Core and Hip Slings - Function Review

8/17/2019 Core and Hip Slings - Function Review

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Core Hip and Slings -Intelligent prescription

PRESENTED BY:

Max MARTIN BAppSc (Hons) AEP


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Prescription Paradigms

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 aSMP!"M

Such dysfunction corresponds to compromisedactivity of muscles

Stabilisers typically become hypotonic#inhibited $%allo&ing' faulty posture

(ross movers typically become hypertonic#facilitated$ %driving' faulty posture


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tightness &ea)ness

antagonist

synergist


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*hy &ea)ness+

Muscle inhibition due to pain#in,ury

Muscle susceptibility $ eg .M" vs ./ atrophy post

surgery

Muscle inactivity in chronic postures $ eg Sedentary

behaviours

C0S driven protection


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*hy tightness+ 1oint 2"M can be limited by the follo&ing factors

3 1oint constraints

4 connective tissue 56789 $ protective:

inactivity: hypertonicity

; 0eurogenic constraints 5voluntary and

re


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ghtness+

r

aining stability++


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tightness &ea)ness

antagonist

synergist

Hamstrings

(lutema=

Hip >le=ors• Psoas• Iliacus• !>/• 2ec fem/umbar?rectors

(lute ma= !r@5Acore9

Clinical#PracticalBndings


8/32Prescription Paradigms

1oint by ,oint approach

@n)le>oot

nee

Hip

Lx Spine

!= Spine

Scapula

(H 1oint

MobileStable

Stable

Mobile

Stable

Mobile

Stable

Mobile

Sti unstable

unstable

Stif

unstable

Sti

unstable

Sti


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C"2? @natomy


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!he research ,ourney3EE4F !r@ found to e=hibit anticipatory function 5activation prior to activation ofprime movers in arm movements9 in healthy sub,ects 5Cress&ell9

3EEG-EF !r@ disrupted in multi-directional arm movements in /P sub,ects

3EEJF !r@ also disrupted in lo&er limb movements among /P patients

4773F !r@ latency in /P patients sho&n to increase &ith increasing tas) demand

4773F ?=perimentally induced pain causes disruption 5hypoactivity9 in the !r@

4774F !r@ contraction sho&n to increase stiness of the sacro-illiac ,oint to a

greater e=tent than a more global abdominal contraction

477F Pelvic


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/umbar .ertebrae

/argest and strongest due tocompressive load

Cortical bone shell &ith cancellousbone core 5trabeculae9 .ertical

Column alignment

@ids shoc) absorption quality of/3-L

@ge and repetitious loadingdegenerate horiontal trabeculae%struts'


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/umbar facet ,oints

ony articulations bet&een vertebrae

Synovial 1oints- articular surfaces

covered in hyaline cartilage@llo&


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Sacroiliac 1oints

1unction point bet&een spine and

pelvis

Synovial 1oint- innervated by pain

receptors

Corrugated design to assist stability

@llo&s for&ard and bac)&ard tilting of

the sacrum

Subla=ation possible: resulting in dull

ache or sharp pain that may referinferiorly


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IntervertebralDiscsColloidal gel nucleus

Concentric rings of Bbrocartilage

5lamellae9 form the annulus

"uter third "0/ innervated by pain and

mechanoreceptors

Slight movement of the vertebrae helps

rehydrate discs

2epetitious torsion forces can derange

annulus: allo&ing nucleus to seep out

/ate &arning of this process due to lac)

of pain receptors amongst inner 4#; of

annulus


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Intervertebral DiscsCont'd

Discs are poor shoc) absorbers – .ery little compressive potential

– 0ucleus facilitates movementrather than compression


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!horacolumbar>ascia

Dense multilayered sheet ofconnective tissue

Insertion point for manymuscles

"veractive lats and#or glutescan cause e=cess collagendeposition: ma)ing !/> moresti

!his can restrict the ability of !r@ to slide freely as it pulls on

deep layer


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!ransversus @bdominis


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!ransversus @bdominis

Intra-abdominal pressure: thus ma)ing this area more sti5less bendable9

Increases the stiness of thoraco-lumbar fascia andabdominal aponeurosis

/ine of pull helps to align the ribs and pelvis in anatomicallycorrect

>ibres crossing the sacroiliac ,oints pull the Ilium and thesacrum closer together: decreasing la=ity in these ,oints


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(luteus Ma=imus

Primary hip e=tensor and e=ternal rotatorNImportant for maintaining upright posture

Stabiliser of SI1 via attachment to !/>

Supports hip and )nee via I! attachment

>unctional role in stepping: running: climbing etc

andO


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(luteus Medius

Primary abductor and controller of rotation of

the hipN>unctionally supports pelvis during S/ stanceand gait

Plays rotator cu-li)e role

Strongest in neutral or slight adduction


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!ensor >ascia /atae

Primary functions are hip


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Iliotibial and

!hic): lateral aspect offascia lata

@ttachment point forglute ma=: !>/ 5and

glute med9Indirect insertion ontopatella

@natomicallyimpossible to stretch

eectively


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Piriformis ?=ternal Hip

2otatorsPrimarily lateral rotator of thehip

In hip


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.astus Medialis

/ateralis

Primary action is )nee e=tension in

inner range- 3L-47deg of )nee


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Single /egged Squat

Functional sten!t"execise

Assess#ent tool


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S/Sq 2esearch 5performance andstrength9

*ilson et al 5477G9 >rontal Plane Pro,ection@ngle measured 5>PP@9

*omen >PP@

*ea)ness in e=ternal rotators correlatedmost closely to >PP@ 5predisposes to @C/in,ury P>P9

Claiborne et al 5477G9

Hip abductor strength most important forresisting valgus alignment

Crossley: 477G

(lute med sho&n to be latent in poor S/Q

Ab$uction sten!t" an$ Ten$elenbu!test s"o%s coelation to SLS&


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Slin!s

!h M @


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SuperBcial >ront/ine

!homas Myers- @natomy !rains


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SuperBcial ac)/ine


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Spiral /ine


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'oecti(es)

)'oe execises:/eg loads 5ant oblique: ant superBcial andSpiral9

hip e=tension 5post oblique and posteriorsuperBcial9

Hip lifts#S/ 5post oblique and postsuperBcial9

Hip execises:

Squat 5posterior superBcial9:

S/ D/ 5/ateral9: hitches 5lateral9 and 2ots

5posterior and anterior oblique9: S/ SQ


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PRESENTED BY:Max MARTIN BAppSc (Hons)AEP

@[email protected]

Date post:	06-Jul-2018
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Core and Hip Slings - Function Review

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