Hinge Theory Case Study · 2020. 3. 30. · Hinge Theory: Case Study Analysis Gina Ponge Angele,...
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8/1/17 1 Hinge Theory: Case Study Analysis Gina Ponge8 Angele8, MPT, MA, CSCS, ART-Cert. Brooke Boehmer, SPT 2017 Permissions •No part, whole, concept, picture or quote may be reproduced without express wriLen consent of Gina Ponge8 Angele8 •This is for educaNon purposes only and non diagnosNc. ConsulNng with medical team as to personal prescripNon of exercise and goals is necessary and this handout does not replace proper medical treatment •Users hold MedGym, LLC and Gina Ponge8 Angele8 harmless for all use and effects About Hinge Theory • Normal spine moNon is an equally force dispersed curve • Arch happens from hand to foot –Hips, spine, and shoulders need to share the stress •PosiNon will happen anyway and force will find the easiest path of least resistance –In an athlete that demands an arch posiNon usually focuses between L3 and S1 •In gymnasNcs, spine flexibility is forced and hip and shoulder are oWen overlooked ENology of GymnasNcs Biomechanics • Balance between strength and flexibility – ex. hip flexors have to be very strong yet demanded flexibility with the acro and dance elements – ex. shoulders: oWen the athlete will get stronger without balancing that strength with ROM – naturally, the lumbar spine lordosis but an arch posiNon requires a reversal of thoracic kyphosis and pelvic and SI involvement Outline • 1. Standing anatomy • 2. AcNve Extension TesNng • 3. ResNng Supine Hip • 4. ResNng Supine Shoulder • 5. Prone Shoulder AcNve ROM/Strength Fight • 6. Thomas RelaNve Ilium Flexibility • 7. Sport Specific • 8. Injury PredicNon • 9. Skill LimitaNon • 10. Phase IA: Stretches • 11. Phase IB: Strength (TBC) 1. Standing Anatomy • Hip flexors Nght, leads to: – LordoNc curve increase – Anteriorly Npped pelvis – Excessive thoracic khyphosis due to compensatory paLern in spine with L/K alternaNng “balance” to verNcal and center of gravity alignment • Effects: – VerNcal posiNoning in standing and handstand
Transcript of Hinge Theory Case Study · 2020. 3. 30. · Hinge Theory: Case Study Analysis Gina Ponge Angele,...
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HingeTheory:CaseStudyAnalysis
GinaPonge8Angele8,MPT,MA,CSCS,ART-Cert.
BrookeBoehmer,SPT2017
Permissions• Nopart,whole,concept,pictureorquotemaybereproducedwithoutexpresswriLenconsentofGinaPonge8Angele8
• ThisisforeducaNonpurposesonlyandnondiagnosNc.ConsulNngwithmedicalteamastopersonalprescripNonofexerciseandgoalsisnecessaryandthishandoutdoesnotreplacepropermedicaltreatment
• UsersholdMedGym,LLCandGinaPonge8Angele8harmlessforalluseandeffects
AboutHingeTheory
• NormalspinemoNonisanequallyforcedispersedcurve
• Archhappensfromhandtofoot– Hips,spine,andshouldersneedtosharethestress
• PosiNonwillhappenanywayandforcewillfindtheeasiestpathofleastresistance
– InanathletethatdemandsanarchposiNonusuallyfocusesbetweenL3andS1
• IngymnasNcs,spineflexibilityisforcedandhipandshoulderareoWenoverlooked
ENologyofGymnasNcsBiomechanics
• Balancebetweenstrengthandflexibility– ex.hipflexorshavetobeverystrongyetdemandedflexibilitywiththeacroanddanceelements
– ex.shoulders:oWentheathletewillgetstrongerwithoutbalancingthatstrengthwithROM
– naturally,thelumbarspinelordosisbutanarchposiNonrequiresareversalofthoracickyphosisandpelvicandSIinvolvement
Outline• 1.Standinganatomy• 2.AcNveExtensionTesNng• 3.ResNngSupineHip• 4.ResNngSupineShoulder• 5.ProneShoulderAcNveROM/StrengthFight• 6.ThomasRelaNveIliumFlexibility• 7.SportSpecific• 8.InjuryPredicNon• 9.SkillLimitaNon• 10.PhaseIA:Stretches• 11.PhaseIB:Strength(TBC)
1.StandingAnatomy
• HipflexorsNght,leadsto:– LordoNccurveincrease– AnteriorlyNppedpelvis– ExcessivethoracickhyphosisduetocompensatorypaLerninspinewithL/KalternaNng“balance”toverNcalandcenterofgravityalignment
• Effects:– VerNcalposiNoninginstandingandhandstand
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1b.Handstand
• Upsidedownstanding• Ifit’sbadinstanding,itwillbejustasbadinhandstand
– Requiresstrengthtocounterthepassiverangeissues
– AbdominalstrengthandunderstandingofneutralposiNoningiskeyinverNcality
2.AcNveExtensionTesNng
• Standingposture:– Tighthipflexors– Increasedlumbarlordosis
• AcNveextension:– Hipextension– Flatthoracicspine– Hingepointwheremovementiscomingfrom
– Flatlumbarspine
AcNveextension160degreesres*nghipflexion-*ghtnessleadstoanteriorpelvic*lt Visualhingingpresent
AnatomicalDominoEffect
1. Howyoustandpredictswhatyourhandstandwilllooklike
2. HowyoustandpredictstheincreasedamountofGRFthatwillbelosttoalackofbeing“stacked”
3. Lordosisleadstohipflexion,leadstohyperextendedortonicparaspinals,leadstoincreasedsacralflexion,leadstodecreasedglutealacNvaNon…..andon...
