HIP ALIGNMENT AND REBALANCING STRATEGIES

HIP ALIGNMENT AND RE-BALANCING STRATEGIESBy: 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•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

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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.medical-illustrations.ca

ANATOMY REVIEW

ANATOMY REVIEW

• Prime Movers of Flexion– TFL– Pectineus– Sartorius– Gracilis– Illopsoas

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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

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ANATOMY REVIEW

• Prime Movers of Abduction– Gluteus Medius– Gluteus Minimus

http://files.myopera.com/sanshan/blog/piriformis.gif

ANATOMY REVIEW

• Prime Movers of Inward Rotation– Gluteus Minimus– Tensor Fascia Lata

ANATOMY REVIEW

• Prime Movers of Outward Rotation– Gluteus Maximus– Piriformis– Obturator Externus– Obterator Internus– Superior Gemellus– Inferior Gemellus– Quadratus Femoris– Gluteus Medius

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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

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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