Hip ABD Firing Pattern

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Dysfunctional Trunk Rotation and/or Dysfunctional Hip Abduction Functional Movement Tests

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Dysfunctional Trunk Rotation and/or Dysfunctional Hip Abduction Functional Movement Tests

These dysfunctional movement tests can be best addressed by mobilizing any spinal dysfunctions that are found at the thoracolumbar junction and/or by stretching the quadratus lumborum and piriformis muscles. It is also sometimes helpful to mobilize the inferiomedial hip capsule and stretch the hip adductors as covered in 4b. These sources of inhibition should be addressed before attempting retraining.

Anatomy and Biomechanical Considerations:

Quadratus Lumborum, Piriformis and Posterior Hip Capsule

Observations:

  1. Hypertonicity in the quadratus lumborum on one side is associated with a FRS dysfunction at the TL junction on that side, i.e., hypertonic right QL found with an FRS R at T12-L1.
  2. Pinching in the anterior groin with FADIR test or when attempting to stretch the piriformis is related to a tight posterior hip capsule. “Groin pain is posterior hip capsule tightness until proven otherwise”, Dr. Philip Greenman.
  3. An apparent tightness in the posterior hip capsule dissipates, often times dramatically, after mobilizing the upper lumbar spine for FRS dysfunctions on the same side, ie., tight R posterior hip capsule, FRS R at L1,2 or L2,3 will be present.
  4. Therefore, before we treat the quadratus lumborum, piriformis and posterior hip capsule we need to first identify and treat any FRS dysfunctions found between T12-L2.
Quadratus Lumborum
  • Three distinct divisions:
    • Lateral (global mobilizer)
    • Iliolumbar
    • Lumbocostal
  • Function – stabilizer of the lumbar supine, a lateral flexor of the lumbar spine and a hip hiker
  • Innervation – thoraco-lumbar spinal nerves
  • Most frequent muscular cause of back pain (Travell and Simons, 1992)

PIRIFORMIS: Origin at S 2-4, exits to insert at greater trochanter.

It crosses the SI joint and hypothetically influences the oblique axis of the sacrum during coupled motion.

  • Attaches to the anterior surface of S2, 3, 4 and
    inserts into the greater trochanter
  • Below 90º of hip flexion it abducts and ER the hip
  • Above 90º of hip flexion it abducts and IR the hip
  • Innervation – S1 and 2

FIVE EXTERNAL ROTATORS OF HIP
Obturator internus
Obturator externus
Gemellus superior
Gemellus inferior
Quadratus femoris

(These muscles are intimately attached to the posterior hip capsule.)

Alternative Test for Hip Abduction: (Hip Clam)

in 2 Movement Tests Lower Quarter, All Lower Quarter, Hip ABD Firing Pattern

Alternative Test for Hip Abduction: (Hip Clam)

To test the right side:

  • Patient is lying on their left side with a pillow under the head and the shoulder and hips perpendicular to the table.
  • The hips are flexed to approximately 45º with the knees flexed and the feet touching.
  • Ask the patient to slowly raise the right knee as high as possible keeping the feet in contact.
  • Compare the right to the left side, and compare any limitations noted in range of motion with the degree of inhibition of the gluteus medius on that side.

Muscle Energy Technique: ERS Dysfunction in the Lower Thoracic Spine

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Muscle Energy Technique: ERS Dysfunction in the Lower Thoracic Spine

  • The therapist places their L index and middle fingers on the L side of the spinous processes and translates the spine towards him looking for any restriction in L to R translation (L side bending). If the restriction is worse in flexion and improves in extension the diagnosis is an ERS R.
  • To treat the ERS R the therapist has the patient sit up tall initially, then introduces flexion from above down and below up creating an apex for flexion at the palpated segment. L side bending is then introduced by translating the patient’s shoulders from L to R to the feather edge of the L side bending barrier.
    The patient is instructed to gently side bend to the R for 5-7 seconds and then relax.
  • The therapist takes up the slack by further translating the shoulders to the R. This is repeated 3-4 times.

Anterior Innominate Self Correction: Home Self-Mobilizing Exercise

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Anterior Innominate Self Correction: Home Self-Mobilizing Exercise

Anterior Innominate Self Correction

To correct an Anterior Innominate on the right:

  • The patient is lying on their back keeping the left leg out straight. Using both hands they bring their R knee up towards their chest then out towards their right shoulder.
  • Instruct the patient to hold the right leg firmly and do not allow the leg to move as they attempt to straighten the right hip. They hold the contraction for 4-5 seconds.
  • When they relax instruct the patient to bring the right leg further up and out towards the R shoulder and repeat 3 to 4 times.

Hip Abduction Test

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Hip Abduction Test

How to Perform

The patient is side lying with the bottom leg flexed for stability. A pillow is placed under the head for support. The top leg is in alignment with the trunk. The examiner palpates the TFL and posterior gluteus medius with his or her right hand and the lateral portion of the quadratus lumborum with the left fingers. The patient is asked to raise the leg toward the ceiling. The examiner palpates for activation of the gluteus medius.

We can add elongation with hip abduction and/or hip external rotation to facilitate the posterior gluteus medius and reassess gluteus medius activation/tone.

An observational active side-lying hip abduction test while having both legs extended to assess for frontal plane stability has shown promise in predicting who is most likely to develop low back pain from prolonged standing (Nelson-Wong, 2009). A subsequent study has found this test to be a reliable observational tool (Davis et al. 2011).

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