Function of the Hip and the lower limb: The relationship between injuries and function of the hip, knee, ankle and foot

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Presentation for WAFIC 2011 by Max Martin AEP, Director of Corrective Exercise Australia. …

Presentation for WAFIC 2011 by Max Martin AEP, Director of Corrective Exercise Australia.

Learn about the functional relationship between the hip, knee and foot, and how dysfunction in one typically affects injury patterns of the others.

Interestingly, a significant portion of chronic injuries below then hip are caused by hip dysfunction.

At the presentation you will learn why, what the research has to say about this, and how to prevent injuries to this complex of joints!

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  • Max, I am a retired track & field coach and I am very interested in the functionality relatiopnship of the ankle, knee, and hip in running. Can you point me in the direction of more stuff?
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  • 1. iNform ACADEMY Hip and Lower Limb Function PRESENTED BY: Max MARTIN BAppSc (Hons) AEP Scott WOOD BAppSc AEP
  • 2. 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.
  • 3. Gluteus Medius Primary abductor and controller of rotation of the hip Plays rotator cuff-like role: sucks femoral head into acetabulum Akin to supraspinatus, ie abductor, commonly injured. Functionally supports pelvis during SL stance and gait- preventing hip adduction, dropping of unsupported side Strongest in neutral or slight adduction
  • 4. 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
  • 5. Iliotibial Band Thick, lateral aspect of fascia lata Attachment point for glute max, TFL Indirect insertion onto patella Anatomically impossible to stretch effectively
  • 6. Piriformis 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
  • 7. External Hip Rotators Include obturators (externus and internus), the gemelli (superior and inferior) and the quadratusfemoris Strong rotators at zero degrees MA changes with flexion/extension Parallel MFO to neck of femur- strong joint compressors (rotator cuff like role)
  • 8. VastusMedialis Primary action is knee extension in inner range- 15-20deg of knee flexion Provides medial stability to patella
  • 9. VastusLateralis Primary action is knee extension in inner range- 15-20deg of knee flexion Provides lateral stability to patella
  • 10. Hip Knee Foot Dysfunction Site of chronic injury often not the cause. Dysfunction at proximal sites often predispose more distal sites to excessive trauma. Injured site must receive best practice care. Origin of dysfunction must be addressed. Powers, 2003
  • 11. Single Legged Squat Functional strength exercise Assessment tool
  • 12. SLSq Research 22 male, 22 female athletes FPPA measured Women > FPPA Weakness in external rotators correlated most closely to FPPA Such alignment can predispose ACL injury, PFP From Willson et al 2006.
  • 13. SLSq Research Claiborne et al (2006)investigated valgus/varus in SLQ Strength around hip and knee investigated Hip abductor strength most important for resisting valgus alignment
  • 14. SLSq Research Similar findings by Zeller (2003) Women > adduction, valgus and pronation ♀ Greater MVC in all muscles except glute med and biceps fem. 2 reasons predisposing ♀ athletes to ACL path. Glute med shown to be latent in poor SLQ (Crossley, 2006) Abduction strength and Trendelenburg test shows correlation to SLSqperf.
  • 15. Hip Strength and Injury Trendelenburg gait highly implicated in LBP TbG associated with: Weak gluteus medius and minimus (atrophy, tear, TrP) Predominance for TFL/ITB abduction stabilisation Sciatica and LBP like symptoms from GlMdTrP profile GTPS and bursitis can result Bewyer & Bewyer
  • 16. Hip Strength and Injury Noehren et al (2007) investigated biomechanics associated with ITBS (female runners) Injured runners greater peak adduction Greater knee internal rotation
  • 17. Hip Strength and Injury PFP common in active and non-active individuals Can result from abnormal motions of femur and tibia in frontal and transverse plane Cowan (2006) observed latency in glutemedius and vasti group in PFP patients
  • 18. Clinically Evidenced Dysfunction of the Hip and Lower Limb Abduction dysfunction – ITB and piriformis adaptations Gl Med main abductor (stabiliser of pelvis) but tonic and typically inhibited more phasic Gl Max and TFL use the ITB sling to stabilise the pelvis However, typically evidenced dysfunction of Gl Max. This results in the TFL being the primary active muscle the body looks for an external rotator of the hip to act as a force-couple for the TFL > piriformis
  • 19. Clinically Evidenced Dysfunction of the Hip and Lower Limb Glute Medius TrP/tightness and poor alignment of pelvis and knee common posture adaptations is an anterior tilted pelvis and the associated medial knee rotation This position separates the attachment points of the posterior fibres of Gl med. Increased tension and potential TrP tends to lead to hypotonicity in these fibres leading to increased adduction and internal rotation of the hip on single leg. ensure good postural alignment (especially of the pelvis) during corrective exercise prescription
  • 20. Clinically Evidenced Dysfunction of the Hip and Lower Limb Knee as a ‘dumb’ joint?? structure > movement primarily in one plane (sagittal). Overuse injuries often due to misalignment (deviation from this plane) of the joint. Due to structure and geographical location it is very likely that such misalignments will be influenced by the two joint complexes it is directly associated to, i.e. the hip and ankle/foot. function and alignment at these two areas should be addressed prior to, or at least in conjunction to addressing knee pathologies.