheASISandPSIS Anincreaseordecreaseinthehipjointangleaslongasknees remainneutrallyaligned
Anotheroptionistoreturnthepelvistowhatyouconsidertobeitscorrect alignmentandseeifoverallalignmentimprovestheaffectedjoints.Ifincorrect changesoccurasaresultofthepelviccorrection,theproblemcouldbe structuralandnotacquired.

PelvicTilts
Anteriortilt (2outof3)
morethan200 anglebetweenASIS PSIS Increaseinnormallumbarcurve Increaseinhipjointanglewithneutralknees I i hi j i l i h lk

Posteriortilt (2outof3)
ASISishigherthanPSIS Decreaseinlumbarcurve Decreaseinhipanglethroughtoextension

SwayBackPosture
Flatteningoflumbarspine Posteriortilt Hipjointhyperextended Pelvisforwardofcentralline Kneejointshyperextended Glutealatrophy

Palpatebonylandmarks Checkfor2outof3rule Correctpostureandobservechanges

ExercisePrescriptionPelvicTilt
AnteriorTilt
Shorten
Hamstrings Gluteusmaximus Externaloblique Quadratuslumborum*

ExercisePrescriptionSwayBack
Shorten
Onejointhipflexors Externalobliques Thoracicextensors Neckflexors

PosteriorTilt
Shorten
Onejointhipflexors Externalobliques q Quadriceps

Lengthen
Hamstrings Internaloblique Rectusabdominis intercostals Adductorgroup*

Lengthen
Iliopsoas Quadriceps

Lengthen
Hamstrings Internaloblique Rectusabdominis Intercostals

Strengthen
VMO Gluteusmedius

Strengthen
VMO* AnteriorGlutemedius Lateralhiprotators

Strengthen
Medialhiprotators*

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PoorGlutealDevelopment
Atrophyofgluteals Associatedwithdeceasein performanceofotherhipextensor muscles 80%ofglutemaxinsertsintoITB.
Weakglutemaxmayleadtotighter misalignedITB TightGlutemaxmayleadtorestricted hipadductionandmedialrotation

HipExtension
Actionofthehamstringsismoredominantthanglute max Hamstringsactivatefirstinpronehipextension Glutemaxdoesntreallybunchuptillfullhip Gl d ll b h illf llhi extension Research1977 Consistentmusclefiringorderof ipsilaterallumbarerectorspinae,semitendinosus, contralaterallumbarerectorspinae,tensorfasciae latae,andgluteusmaximusdemonstratethe characteristicpatterninpronehipextension

ExercisePrescriptionPoorGlutes

Observenormalposture Observeglutedevelopment Observesecondarychangestopelvis Haveyourfriendperformpronehip extension/pronebackextension

Correctpelvicangleifacquiredpoorposition Assesshamstringlengththroughpassive/activeleg raiseROMtestorstandingforwardbendtest Stretchhamstringsifrequired Stretchhamstringsifrequired antigravityand passivefullbodyposition Startgettingglutesaccustomedtocontracting often justgettingthemtoworkishardenoughtask,(dont worryifnotinisolation) Provideexerciseswheretherangeofmotionthatneed glutestoworkoutoffulldepthhipflexion squatand derivatives(allowpelvistotiltatbottomofsquats)

Antetorsion
Increaseinangleoftorsion
Theangleoftheheadandneckofthefemuris rotatedanteriorly Mayhaveexcessivemedialhiprotationand knockknees LikestositinWposition Mayhaveexcessivelateraltibialtorsion Crossleggedsittingorstretchinglaterallymay causeseverepain

Retrotorsion
Decreaseinangleoftorsion
Theangleoftheheadandneckofthefemurrotates posteriorlywithrespecttotheshaft Mayhaveexcessivelateralhiprotation Mayhavefeetturnedoutduckwalk Menliketositwithlegcrossedatankle Morecommoninmenthanwomen

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MedialRotation
WeakGlutesandstrongTFL/tightITBcan alsocausemedialhiprotation
Canbeobservedinwalking Tightmedialrotatorscanbetestedinseated Ti ht di l t t b t t di t d position Weakmedialrotatorsallowlegstofallopen insupinelying Passivehipflexioncausesanincreasein medialrotationifmedialrotatorsaretight

LiePronewithkneebentsothemusclesthatlimit medialrotationarenottight Rotatethighmediallyandlaterallyandobserveif AntetorsionandRetrotorsionarepresent

ExercisePrescriptionMedialRotation
Ensuretightnessorweaknessisfrommuscleandsoft tissuesalonebytestingforante/retrotorsion Lengthenrotatorsthroughlightantigravitystretches aggressivestretchingwillbelesseffective Correctallpatternsofmovementinexerciseslikethe squat,lunge,stepupbyreducingloadsandensuring properalignmentinmovements(reducerangeifrequired toensurecorrectpatterns) StrengthenVMO/anteriorGluteMediusifmedialrotators aretight Strengthenmedialrotatorsandadductorsiflateralrotators tight
Strength&MovementConsulting @ Email mark@markmckean.com Web www.markmckean.com IntellifitnessSoftware Email mark.mckean@intellifitness.com Web www.intellifitness.com Phone +61754792419 Mobile +61403353470