----- Meeting Notes (6/02/11 07:41) -----WHAT DOES IT DO??
1. Core Hip and Slings -Intelligent prescription PRESENTED BY: Max MARTIN BAppSc (Hons) AEP
2. Movement is a behaviour Developmental and learnedQuality over quantityPosture is a good baseline for movementPosture is not the cause of dysfunction but a SYMPTOMSuch dysfunction corresponds to compromised activity of musclesStabilisers typically become hypotonic/inhibited – ‘allowing’ faultypostureGross movers typically become hypertonic/facilitated – ‘driving’faulty posture Prescription Paradigms
3. synergisttightness weakness antagonist
4. Why weakness?Muscle inhibition due to pain/injuryMuscle susceptibility – eg. VMO vs VL atrophy post surgeryMuscle inactivity in chronic postures – eg. Sedentary behavioursCNS driven protection
5. Why tightness?Joint ROM can be limited by the following factors1. Joint constraints2. connective tissue (40%) – protective, inactivity, hypertonicity3. Neurogenic constraints (voluntary and reflexive) - protective4. Myogenic constraints – overload protective
6. tightness? Orgaining stability??
7. Clinical/Practical findings synergist Glute maxtightness weaknessHamstrings Hip Flexors • Psoas antagonist • Iliacus Glute max • TFL • Rec fem TrA (+core) Lumbar Erectors
8. Joint by joint approachFoot Stable unstableAnkle Mobile StiffKnee Stable unstableHip Mobile StiffLx Spine Stable unstableTx Spine Mobile StiffScapula Stable unstableGH Joint Mobile Stiff Prescription Paradigms
9. CORE Anatomy
10. The research journey1992: TrA found to exhibit anticipatory function (activation prior to activation of primemovers in arm movements) in healthy subjects (Cresswell)1996-97: TrA disrupted in multi-directional arm movements in LBP subjects1998: TrA also disrupted in lower limb movements among LBP patients2001: TrA latency in LBP patients shown to increase with increasing task demand2001: Experimentally induced pain causes disruption (hypoactivity) in the TrA2002: TrA contraction shown to increase stiffness of the sacro-illiac joint to a greaterextent than a more global abdominal contraction2007: Pelvic floor shown to share the same pre-emptive quality as TrA and MU2009: LBP patients shown to have greater lumbo-pelvic instability in simple open-chainstability exercises (eg Leg Loads) compared to controls.
11. Lumbar VertebraeLargest and strongest due to compressiveload.Cortical bone shell with cancellous bonecore (trabeculae). Vertical Columnalignment.Aids shock absorption quality of L1-5.Age and repetitious loading degeneratehorizontal trabeculae ‘struts’
12. Lumbar facet jointsBony articulations between vertebrae.Synovial Joints- articular surfaces covered inhyaline cartilage.Allow flexion and extensionMovement pumps fluid in and out of jointspace. Fixed postures lead to joint dehydrationand degeneration.Constant compression caused by hypertonicityof paraspinals can accelerate degeneration.
13. 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.
14. Intervertebral DiscsColloidal gel nucleusConcentric rings of fibrocartilage (lamellae)form the annulus.Outer third ONLY innervated by pain andmechanoreceptors.Slight movement of the vertebrae helpsrehydrate discs.Repetitious torsion forces can derangeannulus, allowing nucleus to seep out.Late warning of this process due to lack ofpain receptors amongst inner 2/3 of annulus.
15. Intervertebral Discs Cont’dDiscs are poor shock absorbers – Very little compressive potential – Nucleus facilitates movement rather than compression
16. Thoracolumbar FasciaDense multilayered sheet ofconnective tissue.Insertion point for many musclesOveractive lats and/or glutes cancause excess collagendeposition, making TLF more stiff.This can restrict the ability of TrA toslide freely as it pulls on deep layer.
17. Transversus Abdominis
18. Transversus AbdominisIntra-abdominal pressure, thus making this area more stiff (less bendable).Increases the stiffness of thoraco-lumbar fascia and abdominal aponeurosis.Line of pull helps to align the ribs and pelvis in anatomically correctFibres crossing the sacroiliac joints pull the Ilium and the sacrum closertogether, decreasing laxity in these joints.
19. Gluteus MaximusPrimary hip extensor and external rotator*Important for maintaining upright postureStabiliser of SIJ via attachment to TLFSupports hip and knee via ITB attachmentFunctional role in stepping, running, climbing etc. and…DECELERATION
20. Gluteus MediusPrimary abductor and controller of rotation of the hip*Functionally supports pelvis during SL stance and gaitPlays rotator cuff-like roleStrongest in neutral or slight adduction
21. Tensor Fascia LataePrimary functions are hipflexion, 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
22. 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 effectively
23. 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
24. 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)
25. Single Legged Squat Functional strength exercise Assessment tool
26. SLSq Research (performance and strength) 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
28. Thomas Myers- Anatomy Trains Superficial Front Line
29. Superficial Back Line
30. Spiral Line
31. 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 andanterior oblique), SL SQ (lateral)
32. PRESENTED BY: Max MARTIN BAppSc (Hons)AEP @iNformMaxMartinmax@correctiveexerciseaustralia.com