Chapter 14 Corrective Strategies for Lumbo-Pelvic-Hip Complex Impairments

Question 1

Learning Objectives

Answer 1

Upon completion of this chapter, you will be able to:

• Understand basic functional anatomy for the lumbo-pelvic-hip complex.
• Understand the mechanisms for common lumbo-pelvic-hip complex injuries.
• Determine common risk factors that can lead to lumbo-pelvic-hip complex injuries
• Incorporate a systematic assessment and corrective exercise strategy for lumbo-pelvic-hip complex impairments.

Question 2

Introduction

Answer 2

The lumbo-pelvic-hip complex (LPHC) is a region of the body that has a massive influence on the structures above and below it. Th e LPHC has between 29 and
35 muscles that attach to the lumbar spine or pelvis ( 1, 2 ). The LPHC is directly associated with both the lower extremities and upper extremities of the body. Because of this, the dysfunction of both the lower extremities and upper extremities can lead to dysfunction of the LPHC and vice versa.

Question 3

Review of LPHC Functional Anatom

Iliofemoral joint

Sacroiliac joint

Answer 3

The femur and pelvis

pelvis and sacrum

Question 4

Thoracolumbar and Cervicothoracic junctions of the spine

Answer 4

the tibia, fibula, and talus

Collectively, these structures anchor the myofascial tissues of the LPHC such as the biceps femoris, medial hamstring complex, and rectus femoris. These bones and joints are of importance in corrective exercise because
they will also have a functional impact on the arthrokinematics of the LPHC

Question 5

Muscles

Answer 5

There are a number of muscles in the upper and lower extremities whose function may be related and have an effect on the LPHC Table 14. 1. As with all muscles, it is important to restore and maintain a normal range of motion and strength, as well as eliminate any muscle inhibition to ensure joints are operating optimally ( 3 – 5 ). See chapter two for a detailed review of the location and function of these muscles.

Question 6

Key Muscles Associated with the LPHC

Answer 6

Gastrocnemius/soleus
Adductor complex
Hamstring complex
Hip flexors
Abdominal complex
Erector spinae
Latissimus dorsi
Tensor fascia latae/IT-band
Gluteus medius and maximus

Question 7

Common LPHC Injuries and Associated
Movement Deficiencies

Answer 7

Local Injuries:

Low-back pain
Sacroiliac joint dysfunction
Hamstring complex, quadriceps, and groin strains

Injuries Above LPHC:

Shoulder and upper-extremity injuries

Cervical-thoracic spine

Rib cage

Injuries Below the LPHC:

Patellar tendonitis (jumper’s knee)
IT-band tendonitis (runner’s knee)
Medial, lateral, and anterior knee pain
Chondromalacia patellae
Plantar fasciitis
Achilles’ tendonitis
Posterior tibialis tendonitis (shin splints)

Question 8

• *Posterior oblique
  subsystem. **

Answer 8

The gluteus maximus and latissimus dorsi along with the thoracolumbar fascia.

As a compensatory mechanism for the underactivity and inability of the gluteus maximus to maintain an upright trunk position, the latissimus dorsi may become synergistically dominant (overactive or tight) to provide stability through the trunk, core, and pelvis

Question 9

the deep longitudinal subsystem

Answer 9

The erector spinae, sacrotuberous ligament, biceps femoris, peroneus longus,
and anterior tibialis work synergistically to form

Question 10

SYSTEMATIC PROCESS TO DETERMINE LPHC IMPAIRMENTS

Answer 10

Because of the freedom of movement at the LPHC and its association with the
upper and lower extremities, there are a number of key elements to assess
for LPHC dysfunction.

Question 11

SYSTEMATIC PROCESS TO DETERMINE LPHC IMPAIRMENTS

cont

Answer 11

A key static postural distortion syndrome to look for to determine potential
movement dysfunction at the LPHC is the lower crossed postural distortion
syndrome

This position of the pelvis and lumbar spine can
place excessive stress on the muscles and connective tissue associated with the LPHC during dynamic movement.

Question 12

SYSTEMATIC PROCESS TO DETERMINE LPHC IMPAIRMENTS

TRANSITIONAL MOVEMENT ASSESSMENTS​

Answer 12

There are several LPHC compensations to look for when performing an overhead squat assessment. As outlined in chapter six, these compensations include excessive forward lean, arching of the low back, rounding of the low back, and an asymmetric weight shift.

Question 13

SYSTEMATIC PROCESS TO DETERMINE LPHC IMPAIRMENTS

DYNAMIC MOVEMENT ASSESSMENTS

Answer 13

Dynamic movement assessments can also help to determine whether LPHC
movement deficiencies exist while performing more dynamic movements such as gait (chapter six). When performing a gait assessment, observe the individual’s LPHC for excessive arching and excessive pelvic rotation as well as hip hiking. These compensations could be indicative of poor neuromuscular control of the LPHC and will need to be addressed in the corrective exercise program.

Question 14

SYSTEMATIC PROCESS TO DETERMINE LPHC IMPAIRMENTS

RANGE OF MOTION ASSESSMENTS

Answer 14

The range of motion (ROM) assessments performed for LPHC impairments will be dependent on the compensations seen during the overhead squat assessment. The table provides a summary of key joints to be measured on potential observations on the basis of the movement compensation(s) seen in the movement assessment.

