What is the Hip? Femur pull-back prone stabilize pelvis and pull the femur up at the top

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1 Spinning the Hip Dr. George Russell 1133 Broadway, #1125 New York, NY georgerusselldc.com Copyright George Russell 2014 What is the Hip? Front bone of the pelvis Anterior Superior Iliac Spine Outer Iliac Crest Hands on your hips Outer bone of the femur Greater Trochanter Articulation of the ball and socket Inner groin Mid-buttock beneath largest part of the piriformis muscle, between sacrum, greater trochanter and sitting bone Ball and socket 6 way ROM ROM is based on the Cartesian coordinates They don t reflect the body s movement -- they are abstract All joint movement is multiplanar All joints are irregular joints We need to think of the hip as a 360 degree structure, and to expand our ideas of where it is to be found and how it is to be treated. Test and treatment: Janda maneuver more for in-joint adhesions test ROM (all ranges except extension) belt upper thigh at groin stabilize femur draw upper femur into desired range supporting with belt hold until you feel motion Each vector must be released separately, like spokes on a wheel. abduction is done from across the body holding the outer femur in a toward-theceiling, toward-you position Test and treatment: Thomas position more for muscle tightness Psoas quadriceps adductors abductors internal and external rotators can assess extension Femur pull-back prone stabilize pelvis and pull the femur up at the top

2 Positional stress on Hip Joint Desired Alignment A. Femoral head tends to fall forward due to structure of pelvis and Y-ligament leads to wear and tear on labrum, hyperextended knees and low back, and head forward. B. Femoral head tends to fall upward and inward in the socket due to structure of femoral head/acetabulum restricts adduction due to glide/roll issue C. Good posture requires keeping femoral head down and back in the socket. Psoas needs to lengthen, trochanters need to stay back and inner groins move back. Tailbone resists by reaching down to floor to prevent hyperexension of lumbar spine and flexion of hips. D. When standing on two legs with the feet planted, the action of the obturators and the gemelli lift the pelvis off the femur because they attach lower on the pelvis than on the greater trochanter. E. Image Two legs out in space, crossbars connecting them into the two ilia which fall into the sacrum which is the foundation of the trunk. Lots of mobility due to side attaching ball/socket; wide support but narrow joint make for combination of upright stacking (less energy for stability) and mobility (less impediment to free motion). Muscular actions around the joint serve to keep the joint in the right combination of stability (ski poles femur and lower leg; ball and socket compression mortar and pestle) and mobility (openness and fluidity of ball and socket; mobility of spine over supportive legs, response of lower body joints to changes in the terrain while still pushing up and holding the torso steady). Image of standing on the feet with the strong long bones going up to the trochanter. Keep that wide and high, and at the same time use the muscles to lift the torso off that structure all the muscles around the joint operating with balance. S/ I Joint A. passive movement B. flex/ ext C. anterior/ posterior D. glide/ twist E. augments flexion/ext of hip, rotation of torso F. when one psoas is tight, or one ilium anteverted, it will make the pelvis look like it s twisting to that side. Watch out for it. Often, lengthening the psoas will remove the twist. Lumbar Spine A. compensates for hips -- Rockettes B. or hips and knees compensate for spine, e.g. in twisting action C. hips and knees also compensate if there is a held twist in the spine to be discussed later to make feet point forward, hips and sometimes knees twist in neutral position. D. A tight psoas will bring the spine into extension and the hips into flexion in standing or lying on the table E. psoas stretch 1 Lie on your side reach top arm forward and back leg backward on diagonal reach through back heel and front fingernails straight limbs for more stretch, turn back leg in, compress abdomen and tuck pelvis or bring leg back more

3 keep them on the floor five breaths if back hurts, roll pelvis further over stretch should be felt inside front bones of pelvis psoas stretch 2 lie on back, feet flat and wide, knees up drop knees to one side, lift opposite arm overhead press inner knee toward floor if it hurts, use another exercise if ok, use outer foot on inner knee to bring it down compress abdomen and tuck pelvis should be felt on inside of pelvic front bone if done as part of bodywork, have them not tuck pelvis or compress abdomen, come in from the side and press fingers straight toward the ground under the rectus abdominis psoas stretch 3 deepest lunge shin parallel to floor bent leg hand supports you on a table, chair or wall compress abdomen and pelvis (no net movement) reach arm on lengthened leg side lift waist with upraised arm bend toward support side with lengthened arm, palm down 5 breaths each side F. Hamstrings Tight hamstrings will push hips into extension They may also create extension in low back Leads to ribcage back, head forward posture Hamstring/glute balance is important. Glutes should be strong enough to allow for balance around hip and to avoid overdominance of hamstring. Back bridge or Setubanda from yoga is a good balancer. The closer the feet are to the butt, the more the glutes are used. Back bridges where you shift the weight without any apparent visual change use the glutes a lot. Alternately lifting the legs without shifting the pelvis strengthens the glutes in a context that maintains alignment. Glute strength is important in core strength because the glute is big and close to the hip joint. Hamstring takes longer to react to a change in joint position. hamstring stretch 1 hands on a table or high on a wall so that back is straight ground heels hip-width apart lengthened hamstring into calf so knee is straight don t push knees back relax belly! press knuckles into wall or table and extend sitting bones away from body hamstring stretch 2 legs are hip-width apart one forward, one back

