Mechanical complications and reconstruction strategies at the site of hip spacer implantation
HIP ALIGNMENT AND REBALANCING STRATEGIES HIP ALIGNMENT AND RE-BALANCING STRATEGIES By: Scott Adams,...
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Transcript of HIP ALIGNMENT AND REBALANCING STRATEGIES HIP ALIGNMENT AND RE-BALANCING STRATEGIES By: Scott Adams,...
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HIP ALIGNMENT AND REBALANCING STRATEGIES
HIP ALIGNMENT AND RE-BALANCING STRATEGIESBy: Scott Adams, BHK, MA, ATC, CES
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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
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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)
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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
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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
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ANATOMY REVIEW
Source: www.medical-illustrations.ca
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ANATOMY REVIEW
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ANATOMY REVIEW
• Prime Movers of Flexion– TFL– Pectineus– Sartorius– Gracilis– Illopsoas
Courtesy of ImageRepository.net
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ANATOMY REVIEW
• Prime Movers of Extension– Gluteus Maximus– Hamstrings– Adductor Magnus
(posterior region)
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ANATOMY REVIEW
• Prime Movers of Adduction– Adductor Longus– Adductor Brevis– Adductor Magnus– Gracilis
www.medmeshop.com
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ANATOMY REVIEW
• Prime Movers of Abduction– Gluteus Medius– Gluteus Minimus
http://files.myopera.com/sanshan/blog/piriformis.gif
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ANATOMY REVIEW
• Prime Movers of Inward Rotation– Gluteus Minimus– Tensor Fascia Lata
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ANATOMY REVIEW
• Prime Movers of Outward Rotation– Gluteus Maximus– Piriformis– Obturator Externus– Obterator Internus– Superior Gemellus– Inferior Gemellus– Quadratus Femoris– Gluteus Medius
www.aroundhawaii.com
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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
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ANATOMY REVIEW
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CHRONIC CONTRACTORS
• Muscles that are constantly contracted
• Constant state of fatigue
• May be the primary site of a breakdown leading to chronic injury
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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
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CHEST MUSCLES
• Pre and post treatment of releasing the chest muscles
• Note: Hip position
http://www.hellerworkstructuralintegration.com/assets/images/client_photos.jpg
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MOVEMENT DIFFERENCES
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MOVEMENT DIFFERENCES
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MOVEMENT DIFFERENCES
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ASSESSING HIP ORIENTATION
• Athlete Supine• Hips and knees bent
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ASSESSING HIP ORIENTATION
• Perform three bridges
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ASSESSING HIP ORIENTATION
• Gently return the athlete to a supine position with the legs resting on the table
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ASSESSING HIP ORIENTATION
• Landmark the ASIS– Compare left vs. right– Note variation in the
height of each
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ASSESSING HIP ORIENTATION
• Have the athlete move into a prone position
• Landmark the PSIS– Compare left vs. right
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ASSESSING HIP ORIENTATION
• Note leg lengths• Gives an insight if an
up-shift has occurred• This will not show a true
anatomical leg length
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ASSESSING HIP ORIENTATION
• RESULTS– If ASIS and PSIS are even, the hips are in a
balanced position
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ASSESSING HIP ORIENTATION
• IF ASIS on one side is high, and PSIS on opposite side is high -> we have a rotation of the hips
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ASSESSING HIP ORIENTATION
• If the ASIS and PSIS are elevated on the same side -> an up-shift has occurred
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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
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CORRECTING HIP ORIENTATION
• Rotation– Break arm method
• Up-Shift– Distraction method
• Flairs– Abduction contraction
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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
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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
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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
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THANK YOU