Core Hip and Slings Intelligent prescription

PRESENTED BY:
Max MARTIN BAppSc (Hons) AEP

Movement is a behaviour
Developmental and learned
Quality over quantity
Posture is a good baseline for movement
Posture is not the cause of dysfunction but a
SYMPTOM
Such dysfunction corresponds to compromised
activity of muscles
Stabilisers typically become hypotonic/inhibited
allowing faulty posture
Gross movers typically become hypertonic/facilitated
driving faulty posture

Prescription Paradigms

synergist
tightness

weakness
antagonist

Why weakness?
Muscle inhibition due to pain/injury
Muscle susceptibility eg. VMO vs VL atrophy post
surgery
Muscle inactivity in chronic postures eg. Sedentary
behaviours
CNS driven protection

Why tightness?
Joint ROM can be limited by the following factors
1. Joint constraints
2. connective tissue (40%) protective,
inactivity, hypertonicity
3. Neurogenic constraints (voluntary and
reflexive) - protective
4. Myogenic constraints overload protective

ghtness?

Or

aining stability??

Clinical/Practical
findings
synergist
tightness
Hamstrin
gs

Hip Flexors
Psoas
Iliacus
TFL
Rec fem
Lumbar
Erectors

weakness

Glute
max

antagonist
Glute max
TrA
(+core)

Joint by joint approach

Foot

Stable

unstable

Ankle

Mobile

Stif

Knee

Stable

unstable

Hip

Mobile

Stif

Lx Spine

Stable

unstable

Tx Spine

Mobile

Stif

Scapula

Stable

unstable

GH Joint

Mobile

Stif

Prescription Paradigms

CORE Anatomy

The research journey

1992: TrA found to exhibit anticipatory function (activation prior to activation of
prime movers in arm movements) in healthy subjects (Cresswell)
1996-97: TrA disrupted in multi-directional arm movements in LBP subjects
1998: TrA also disrupted in lower limb movements among LBP patients
2001: TrA latency in LBP patients shown to increase with increasing task demand
2001: Experimentally induced pain causes disruption (hypoactivity) in the TrA
2002: TrA contraction shown to increase stifness of the sacro-illiac joint to a
greater extent than a more global abdominal contraction
2007: Pelvic floor shown to share the same pre-emptive quality as TrA and MU
2009: LBP patients shown to have greater lumbo-pelvic instability in simple
open-chain stability exercises (eg Leg Loads) compared to controls.

Lumbar Vertebrae
Largest and strongest due to
compressive load.
Cortical bone shell with cancellous
bone core (trabeculae). Vertical
Column alignment.

Aids shock absorption quality of

L1-5.
Age and repetitious loading
degenerate horizontal trabeculae
struts

Lumbar facet joints

Bony articulations between vertebrae.
Synovial Joints- articular surfaces
covered in hyaline cartilage.
Allow flexion and extension
Movement pumps fluid in and out of
joint space. Fixed postures lead to joint
dehydration and degeneration.
Constant compression caused by
hypertonicity of paraspinals can
accelerate degeneration.

Sacroiliac Joints
Junction point between spine and
pelvis.
Synovial Joint- innervated by pain
receptors.
Corrugated design to assist stability.
Allows forward and backward tilting of
the sacrum.
Sublaxation possible, resulting in dull
ache or sharp pain that may refer
inferiorly.

Intervertebral
Discs
Colloidal gel nucleus
Concentric rings of fibrocartilage
(lamellae) form the annulus.
Outer third ONLY innervated by pain and
mechanoreceptors.
Slight movement of the vertebrae helps
rehydrate discs.
Repetitious torsion forces can derange
annulus, allowing nucleus to seep out.
Late warning of this process due to lack
of pain receptors amongst inner 2/3 of
annulus.

Intervertebral Discs
Contd
Discs are poor shock absorbers
Very little compressive potential
Nucleus facilitates movement
rather than compression

Thoracolumbar
Fascia
Dense multilayered sheet of
connective tissue.
Insertion point for many
muscles
Overactive lats and/or glutes
can cause excess collagen
deposition, making TLF more
stif.
This can restrict the ability of
TrA to slide freely as it pulls on
deep layer.

Transversus Abdominis

Transversus Abdominis
Intra-abdominal pressure, thus making this area more stif
(less bendable).
Increases the stifness of thoraco-lumbar fascia and
abdominal aponeurosis.
Line of pull helps to align the ribs and pelvis in anatomically
correct
Fibres crossing the sacroiliac joints pull the Ilium and the
sacrum closer together, decreasing laxity in these joints.

Gluteus Maximus

Primary hip extensor and external rotator*

Important for maintaining upright posture
Stabiliser of SIJ via attachment to TLF
Supports hip and knee via ITB attachment
Functional role in stepping, running, climbing etc.
and

Gluteus Medius
Primary abductor and controller of rotation of
the hip*
Functionally supports pelvis during SL stance
and gait
Plays rotator cuf-like role
Strongest in neutral or slight adduction

Tensor Fascia Latae

Primary functions are hip

flexion, internal rotation and
abduction (via ITB)
Works in synergy with glute
max:
Tighten ITB to extend
knee joint
Control movements of pelvis
on femur and femur on tibia
when weight bearing

Iliotibial Band
Thick, lateral aspect of
fascia lata
Attachment point for
glute max, TFL (and
glute med)
Indirect insertion onto
patella
Anatomically
impossible to stretch
efectively

Piriformis & External Hip

Rotators
Primarily lateral rotator of the
hip
In hip flexion, will also abduct
the hip
Secondary phasic stabiliser of
the SIJ
Close relationship to sciatic
nerve
Piriformis syndrome

Vastus Medialis &

Lateralis
Primary action is knee extension in
inner range- 15-20deg of knee
flexion
Provide medial and lateral
stability
to patella respectively
Perform anticipatory role
Often dysfunctional (knee pain,
pronation)

Single Legged Squat

Functional strength
exercise
Assessment tool

SLSq Research
strength)

(performance and

Wilson et al (2006) Frontal Plane Projection

Angle measured (FPPA)
Women > FPPA
Weakness in external rotators correlated
most closely to FPPA (predisposes to ACL
injury & PFP)
Claiborne et al (2006)
Hip abductor strength most important for
resisting valgus alignment
Crossley, 2006
Glute med shown to be latent in poor SLQ
Abduction strength and Trendelenburg
test shows correlation to SLSq

Slings

Thomas Myers- Anatomy

Trains

Superficial Front
Line

Superficial Back
Line

Spiral Line

Correctives!
!

Core exercises:
Leg loads (ant oblique, ant superficial and
Spiral)
hip extension (post oblique and posterior
superficial)
Hip lifts/SL (post oblique and post
superficial)
Hip exercises:
Squat (posterior superficial),
SL DL (Lateral), hitches (lateral) and Rots
(posterior and anterior oblique), SL SQ

PRESENTED BY:
Max MARTIN BAppSc (Hons)AEP
@iNformMaxMartin
max@correctiveexerciseaustralia.com