Dysfunctional Supine Abduction and External Rotation Test

Anatomy and Biomechanics:

The pubic symphysis is a fibrocartilagenous joint whose stability is dependent upon a balance of tension/tone between the superior muscle attachments (obliques and rectus abdominis) and the inferior muscle attachments (hip adductors). Pubic dysfunctions are a reflection of an imbalance in tension between these two competing muscle groups. Abdominal surgeries, ie, appendectomies, hernia repairs, c-sections all result in scarring and fibrosis of the abdominals resulting in inhibition of the abdominals and contribute to the development of an inferior pubic shear. An inferior pubic shear occurs due to the dominance of the hip adductors that respond to abnormal afferent information by becoming hypertonic. This is more commonly seen on the right side. Rebalancing these competing muscle groups is a goal for the following home exercises.

Substitution Patterns to watch out for during retraining:

Dysfunction with this movement test is almost always found on the right versus the left side so pay attention to the R ASIS which will drop inferiorly prematurely when compared to the left side. Tightness of the R medial and anterior hip capsule, hypertonicity of the R hip adductors and an inferior pubic shear dysfunction on the R side can all result in a positive test and need to be addressed before retraining is initiated.

See Module #3 to review.