Core Hip and Slings -

Intelligent prescription
PRESENTED BY:
Max MARTIN BAppSc (Hons) AEP
Movement is a behaviour
Developmental and learned
Quality over quantity
Posture is a good baseline for movement
Posture is not the cause of dysfunction but a SYMPTOM
Such dysfunction corresponds to compromised activity of muscles
Stabilisers typically become hypotonic/inhibited – ‘allowing’ faulty
posture
Gross movers typically become hypertonic/facilitated – ‘driving’
faulty posture

Prescription Paradigms
 synergist

tightness weakness

antagonist
 Why weakness?

Muscle inhibition due to pain/injury

Muscle susceptibility – eg. VMO vs VL atrophy post surgery
Muscle inactivity in chronic postures – eg. Sedentary behaviours
CNS driven protection
 Why tightness?
Joint ROM can be limited by the following factors

1. Joint constraints

2. connective tissue (40%) –

protective, inactivity, hypertonicity

3. Neurogenic constraints (voluntary and reflexive) -

protective

4. Myogenic constraints – overload protective

 tightness?

Or

gaining stability??
 Clinical/Practical findings

synergist
Glute max

tightness weakness
Hamstrings
Hip Flexors
• Psoas
antagonist
• Iliacus Glute max
• TFL
• Rec fem TrA (+core)
Lumbar Erectors
 Joint by joint approach

Foot Stable unstable

Ankle Mobile Stiff
Knee Stable unstable
Hip Mobile Stiff
Lx Spine Stable unstable
Tx Spine Mobile Stiff
Scapula Stable unstable
GH Joint Mobile Stiff

Prescription Paradigms
CORE Anatomy
 The research journey
1992: TrA found to exhibit anticipatory function (activation prior to activation of prime
movers in arm movements) in healthy subjects (Cresswell)
1996-97: TrA disrupted in multi-directional arm movements in LBP subjects
1998: TrA also disrupted in lower limb movements among LBP patients
2001: TrA latency in LBP patients shown to increase with increasing task demand
2001: Experimentally induced pain causes disruption (hypoactivity) in the TrA
2002: TrA contraction shown to increase stiffness of the sacro-illiac joint to a greater
extent than a more global abdominal contraction
2007: Pelvic floor shown to share the same pre-emptive quality as TrA and MU
2009: LBP patients shown to have greater lumbo-pelvic instability in simple open-chain
stability exercises (eg Leg Loads) compared to controls.
 Lumbar Vertebrae
Largest and strongest due to compressive
load.
Cortical bone shell with cancellous bone
core (trabeculae). Vertical Column
alignment.

Aids shock absorption quality of L1-5.

Age and repetitious loading degenerate
horizontal trabeculae ‘struts’
 Lumbar facet joints

Bony articulations between vertebrae.

Synovial Joints- articular surfaces covered in
hyaline cartilage.
Allow flexion and extension
Movement pumps fluid in and out of joint
space. Fixed postures lead to joint dehydration
and degeneration.
Constant compression caused by hypertonicity
of paraspinals can accelerate degeneration.
Sacroiliac Joints
Junction point between spine and pelvis.
Synovial Joint- innervated by pain
receptors.
Corrugated design to assist stability.
Allows forward and backward tilting of the
sacrum.
Sublaxation possible, resulting in dull ache
or sharp pain that may refer inferiorly.
 Intervertebral Discs
Colloidal gel nucleus
Concentric rings of fibrocartilage (lamellae)
form the annulus.
Outer third ONLY innervated by pain and
mechanoreceptors.
Slight movement of the vertebrae helps
rehydrate discs.
Repetitious torsion forces can derange
annulus, allowing nucleus to seep out.
Late warning of this process due to lack of
pain receptors amongst inner 2/3 of annulus.
 Intervertebral Discs Cont’d

Discs are poor shock absorbers

– Very little compressive potential
– Nucleus facilitates movement rather
than compression
 Thoracolumbar Fascia

Dense multilayered sheet of

connective tissue.
Insertion point for many muscles
Overactive lats and/or glutes can
cause excess collagen
deposition, making TLF more stiff.
This can restrict the ability of TrA to
slide freely as it pulls on deep layer.
Transversus Abdominis
 Transversus Abdominis

Intra-abdominal pressure, thus making this area more stiff (less bendable).
Increases the stiffness of thoraco-lumbar fascia and abdominal aponeurosis.
Line of pull helps to align the ribs and pelvis in anatomically correct
Fibres crossing the sacroiliac joints pull the Ilium and the sacrum closer
together, decreasing laxity in these joints.
 Gluteus Maximus

Primary hip extensor and external rotator*

Important for maintaining upright posture
Stabiliser of SIJ via attachment to TLF
Supports hip and knee via ITB attachment
Functional role in stepping, running, climbing etc. and…
DECELERATION
 Gluteus Medius
Primary abductor and controller of rotation of the hip*
Functionally supports pelvis during SL stance and gait
Plays rotator cuff-like role
Strongest in neutral or slight adduction
 Tensor Fascia Latae

Primary functions are hip

flexion, internal rotation and abduction
(via ITB)
Works in synergy with glute max:
Tighten ITB to extend
knee joint
Control movements of pelvis on
femur and femur on tibia when
weight bearing
Iliotibial Band

Thick, lateral aspect of

fascia lata
Attachment point for glute
max, TFL (and glute med)
Indirect insertion onto
patella
Anatomically impossible to
stretch effectively
Piriformis & External Hip Rotators

Primarily lateral rotator of the hip

In hip flexion, will also abduct the hip
Secondary phasic stabiliser of the SIJ
Close relationship to sciatic nerve
Piriformis syndrome
Vastus Medialis & Lateralis

Primary action is knee extension in inner

range- 15-20deg of knee flexion
Provide medial and lateral stability
to patella respectively
Perform anticipatory role
Often dysfunctional (knee pain, pronation)
Single Legged Squat

Functional strength exercise

Assessment tool
SLSq Research (performance and strength)
Wilson et al (2006) Frontal Plane Projection Angle measured
(FPPA)
 Women > FPPA
 Weakness in external rotators correlated most closely to
FPPA (predisposes to ACL injury & PFP)
Claiborne et al (2006)
 Hip abductor strength most important for resisting
valgus alignment
Crossley, 2006
 Glute med shown to be latent in poor SLQ
 Abduction strength and Trendelenburg test shows
correlation to SLSq
Slings
Thomas Myers- Anatomy Trains

Superficial Front Line

Superficial Back Line
Spiral Line
 Correctives!!
Core exercises:
Leg loads (ant oblique, ant superficial and Spiral)
hip extension (post oblique and posterior superficial)
Hip lifts/SL (post oblique and post superficial)
Hip exercises:
Squat (posterior superficial),
SL DL (Lateral), hitches (lateral) and Rots (posterior and
anterior oblique), SL SQ (lateral)
 PRESENTED BY:
Max MARTIN BAppSc (Hons)AEP
@iNformMaxMartin
max@correctiveexerciseaustralia.com