Prone Hip Extension Off the Table

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Hip EXT Firing Pattern, Retraining

Prone Hip Extension Off the Table

The patient is lying on their stomach on a table top, positioned with their knees bent and feet flat on the floor.
Instruct the patient to find a neutral lumbar spine by rocking the pelvis towards 12:00 then 6:00, finding the midpoint in between. The therapist monitors the PSISs to insure that they are level in the frontal plane.
The patient is instructed to hold this position by drawing the belly button in towards the spine.
Ask the patient to extend one leg at a time, maintaining flexion of the knee and keeping a neutral lumbar spine. Make sure that the patient does not abduct or externally rotate the leg during hip extension and that the PSISs remain level.
The patient should feel their buttocks tighten during the movement. The therapist should also be able to palpate tone in the gluteus maximus during this exercise.
Make sure that the movement occurs in the hip joint, avoiding extension of the spine.
It may be helpful to instruct the patient to try and elongate the leg by reaching away with their knee as the hip is extended.
Have the patient hold for 10 seconds and initially repeat only 3-5 times. Alternate legs.

Dysfunctional Prone Hip Extension Functional Movement Test

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

Dysfunctional Prone Hip Extension Functional Movement Test

Anatomy and Biomechanics:

This prone lying test assesses the recruitment of the gluteus maximus and hamstrings and requires 5 to 10 degrees of active hip extension mobility. Restriction of hip extension ROM can be due to tight hip flexors and/or a tight anterior hip capsule which needs to be addressed first before attempting retraining. (See Module #3) If the prone hip extension test is dysfunctional then to maximize gluteus maximus recruitment, retraining should initially begin with the hip flexed, ie,. short of neutral, thereby reducing some inhibitory factors.

Substitution patterns to watch out for during retraining:

Janda, 1990, originally described an ideal hip extension firing pattern in which the hamstrings fired first followed by the gluteus maximus then the contralateral and finally ipsilateral lumbar erector spinae. Subsequent studies have not supported this firing pattern (Pierce and Lee, 1990; Vogt and Banzer, 1997). Clinically what seems to be most important is whether or not the gluteus maximus fires at all and how well is the pelvis and trunk stabilized during hip extension. Often patients are able to extend a leg without any palpable tension felt in the gluteus maximus at all with substitution occurring by the patient using their erector spinae and hamstrings to lift the leg.

Patients will often substitute for a lack of hip extension mobility by anteriorly rotating the ipsilateral innominate as they raise the leg. This is why it’s important both during the functional movement test and during retraining that the therapist monitors the position of the PSISs during hip extension to insure that minimal anterior innominate rotation occurs (slight superior migration of the PSIS is ok).

The therapist should also watch for any pelvic rotation in the transverse plane during hip extension retraining indicative of a loss of anterior stabilization of the pelvis. This substitution pattern occurs due to inhibition of the abdominal obliques and hypertonicity of the erector spinae on one side, ie., during L hip extension the R ASIS lifts off the table excessively as the thoracolumbar junction and pelvis rotate to the R. These patients often present with an increase in tone and palpable tension of the R erector spinae muscles even with the patient lying at rest.

Star Diagram

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Functional Integration, Hip ABD Firing Pattern, Hip EXT Firing Pattern, Sensorimotor, Supine Hip ABD and ER

Star Diagram

Closed kinetic chain facilitation of the gluteal muscles:

With the patient’s arms at their sides instruct the patient to advance the right leg as far forward as possible keeping their right foot approximately an inch off the floor as they bend the left knee.
The patient then reaches back as far as they can with the right foot staying an inch off the floor.
Then ask the patient to reach with their right foot out to the side and finally to draw a star taking the right foot behind and to the left and forward to the right and finally back to the right keeping the right foot an inch off the floor each time and bending their left knee as far as possible.
Repeat in each direction 4 to 5 times, then repeat standing on the right leg.
Make sure to watch for any valgus deviation of the stance knee during this retraining, which should be avoided.

Muscle Energy Technique for a FRS Right in R Side Lying

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, Active Trunk Rotation, All Lower Quarter, All Manual Therapy, Hip ABD Firing Pattern, Hip EXT Firing Pattern, Muscle Energy, Pelvic Clocks, Rolling

Muscle Energy Technique for a FRS Right in R Side Lying

Extension is introduced from above down and from below up to the barrier
Rotation is then introduced from above down to the feather edge of the barrier
The segment to be treated must remain perpendicular to the table
Using the R forearm the therapist introduces L side bending thru the pelvis by pushing up in an anterior and superior direction
Patient is instructed to push the pelvis caudally to activate the R side benders
Upon relaxation the therapist takes up the slack thru the pelvis
Repeat 3 to 4 times
To finish the patient is asked to extend the top leg (L) back while the therapist maintains the correction

Anterior Innominate Self Correction: Home Self-Mobilizing Exercise

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Hip ABD Firing Pattern, Hip EXT Firing Pattern, Self-mobilization, Supine Heel slide, Supine Hip ABD and ER

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 Extension Test

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

Hip Extension Test

How to Perform

Step 1: The patient is lying prone and the examiner palpates the gluteus maximus for activation during hip extension. Janda originally described an ideal hip extension firing pattern in which the hamstrings fired first followed by the gluteus maximus then the contralateral and finally ipsilateral lumbar erector spinae. (Janda, 1990). Subsequent studies have not supported this firing pattern. (Pierce and Lee, 1990; Vogt and Banzer, 1997). Clinically what seems to be most important is whether or not the gluteus maximus fires at all and how well are the pelvis and trunk stabilized during hip extension.

Step 2: The second part of the hip extension test is for the examiner to monitor the PSISs during active hip extension. Normally the PSISs should stay still or move slightly superior during the movement.