WhyTightness?
• PsoasaLachments:– T10-Lumbar– AnteriorshiWing“moment”tothelumbarspine,leadingtorelaNvelordosis
– Specialconcernforspondycategory:conundrum• Needtolengthenthepsoasbutyoucan’tstretchit
• ExtensorseriesadapNveshortening– QL:unilateralsideflexorbutbilateralspineextensor– ILS:unilateralextension– MulNfidi:powerfulintersegmentalsecondaryextensorwhencontractedbilaterally
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PrimarySpinalPosiNoningReversal
• ImportantforrelaNveintersegmentalmoNon• PosiNonsinsports,andinflexibility,demandreversaloftheseadapNvelyshortenedposiNons
• Lordosisneedstoatleastbeabletobeneutralized
• KyphoNcTspineaswellneedstobeneutralized• Extensionthoracic(total-nonsegmental)between30-45(researchmeta-analysis)
• NutaNon/CounternutaNonconcept:asLordosisincreases,sacralkyphosisincreases
Rangeofmo*onofthoracicspineinsagi=alplane
EurSpineJ(2014)23:673-678
3.ResNngSupineHip
• Unabletomaintainflatspineinsupinewithshoulderflexion– AnteriorpelvicNlt– Hipflexionpresent
• Goniometricmeasure:– FemoralshaWtopelvicNlt
• DifferencesinstandingvssupineposiNoning– Ifposturalmusclesareremoved,anNcipatedlordoNcmeasuresshoulddecrease
4.SupineShoulderPROM
• Shoulderflexionangle– Goniometricmeasure:
• HumerustoribNltangle
• Unabletomaintainflatspineinsupine– Lackofpassiveshoulderflexionrange– Forcedlordosisduetohipflexion– Integrityofthejoint
Measure-Supine163degrees
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ENologyofLackofShFlex1. Lackofpassiveshoulderflexionrange(like
overheadextension)1. Subscapularis,laNssimusdorsi,teresmajorand
minor,pecmajor,posteriorfibersofdeltoid2. Forcedlordosisduetohipflexion
1. LumbarlordosiseffectsposiNonofrib“Nlt”duetosharedmusculature,includingverNcallengthofPSP
3. Integrityofthejoint1. Capsule2. Labrum3. Jointmobilityofthehumeralhead4. Focus:abilityforinferiorglide
4A.AngleSimilarity• EvenwithpaNentinperfectneutralspine,“angle”ofhum/ribstayssame
– Measurementrocking• ShoulderflexionROMkeepspineflatonthetable– AtNmesmayevendecreaseduetoacNvaNonofintercostals,leadingtoincreasedrelaNveanteriorhipNlNngduetoapproximaNonofribs
• Precursortohandstandissues,lackofverNcality(Jengastacked,whetherstandingorinverted)
MeasureinPelvicNeutral 5.ProneAROMtesNng
• ShoulderflexionROMkeepingchestflat• AlsotesNngshoulderstrength• ROMislessinpronethaninsupine
– Strengthcomponentaswellisadded• CompensaNonsseen:
– Hyperextensionoflumbar– **Followthegoniometerlandmarks,measurewillliterally“see-saw”andbesame
Pronechestflat-136Degrees LackofHipExtension
• HipflexorNghtness• JointcapsulelimitaNon• SIjointdysfuncNon• TailbonedysfuncNon• Labraltearissues• EasiestgeneralassessmenttoolisThomasstretchbecauseit’sfuncNonal
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Thomas AssessmentofFuncNonalBridge/Arch
• Thingswearelookingfor:– Openhipangle:goalof20-30degrees– Shoulderangle:atleast20degreesfromthoracicspineand20-30degreesfromglenohumeral– Smoothcurveofthespine:45-60degrees
Feetasclosetohands:92degreestotalat3LumbarLevels!!!! What’swrongwiththispicture?
