1. HIP ALIGNMENT AND REBALANCING STRATEGIES HIP ALIGNMENT AND RE-BALANCING STRATEGIES By: Scott Adams, BHK, MA, ATC, CES

2. 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

3. 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)

4. 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

5. 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

6. ANATOMY REVIEW Source: www.medical- illustrations.ca

7. ANATOMY REVIEW

8. Prime Movers of Flexion –TFL –Pectineus –Sartorius –Gracilis –Illopsoas Courtesy of ImageRepository.net

9. ANATOMY REVIEW Prime Movers of Extension –Gluteus Maximus –Hamstrings –Adductor Magnus (posterior region)

10. ANATOMY REVIEW Prime Movers of Adduction –Adductor Longus –Adductor Brevis –Adductor Magnus –Gracilis www.medmeshop.com

11. ANATOMY REVIEW Prime Movers of Abduction –Gluteus Medius –Gluteus Minimus http://files.myopera.com/san shan/blog/piriformis.gif

12. ANATOMY REVIEW Prime Movers of Inward Rotation –Gluteus Minimus –Tensor Fascia Lata

13. 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

14. 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

15. ANATOMY REVIEW

16. CHRONIC CONTRACTORS Muscles that are constantly contracted Constant state of fatigue May be the primary site of a breakdown leading to chronic injury

17. 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

18. CHEST MUSCLES Pre and post treatment of releasing the chest muscles Note: Hip position http://www.hellerworkstructuralintegration. com/assets/images/client_photos.jpg

19. MOVEMENT DIFFERENCES

22. ASSESSING HIP ORIENTATION Athlete Supine Hips and knees bent

23. ASSESSING HIP ORIENTATION Perform three bridges

24. ASSESSING HIP ORIENTATION Gently return the athlete to a supine position with the legs resting on the table

25. ASSESSING HIP ORIENTATION Landmark the ASIS –Compare left vs. right –Note variation in the height of each

26. ASSESSING HIP ORIENTATION Have the athlete move into a prone position Landmark the PSIS –Compare left vs. right

27. ASSESSING HIP ORIENTATION Note leg lengths Gives an insight if an up-shift has occurred This will not show a true anatomical leg length

28. ASSESSING HIP ORIENTATION RESULTS –If ASIS and PSIS are even, the hips are in a balanced position

29. ASSESSING HIP ORIENTATION IF ASIS on one side is high, and PSIS on opposite side is high -> we have a rotation of the hips

30. ASSESSING HIP ORIENTATION If the ASIS and PSIS are elevated on the same side -> an up-shift has occurred

31. 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

32. CORRECTING HIP ORIENTATION Rotation –Break arm method Up-Shift –Distraction method Flairs –Abduction contraction

33. 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

34. 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

35. 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

36. THANK YOU