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TherEx > Hip, Thigh, PNF > Flashcards

Hip, Thigh, PNF Flashcards

1
Q

Why is scar tissue build up from a hip muscle injury bad?

A

There are a lot of muscles that attach to the different places on the femur at different angles, so tightness or scar tissue around one or some of them can throw off vector pull for all other muscles, affecting balance from anterior to posterior chain.

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2
Q

Abnormal function of the muscles surrounding the hip may lead to…

A

degenerative changes in the articular cartilage, bone and soft tissue

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3
Q

Primary Hip Flexors

A
  • Iliopsoas: flexes hip and the trunk
  • Sartorius
  • Tensor fasciae latae
  • Rectus femoris
  • Pectineus
  • Adductor longus
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4
Q

Hip Flexor Tightness

A

Undiagnosed muscle imbalances cause hip flexor tightness, which makes the head of femur bang into the labrum, eventually resulting in DEGENERATIVE CHANGES.
Hip Flexor tightness also causes the PELVIS TO TILT ANTERIORLY and INCREASE LUMBAR LORDOSIS, increasing the pressure on the low back.

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5
Q

Primary Hip Extensors

A
  • gluteus maximus

- hamstrings

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6
Q

Hip External Rotators

A
  • “rotator cuff of the hip”
  • Gluteus maximus
  • Piriformis
  • Obturator Internus
  • Gemellus superior & inferior
  • Quadratus femoris
  • Although these are mostly external rotators, a big job of theirs is stabilizing
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7
Q

Hip Abductors

A
  • Gluteus Medius (all fibers)
  • Anterior fibers (IR)
  • Posterior fibers (extension and ER)
  • Gluteus Minimus (all fibers)
  • TFL
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8
Q

Trendelenburg Gait

A

Caused by gluteus medius weakness

When swing leg is in swing phase, standing leg glute holds up that contralateral limb.

Glute med weakness causes the hip to sink/drop into a waify model-type walk.

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9
Q

Hip Adductors

A
  • Adductor longus, magnus, brevis
  • Gracilis
  • Pectineus
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10
Q

The proper positions for performing passive ROM in the hip

A
  • Flexion: Supine, SL, Seated
  • Extension: Prone, SL
  • Adduction/Abduction: Supine, Prone
  • Internal Rotation/External Rotation: Supine, Prone, Seated
  • SL = side lying
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11
Q

Hip AAROM (Active Assisted)

A
  • Heel Slides with assistance of towel or contralateral limb

- Assistance from AT

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12
Q

Hip Flexor Stretch

A
  • Thomas Test position position
  • kneeling
    • Stretch on proximal AND distal segments of the rectus femoris
    • flexion at the hip prevents reaching full stretch there
    • couch stretch
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13
Q

Hamstring Stretch

A
  • ER tibia stretches semimembranosus and semitendinosus

- IR tibia stretches biceps femoris

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14
Q

Hamstring Stretch

A
  • Passive
    • wall stretch
    • self stretch with towel
    • ATC assisted
  • Active
    • supine: hands behind hamstring/knee
    • standing
  • watch out for poor technique - bending down to a straight leg on a low surface may not do much from the hamstring, but it may be a decent stretch for the erector spinae and glutes
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15
Q

Piriformis Stretch

A
  • quadruped position
  • Bending knee along wall drives the piriformis elongation
  • the piriformis reverses its rotary action and becomes a hip internal rotator as the hip is flexed > 90 degrees
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16
Q

Stretching the Iliotibial band/Tensor fascia lata

A
  • Standing cross legged squat
  • SL runner’s stretch
  • supine SLR bringing leg across midline (arm at 45 degrees for diagonal chain)
  • SL with assistance: Scissoring position with extreme adduction

Major problem: lack of pelvic stabilization
Maximize stretch by manually stabilizing the pelvis

If TFL tight: hip should be flexed, abducted, extended, and adducted (in sequence) to position TFL fibers directly over greater trochanter (rather than anterior to it) to produce max stretch.

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17
Q

Adductor/Groin Stretch

A
  • butterfly stretch
  • side lunge
  • frog stretch
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18
Q

Isometric Hip Strengthening

A
  • Flexion
    • Seated, use hand for resistance
  • Extension
    • Glut set
    • Supine or seated
  • Abduction
    • Seated, use hand for resistance
    • CKC, against wall
  • Adduction
    • Long-sit, seated
    • Squeeze ball, pillow
  • Big thing you can do with isometrics = muscle activation patterns/motor sequencing (keep the neurological signals/proprioceptive awareness from atrophying like the muscles from disuse)
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19
Q

Generalized Hip Strengthening

A
  • Bike
  • Stepper
  • Elliptical
  • Treadmill
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20
Q

Actions of Gluteus Medius

A
  • Concentrically abducts hip
  • Isometrically stabilizes the pelvis
  • Eccentrically controls hip adduction and IR
21
Q

Are eccentric step-downs or step downs easier?