• Openhipangle• HingepointinspinesNllpresent• Noshoulderangle
Holdingfeetfromsliding-same,92d 7.Sport-Specific• GymnasNcsrequires:
– 30Degreesoftruehipextension(arabesqueposiNon,backlegleap,etcaLainedwithcombinaNonoflordosis,hipNltandtruehipflexorandcapsularflexibility)
– Upto210degreesofshoulderflexion• ALainedbyreversalofthoracickyphosis,trueshoulderextensormuscleflexibilityintoflexion,GHjointintegrityandavailableROMwithoutcompromisingstabilityrequirementsofthesamesport)
– SpineExtension• Actuallywantonly2-6degreespersegmentoflumbarspineforarch(T10-L1,L1-2,L2-3,L3-4,L4-5,L5-S1minimal)
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8.InjuryPredicNon• Spinalfractures/spondy
– Excessivestressonlumbarspine• Vertebralendplatefracture
– Excessivekyphosis• Shoulderimpingement
– LoadedoverheadacNviNesandweightbearingwithlackofflexibility
• Hiplabraltear– Poormechanicsleadingtoincreasedforcetoachieve
ROMnecessarytocompleteskills• Elbowissues
– Loadingwithpoorbiomechanics• WristandTFCC
– Loadingwithpoorbiomechanics
9.SkillLimitaNons
• General– Limitedforcedarching– Painwithskillsrequiringhyperextension– Difficultyachievinghipextensionwithbackwardkicksandleaps
– HandstandposiNonwillnotbestraightverNcal– Poundingandreboundingskills– OverheadposiNoningwillbealteredduetolackofaxillaryflexibility
9.SkillLimitaNons
• Vault– Difficultywithvaultentryduetolackofhandsge8ngtovaulttableandlackofarch
– Yurchenko– HandspringfrontvaultsbecauseofopNmalblockposiNoning
9.SkillLimitaNons• Bars
– AchievingverNcalhandstand• Blindchanges• PiroueLes• Baillandings
– Giants(verNcality)– Interbarwork
• Paksalto(openarchposiNon)• Shaposhnikova
– Frontgiants(difficulttolearnbecauselackofshoulderopening)
– Releasemoves• Tkatchev(replacementopNonofHindorfforRay)• Jaeger(replacementgienger)
9.SkillLimitaNons
• Beam– Back/frontwalkover,backhandspring(requiresopenshoulderposiNonandarch/curve)
– Frontaerial(requireshipextensiontoplacelandingfootunderneathgymnast)
– Achieving180degreesinjumpsorleap(lackofhipextension)
– AchievingverNcalhandstand• Presshandstand
9.SkillLimitaNons
• FloorExercise– Fronttumbling(openposiNoningrequiredforupwardtrajectory)
– Doublelayout(willbehollowinsteadofarched)– Abilitytoachieve180degreeleaporjumpswithproperform
• SheepjumpsorringposiNoningrequiresgreaterflexibilityof2-jointhipflexor
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10.PhaseIA:Stretches
• Startlengtheningmuscles– ThismustbedoneinparallelwithassessingandtreaNngjointandcapsuleintegrity
• AWeryougainmoNon,youmustthenstrengthenthejointinitsnewendrangetopreventstrainsandinjury
• GoalistocounterwhateverisprevenNngopeningofthejoint Teachingneutralpelvicposi*onforallexercises
BasedontheSahrmannbiofeedbackprogram,thegoalistoteachpelvicneutralespeciallytopeoplelivinginexcessivelordosis.NotonlyisthisforabdominalmuscletrainingbutpropriocepNvetrainingforribsandpelvisaswell.Ifthehipflexorsworkharderthantheabs,thespinelordoses.Iftheabsworkharderthanthespine,neutralismaintained
ProneShoulderFlexion• Layingonstomach
withchestandheadrelaxed,placearmsonahighersurface(box,StallBars,panelmat,etc.)