Question 15

SYSTEMATIC PROCESS TO DETERMINE LPHC IMPAIRMENTS

STRENGTH ASSESSMENTS

Answer 15

As with the ROM assessments, the manual muscle tests that are selected will also be dependent on the compensations seen during the overhead squat assessment. The table provides a summary of key muscles to be tested on the basis of the movement compensation(s) seen in the movement assessment. See chapter eight to view the proper execution of these assessments.

Question 16

SYSTEMATIC CORRECTIVE EXERCISE STRATEGIES FOR
LPHC IMPAIRMENTS

IMPAIRMENT

EXCESSIVE FORWARD LEAN

Answer 16

Step 1: Inhibit: Key regions to inhibit via foam rolling include the gastrocnemius/soleus and hip flexor complex (rectus femoris).

Step 2: Lengthen: Key lengthening exercises via static and/or neuromuscular stretches include the gastrocnemius/soleus, hip flexor complex, and abdominal complex.

Step 3: Activate Key activation exercises via isolated strengthening exercises and/or positional someone stabilizers.

Step 4: Integration An integration exercise that could be implemented for this compensation could be a ball squat to overhead press. This exercise will help teach proper hip hinging while maintaining proper lumbo-pelvic control. Adding the overhead press component will place an additional challenge to the core. The individual can then progress to step-ups to overhead presses (sagittal, frontal, and transverse planes), then to lunges to overhead presses (sagittal, frontal, and transverse planes), and then to single-leg squats to overhead presses.

See chart on pg 325 for program

Question 17

SYSTEMATIC CORRECTIVE EXERCISE STRATEGIES FOR
LPHC IMPAIRMENTS

LPHC IMPAIRMENT: LOW BACK ARCHES ​

Answer 17

Step 1: Inhibit Key regions to inhibit via foam rolling include the hip flexor complex (rectus femoris) and latissimus dorsi.

Step 2: Lengthen Key lengthening exercises via static and/or neuromuscular stretches include the hip flexor complex, erector spinae, and latissimus dorsi.

Step 3: Activate Key activation exercises via isolated strengthening exercises and/or positional isometrics include the gluteus maximus and abdominal complex.

Step 4: Integration An integration exercise that could also be implemented for this compensation could also be a ball squat to overhead press and use the same integrated the progression that was provided for the excessive forward lean programming.

Question 18

SYSTEMATIC CORRECTIVE EXERCISE STRATEGIES FOR
LPHC IMPAIRMENTS

IMPAIRMENT: LOW BACK ROUNDS

Answer 18

Step 1: Inhibit Key regions to inhibit via foam rolling include the hamstring complex and adductor Magnus

Step 2: Lengthen Key lengthening exercises via static and/or neuromuscular stretches include the hamstring complex and adductor magnus.

Step 3: Activate Key activation exercises via isolated strengthening exercises and/or positional
isometrics include the gluteus maximus, hip flexors, and erector spinae.

Step 4: Integration An integration exercise that could also be implemented for this compensation could also be a ball squat to overhead press and use the same integrated progression that was provided for the excessive forward lean programming.

Question 19

SYSTEMATIC CORRECTIVE EXERCISE STRATEGIES FOR
LPHC IMPAIRMENTS

ASYMMETRIC WEIGHT SHIFT

Answer 19

Step 1: Inhibit Key regions to inhibit via foam rolling include the same side (side toward shift) adductors and TFL/IT-band and the opposite side (side away from shift) piriformis and biceps femoris. The gastrocnemius and soleus can also play a major factor in this compensation as well. As the client descends into the squat, if one of the ankle joints lacks sagittal plane dorsiflexion, this forces the body to shift away from the restricted side and move to the side capable of greater motion. For example, if the left ankle is restricted, it can force the individual to the right to find that ROM.

Step 2: Lengthen Key lengthening exercises via static and/or neuromuscular stretches include the
same side adductors and the opposite side gastrocnemius/soleus, TFL/IT-band, biceps femoris, and piriformis.

Step 3: Activate Key activation exercises via isolated strengthening exercises and/or positional
isometrics include the same side gluteus medius and the opposite side adductor complex.

Step 4: Integration An integration exercise that could also be implemented for this compensation
could be a ball squat to overhead press and use the same integrated
the progression that was provided for the excessive forward lean programming.

Question 20

SUMMARY

Answer 20

The LPHC operates as an integrated functional unit, enabling the entire kinetic chain to work synergistically to produce force, reduce force, and dynamically stabilize against abnormal force. In an efficient state, each structural component distributes weight, absorbs a force, and transfers ground reaction forces. This integrated, interdependent system needs to be appropriately trained to enable it to function efficiently during dynamic activities. Because of the many muscles associated with the LPHC, dysfunction in this region can potentially lead to dysfunction in both the upper and lower extremities, and dysfunction in either the upper or lower extremities can lead to LPHC dysfunction. For this reason, it becomes a crucial region to assess and will most likely be a region that will need to be addressed in most individuals with movement deficits.