4 ground back heel straighten both legs feet parallel twist toward front leg hamstring stretch 3 lie supine one leg up with thigh clasped in hands don t move thigh away from belly at all lift lower leg until taut, not straight (don t let thigh move away from belly) breathe in and out three times rest, then repeat a total of three times. G. quadratus lumborum H. Knee when short, hikes hip (ilium) when short, simulates leg length discrepancy (so does scoliosis) To measure leg roughly, measure from asis to medial malleolus If there aren t major traumas or anomalies, this should distinguish a true short leg (rare) from an apparent one (common) If leg appears short but isn t, start by checking QL Working fascia at and above/under iliac crest allows for more lift of the ribcage off the ilium lengthens waist, makes space for nerves and discs, allows for separation of ilium from lumbar spine. bent go passive rotation when legs are bent takes up slack in sports i.e. basketball, soccer, and skiing when hips and ankles move into quick changes of position substitutes for hip external rotation/abduction in yoga e.g. lotus tests for hip mobility to show if you should try lotus (shin parallel when you hold up bent leg) and how to sit cross legged (knees no higher than hips). Assessment for knee internal and external rotation and meniscal position do with leg and supported. hamstring and quad both cross 2 joints so hip problems become knee problems and vice versa. hyper ext knee, hyper ext hip bent knees, hip instability and tightness Psoas issues and knee issues seem to go together Psoas externally rotates hip stress on knee to internally rotate Tight psoas tightens front of hip, placing it in a flex position which puts more extension stress on knee To address psoas supine, go in gently outside of rectus abdominis, sink into tissue, then diagonally down toward spine To address psoas prone, reach from same or opposite side and draw fingers diagonally up into muscle

5 I. Feet J. ITB Arch needs to lift to support inner knee, hold up inner leg to have the masaai warrior leg. Footprint shape needed to ground, arch needed to lift. Straight joints at knee and ankle needed for length and lift. Foundation feet Superstructure muscles of trunk, esp. external rotators to lift chassis Gluteus maximus and tensor fasciae latae are the reins on the fascia latae girdle whose fibers balance and mix into the narrower iliotibial band Compresses and integrates leg on the side The total structure crosses hip and knee. TFL is a flexor, abductor and internal rotator Glut max is an extensor and external rotator Balancing the ITB involves balancing these two Further down, it s a ligamentous/fascial structure If not lengthened can cause knee problems passive external rotation of tibia on femur jumper s knee and pain on side of leg Check fascia at and above iliac crest if ITB won t give way. Stretch ITB by lying on back and taking leg across body (if groin allows it) Stretch ITB by putting one foot behind the other and forward bending Tennis ball or Feldenkrais roll under structure proceed with caution Stretch ITB by lying flat on back with knees up and feet flat. Adduct one leg by dropping knee across midline. Cross the other leg over that one. Spinning the hip Front Psoas creates flexion in hip/extension in low back/forward tilt of pelvis adductors tight on a short leg, tight on a less weighted leg attach to pubic bone and all the way down the inner leg to the inner tibia often people substitute medial quad, less often medial hamstring for weak adductors rectus femoris only muscle of the quadriceps that crosses the hip (AIIS attachment) sartorius can be tight makes the number 4 with other leg abducts, externally rotates and flexes longest muscle in body ASIS to inside top of tibia (pes anserine) Side Tensor fasciae latae, gluteus med & min, abduct the femur and rotate it in. TFL attaches into fasciae latae and thence into ITB Gluteus medius and minimus from ilium (mouse ear) to greater trochanter an internally rotated leg is shorter

6 Back Gluteus Maximus externally rotates and extends attaches to ilium, sacrum, fascia latae and back of upper femur. Important to have strength here for hamstring suppleness and core strength External rotators deep six Major one is piriformis Pear shaped Front of sacrum to greater trochanter Because of its fiber angle, piriformis can be stretched in external rotation if the leg is flexed, abducted and externally rotated crossed like a guy over the other leg All external rotators go from somewhere on pelvis to back of femur greater trochanter and down. Clinical notes on rotation: An externally rotated leg is longer than a neutral one Obturators and gemelli attach higher on femur than on pelvis. Hence they lift the pelvis off the legs when the legs are fixed When the pelvis is rotated to one side, the side it s rotated toward will have tight internal rotators, and the side it s rotated away from will have tight external rotators so the feet can still point forward. Feel free to contact me with questions, comments or referrals! Copyright George Russell 2014 Feel free to share this information. Please credit me if you do so.

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