• Armsshouldbestraightandnothyperextendedasthiswillplacetoomuchstressonelbows
• Relaxthelowerspine
AcNveShoulderLiWing● Keepingchestflatontabletoprevent
hyperextensionofback,liDarmsabovehead
● Focusonscapsqueezing● Keepabs*ghttocounterarching
Roller• Startwithrollerinmid
back• Keephipsincontactwithground
• Archoverthetopwithhandsbehindnecktosupporthead
• RepeatinmulNplelocaNons(upanddown)oftheupperback
ArchOverswithSwissBall
● Archovertheballwithstraightelbows,armsbyears,andstraightenlegs● Touchhandstothefloor
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StraightArmSuperman● Layonstomach● Armsaboveheadin“Y”posi*onwith
thumbsturneduptowardceiling
● LiDarmsofffloorwithoutshruggingshoulders
● Keepchestflat.Donotarchback● Holdthisposi*on
BentArmSuperman● Layonstomach● Elbowsbentto90degreesand
shouldersabductedto90○ Armsina“fieldgoalpost”posi*on
● LiDarmsofffloorwithoutshruggingshoulders
● Keepchestflat.Donotarchback● Holdthisposi*on
ProneQuadStretch
● Layonstomachandpullfootuptowardsbu=ock● Keephipturnedunder(posteriorpelvicrota*on)inordertodecreaselumbarlordosisand
keephipflatontable● Holdthisposi*on
ThomasStretch
ThomasStretch• GoalistoprotectthespinebyrotaNngonehalfofyour
“hips”(ilium)posteriortofocusthestretchonthedownleg• LayontheendofthetablewithboLomattheveryedge
– Tablemustbehighenoughtodropleg• Pulloneleguptoyourchestwhenyoulaydowntoprotect
yourback– GrabNghtly!Thisblockstheonesideofyourhip,or
ilium,sothattheotherside(LeWinpicture)isstretchingindependently
• Partnerpushesbentleg(rightinpicture)upandlowerknee(leW)down
• Toaddthestretchtothetwo-jointhipflexors(thatalsoextendtheknee),trytoflexthekneegentlywiththepartner’sleg
BentKneeHipRollUnder
Sideview Frontview
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BentKneeHipRollUnder• Kneelasshowninpicture• Bodyshouldbeinlinewithfemur• Donot“arch”andleanforward
– Hipflexorsshortenwithincreasedlumbarlordosisorarch• Defeatsthepurposeofstretchingthehipflexors
• Tiltyourpelvisunder– Bringpubicboneuptowardbreastbone
• Undoinglumbarlordosis/arch• Keepchestupright
– DonotdropribcageorbreastbonewhenNlNngpelvis• Hold-donotbounceorlean
UnsquaresplitposiNonDemo
SquaresplitrealizaNon!SquareMeasure:R=80,L=85Usematsorsomethingtopropyouup
UnsquareMeasure:R=140,L=145
PartnerSNckUpStretch• Situpstraightwithlegs
straightout• Partnerstandsbehindyou,
placestheirkneetoblockyourupperspine(nottoarchyourlowerback)
• Placehandsclaspedbehindheadwithelbowsout
• Partnerholdsarmsandpullsback
• Goalistofulcrumatthearmpit
• TrytokeepabsNghttoavoidarching
OverheadHold
• Situpstraightwithlegsstraightout
• Holdbaroverheadwithhandsshoulderwidthapart
– KeepingabsNghttoavoidarchposiNon
• HoldthisposiNon
PartnerBridge● Placehandsonpartner’sankles● Pushuptobridgewithstraightelbows
● Partner-pullbacktowardyoutocounterbalancewithhandsontheirshouldersinordertoopenthearmpit
● Walkfeetawayfromhandssothereisenoughcounterbalance-wantnolowbackpain
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AddiNonalTreatment-FurtherSteps
• McKenzietechniqueforintersegmentalspinemoNon
• ARTforspine,axilla,hipflexors• JointmobilizaNonforspine,GH,fem-acet,SI
joint• PossibleGrastonforfascialrelease• TPDNfortone,guarding,musclememory• NeurodynamicstretchingtoresetMTjuncNon
feedbackandmyotaNcstretchreflex• MFR• PossiblechiropracNcadjustments
Summary
• BackpaincanpotenNallybepredictedbasedondevelopmentalbiomechanicalassessment
• Ifpainisalreadyoccurring,afullbodysportspecificevaluaNontreaNngthecauseandnotjustthepainisnecessary
• takingtheNmetoallowflexibility,nervoussystemchange,andstrengtheningisnecessary
• phase1beingbetween6-8weeks
BeyondPhase1
• Phase2:dynamicmoNonandstrengthandbodyposiNoning
• Phase3:sportspecificreturntobodyshaping,basics,andaddiNonalstrength
• Phase4:progressiveskillreturnwithmonitoredrange,reps,andintensity
• Phase5:rampuptofullsportsreturn
ReturntoSport
• CauNousprogressionwithconstantvideoanalysis
• SkillslimitaNons:someforeverandsometemporarysuchas(onthewatchlist)
– Jaeger– Tkatchev– Pre-flightforYurchenko– Backhandspring– Onodi
– Frontwalkover– RepeNNve(onunnecessaryorunreplaceablebackhandsprings)– Unevenbarskillswithhightapping– Unevenbarskillswitharchinair(release)– Frontgiants
