Posture & Function of the Hips

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Information about Posture & Function of the Hips

Published on October 31, 2008

Author: markmckean


Posture & Function of the Hips : Posture & Function of the Hips Mark McKean Dip.T (HPE/Sc), CSCS, Level 2 ASCA, MAAESS, AEP, PhD Candidate Outline : Outline Ideal Posture of the hips Assessing Hip conditions Dealing with specific hip conditions Ideal Posture of the Hips : Ideal Posture of the Hips Palpation Bony : Palpation Bony Iliac crest Anterior superior iliac spine (ASIS) Anterior inferior iliac spin (AIIS) Posterior superior iliac spine (PSIS) Pubic symphysis Ischial tuberosity Greater trochanter Femoral neck Poster inferior iliac spine (PIIS) Observation : Observation Symmetry- hips, pelvis tilt (anterior/posterior) Lordosis or flat back Lower limb alignment Knees, patella, feet Pelvic landmarks (ASIS, PSIS, iliac crest) Standing on one leg Pubic symphisus pain or drop on one side Ambulation Walking, sitting - pain will result in movement distortion Sagittal plane – Side View : Sagittal plane – Side View Alignment Centre line passes just anterior of lateral maleolus of ankle Centre line passes just in front of the centre of the knee joint Centre line passes just behind the centre of the hip joint Centre line passes through the centre of the lumbar vertebrae bodies Observations Lumbar spine normal curve slightly convex to front Pelvis in neutral - ASIS and Symphysis Pubis in vertical alignment Hip joints neutral – not flexed or extended Knee joints neutral – not flexed or hyper-extended Frontal Plane : Frontal Plane Alignment Centre line passes through umbilicus Centre line passes through symphysis pubis Centre line falls centrally between knees and ankles Observations – Front on Hip in neutral – not adducted or abducted ASIS level L-R Knee caps facing front Foot slightly turned out Observations from rear Lumbar spine straight PSIS level L-R Legs straight – not bowed or knock kneed Tendon of gastrocnemius straight into calcaneus Normal Ranges of Motion : Normal Ranges of Motion Hip Flexion – 1250 Extension – 100 Abduction – 450 Adduction – 100 Lateral rotation – 450 Medial rotation – 450 Knee Flexion – 1400 Extension – 00 Ankle Plantar Flexion – 450 Dorsi Flexion – 200 Assessing Hip Positions : Assessing Hip Positions 2 Accepted Structural Variations : 2 Accepted Structural Variations Low position of ASIS in women often misinterpreted as anterior pelvic tilt Flat back in men with a tall pelvis misinterpreted as posterior tilt when ASIS is higher than belt line Horizontal angle of up to 150 difference between ASIS and PSIS when ASIS and Symphisus Pubis aligned vertically has been found. ‘2 Out of 3’ Rule for Pelvic Tilt : ‘2 Out of 3’ Rule for Pelvic Tilt Because of these potential sources of error in assessing pelvic tilt, you should use the 2 out of 3 rule. You need to find at least 2 of these 3 conditions present before you can say that the pelvic tilt is acquired and not structural An increase or decrease in ‘normal’ depth of lumbar curve An angle greater than 200 between the ASIS and PSIS An increase or decrease in the hip joint angle as long as knees remain neutrally aligned Another option is to return the pelvis to what you consider to be its correct alignment and see if overall alignment improves the affected joints. If incorrect changes occur as a result of the pelvic correction, the problem could be structural and not acquired. Pelvic Tilts : Pelvic Tilts Anterior tilt – (2 out of 3) more than 200 angle between ASIS- PSIS Increase in normal lumbar curve Increase in hip joint angle with neutral knees Posterior tilt – (2 out of 3) ASIS is higher than PSIS Decrease in lumbar curve Decrease in hip angle through to extension Sway Back Posture : Sway Back Posture Flattening of lumbar spine Posterior tilt Hip joint hyper-extended Pelvis forward of central line Knee joints hyper-extended Gluteal atrophy Assess a Friend - 1 : Assess a Friend - 1 Palpate bony landmarks Check for 2 out of 3 rule Correct posture and observe changes Exercise Prescription Pelvic Tilt : Exercise Prescription Pelvic Tilt Anterior Tilt Posterior Tilt Shorten Hamstrings Gluteus maximus External oblique Quadratus lumborum* Lengthen Iliopsoas Quadriceps Strengthen VMO* Anterior Glute medius Lateral hip rotators Shorten One joint hip flexors External obliques Quadriceps Lengthen Hamstrings Internal oblique Rectus abdominis Intercostals Strengthen Medial hip rotators* Exercise Prescription Sway Back : Exercise Prescription Sway Back Shorten One joint hip flexors External obliques Thoracic extensors Neck flexors Lengthen Hamstrings Internal oblique Rectus abdominis intercostals Adductor group* Strengthen VMO Gluteus medius Poor Gluteal Development : Poor Gluteal Development Atrophy of gluteals Associated with decease in performance of other hip extensor muscles 80% of glute max inserts into ITB. Weak glute max may lead to tighter misaligned ITB Tight Glute max may lead to restricted hip adduction and medial rotation Hip Extension : Hip Extension Action of the hamstrings is more dominant than glute max Hamstrings activate first in prone hip extension Glute max doesn’t really bunch up till full hip extension Research 1977 - “Consistent muscle firing order of ipsilateral lumbar erector spinae, semitendinosus, contralateral lumbar erector spinae, tensor fasciae latae, and gluteus maximus demonstrate the characteristic pattern in prone hip extension” Assess a Friend - 2 : Assess a Friend - 2 Observe normal posture Observe glute development Observe secondary changes to pelvis Have your friend perform prone hip extension/prone back extension Exercise Prescription Poor Glutes : Exercise Prescription Poor Glutes Correct pelvic angle if acquired poor position Assess hamstring length through passive/active leg raise ROM test or standing forward bend test Stretch hamstrings if required – antigravity and passive full body position Start getting glutes accustomed to contracting – often just getting them to work is hard enough task, (don’t worry if not in isolation) Provide exercises where the range of motion that need glutes to work out of full depth hip flexion – squat and derivatives (allow pelvis to tilt at bottom of squats) Antetorsion : Antetorsion Increase in angle of torsion The angle of the head and neck of the femur is rotated anteriorly May have excessive medial hip rotation and knock knees Likes to sit in ‘W’ position May have excessive lateral tibial torsion Cross legged sitting or stretching laterally may cause severe pain Retrotorsion : Retrotorsion Decrease in angle of torsion The angle of the head and neck of the femur rotates posteriorly with respect tot he shaft May have excessive lateral hip rotation May have feet turned out duck walk Men like to sit with leg crossed at ankle More common in men than women Medial Rotation : Medial Rotation Weak Glutes and strong TFL/tight ITB can also cause medial hip rotation Can be observed in walking Tight medial rotators can be tested in seated position Weak medial rotators allow legs to fall open in supine lying Passive hip flexion causes an increase in medial rotation if medial rotators are tight Assess a Friend - 3 : Assess a Friend - 3 Lie Prone with knee bent so the muscles that limit medial rotation are not tight Rotate thigh medially and laterally and observe if Antetorsion and Retrotorsion are present Exercise Prescription Medial Rotation : Exercise Prescription Medial Rotation Ensure tightness or weakness is from muscle and soft tissues alone by testing for ante/retro-torsion Lengthen rotators through light antigravity stretches – aggressive stretching will be less effective Correct all patterns of movement in exercises like the squat, lunge, step up by reducing loads and ensuring proper alignment in movements (reduce range if required to ensure correct patterns) Strengthen VMO/anterior Glute Medius if medial rotators are tight Strengthen medial rotators and adductors if lateral rotators tight Mark McKean : Mark McKean Strength & Movement Consulting Email - Web - Intellifitness Software Email - Web - Phone - +61 7 54792419 Mobile - +61 403 353470

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