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Answer SheetHip Pain – Restoring the Kinetic Chain: What did you learn? Choose the best selection to answer each question:How might scoliosis with a pelvis shift affect the hip muscles?If the pelvis is shifted to the left, it may cause left hip abductors to be overstretched.If the pelvis is shifted to the left, it may cause tightness in the left hip adductors.If the pelvis is shifted to the right, it may cause left hip muscles to be overstretchedA and B are correctOverstretched and shortened muscles are both in sub optimal muscle length-tension relationship and therefor continue to enhance muscle imbalance.How does the Q Angle directly impact the hip?Q Angle is a test for valgus angulation of the knee causing a varus angulation of the hipQ Angle is the angle of varus between hip and knee and is found primarily in womenQ Angle is larger in women than in men due to a wider pelvis and may contribute to over stretch of Gluteus mediusQ angle is larger in women than in men and may contribute to knee injuries in girls’ sportsWhile D is also a correct statement, the question asked about the effect on the hip. That said, the length-tension relationship is sub optimal and contributes to muscle imbalance that affects the knee and the hip. Christopher Powers has done impressive research about Patella-femoral dysfunction and how it is strongly impacted by the hip (see reference in handout).How does Femoral Acetabular Impingement (FAI) affect exercise prescription?FAI is a structural issue that cannot be influenced by exercise FAI is a structural issue that my be influenced by large hip movements during exerciseFAI can be corrected by omitting large hip movement (ER and ABD) during exercise.B and C are true FAI cannot be “corrected” with exercise since it is a structural issue caused by the incompatible relationship between the shape of the femoral head and the shape of the acetabulum - not a muscle imbalance issue. Often it will go unnoticed until large movements, especially external rotation and abduction (leg circles), are repeated on a regular basis.What hip assessment should be done before prescribing Inferior Capsular Glide with a strap?Excessive Anterior Femoral Head Movement comparison right to leftKnee to Chest Hip Flexion comparison right to leftThomas Test Ober test The knee to chest asymmetry between right and left hip suggests that the inferior (and posterior) capsule is restricted. There is no reason to perform this maneuver unless there is an imbalance. Maintain neutral spine in the sagittal and frontal plane to reduce influence on the spine and isolate the hip capsule.Name 3 functional tests for the hip. Thomas Test, Q Angle, Step DownJump Test, Ober Test, Anterior Femoral Head AssessmentThomas Test, Step Down Test, Anterior Femoral Head AssessmentAll are functional tests for the hipWhile the jump test is a functional test, you would not perform this on the aging adult. The Ober test is a passive test for tight IT band and not a functional test. The Q angle is not a test but a physiological measurement. While the Thomas test may be seen as a passive test, it can be performed independently and actively by the client as they are asked to extend the hip and maintain neutral spine. The Anterior Femoral Head Assessment requires the client to do a straight leg raise in order to assess if the femoral head is gliding anteriorly and not posteriorly (the natural motion), which can happen if the hip stabilizers are being overpowered by the Rectus Femoris and other long hip flexors. This often happens in the dancer and can be one of the causes of “Snapping Hip Syndrome”.What has been shown to have the greatest impact on the aging client?Hip arthritis and Total Hip Replacement (Arthroscopy)Total Hip Replacement (Arthroscopy) and Hip FractureFrontal Plane Spino-pelvic misalignment and Total Hip Replacement (Arthroscopy)Sagittal Plane Spino-pelvic misalignment and hip FractureMortality rates double after a hip fracture and Sagittal Spino-perlvic misalignment is a leading risk factor for pain and disability in the aging adult. How might you modify the Glute Reeducation Exercise for people with tight hip flexors?Place pillow under pelvis/abdomen Have client lie on long box with hips flexed over edge and feet on floorBegin in Quadruped instead of prone All are options to increase hip flexion for those who have tight hip flexorsWhile we did not discuss the quadruped option, this is also another optional starting position for the glute re-education exercise. It provides the greatest modification/limit to hip extension. This is one of the most prevalent findings in people with unilateral back pain and following lower extremity injuries. What are you most likely to find in the Glute Reeducation exercise?Bilateral glute inhibitionUnilateral glute inhibition Unilateral hip flexor tightnessB and CGlute inhibition is most often accompanied by hip flexor tightness and it is unilateral. So if you chose B you would get credit, but it is important to recognize the two often go hand in hand and tightness will inhibit the glute at end range hip extension. This is why - it is important to begin in some hip flexion in many cases. This test is also the prescriptive exercise.Why might you need to place a wider object (half foam roller, ? foam roller) between feet during the Double Leg Kick Variation?Because of tight IT BandsBecause of tight hip flexorsBecause of tight quadsBecause of lumbar hyperextensionThis is also the same reason you may need to abduct a client’s hips during the bridge exercise or during Thigh Stretch on the Reformer when they complain of knee pain. The IT Band attaches to the Tensor Fascia Latae, the patellar retinacula and the Tibia. It may even cause people to stand in relative hip abduction. Thigh Stretch is also a corrective exercise, beginning with hips abducted (or/and externally rotated) then slowly bringing the knees closer together while performing these exercises over time. Thomas Test would show hip abduction when the leg is lowered.What is the best overall assessment of the lower extremity kinetic chain?Pelvis Functional Reeducation TestSide PlankStep Down TestGaitGait is a better assessment than the Step Down Test because it includes the function component of leg reciprocation. Step Down test assesses how increasing load impacts the kinetic chain.BONUS: We did not discuss this in the workshop but based on your understanding of the hip: What is most likely the largest contribution to the cause of SI dysfunction and pain?Hypermobility of the SI jointHypo-mobility of the SI jointHip joint: injury, hypermobility or hypo-mobilityHip muscle imbalanceThe SI joint is primarily unilateral and primarily influenced by the hip muscles and to a certain extent the quadratus lumborum (QL). You will often find, for example, unilateral: glute inhibition, hip abductor weakness, hip flexor or ITB tightness, hip capsule tightness and over recruitment of QL. Once these imbalances are addressed, the client with SI joint dysfunction should advance to the Greg Johnson exercise: Anterior Elevation and Posterior Depression (often called “Basking Seal”) to integrate the pelvic component of gait. ................
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