A

Eccentric step downs are easier than step ups because muscles are always stronger eccentrically

22
Q

Gluteus Medius Strengthening Exercises

A

Prone
- Active/resisted abduction with extension

Side-lying

  • Hip ER (“clam shells”)
  • Hip abduction with extension (Hip abd wall slides)

Standing

  • Hip abduction against cable column, tubing
  • Hip abduction/extension with t-band loop
  • Stand in SLS // to wall with uninvolved side toward wall. Abduct uninvolved side
  • Single limb squat
  • Single limb deadlift

Quadruped/Steamboat position (“fire hydrants”)

23
Q

the BEST exercise for gluteus medius activation

A

side lying hip abduction against a wall

24
Q

Gluteus Maximus Strengthening

A

Prone

  • hip extension with knee flexed (open chain)
  • hip extension with knee extended (open chain)

Quadruped

  • “donkey kick” (open chain)
  • best for isolation (although isolated work is not very functional
25
Q

Hip Extension / Glutes Strengthening

A
  • bridging progression
    • basic flat on floor
    • back on boss
    • straight legs on exercise ball
    • single straight leg on ball
  • Standing
    • Squats (esp single limb) with kettle bell, back rack barbell, front rack position
    • Lunges
    • T-Band
    • Hip extension against tubing/cable column
26
Q

Hip Adduction Strengthening

A

Sidelying
- SLR

Standing

- Adduction against t-band/cable column
- Multi-hip machine

Seated
- “Nautilus” machine

27
Q

Hip Flexor Strengthening

A

Supine: SLR (flexion)
* watch out for anterior rotation of the pelvis (lumbar lordosis)!! Without sufficient pelvic stabilization by the abdominals, a strong contraction of the hip flexors may cause the pelvis to tilt anteriorly –> LOW BACK PAIN!

Prone: Walk outs/ins on swiss ball

Seated: Marches with ankle weights

Standing

  • Hip flexion against tubing/cable column
  • Multi-hip machine
28
Q

Internal/External Hip Rotation Strengthening

A

Seated: T-band resistance at ankle
Prone: T-band resistance at ankle

29
Q

Manual Resistance Exercise

A
  • Form of resistance exercise in which resistance is applied by the ATC
  • May be static or dynamic
  • When allowed, resistance performed throughout ROM
  • PNF is a common form
30
Q

Proprioceptive Neuromuscular Facilitation

A

exercises that enhance a neuromuscular response (fire a nerve pattern) through the stimulation of proprioceptors

= proprioceptive feedback pathway building to improve coordination/getting muscles to work in a particular sequence

PNF techniques require placing a resistance to a muscle where a response is desired.

PNF uses diagonal patterns representing gross movement patterns characteristic of normal activity

31
Q

advantages of manual resistance

A
  • Most effective during early stages of healing when muscles are weak
  • Allows ATC to have sensory feedback on quality of contraction
  • Resistance may be adjusted throughout ROM
  • Can make muscle work maximally throughout ROM
  • ROM may be carefully controlled by ATC to prevent unwanted motion
  • ATC may prevent compensatory patterns
  • Performed in variety of positions
  • Direct interaction with patient
  • Cost effective
32
Q

disadvantages of manual resistance

A
  • Exercise load is subjective by ATC
  • Resistance limited by strength of ATC
  • Min value for strong muscles (focus is not strength training)
  • May not directly carry over to functional activities due to decreased speed of exercise (but still somewhat functional because it fixes patterns of activation for later)
  • Unable to be performed by patient/athlete at home
  • Labor and time intensive for ATC
  • May lead to ATC injury if improper body mechanics are utilized
33
Q

Principles of PNF

A
  • Combines functional diagonal patterns
  • Improves neuromuscular control and function
  • Develops
    - Strength
    - Endurance
    - Facilitation of stability, mobility, neuromuscular control
    - Coordinated movements
  • May be used throughout rehab process from acute inflammatory through maturation phases
  • Dependent upon visual, verbal, & tactile cues
  • PNF Patterns
    - Diagonal, functional
    - Triplanar: Flexion/extension, abduction/adduction, rotation
  • important for exercises to occur in all 3 planes
  • May be used unilaterally or bilaterally
  • Good warmup to increase firing and proprioception
34
Q

Principles of PNF

A

Hand placement

  • On the surface toward which the patient should move
  • Over the agonist muscle groups
  • Cues pt on desired direction of movement
  • Allows AT to provide resistance to appropriate muscles

Position of the AT

  • Along the diagonal planes of movement
  • Shoulders and trunk facing direction of moving limb

Sequence: distal to proximal

  • Distal motion should be completed halfway through the pattern
  • Promotes neuromuscular control and coordinated movements

Verbal commands
- Auditory cues to enhance motor output

Visual cues: Ask pt to follow limb movement to enhance control throughout the ROM

35
Q

Diagonal PNF Patterns

A

May be performed in flexion or extension
E.g. “D1 flexion”, “D2 extension”

Patterns I.D. by motions at proximal joints (i.e. hip)
Flexion/extension are coupled with abd/adduction and internal/external rotation

*Don’t have to memorize all of them – if you just learn the pattern, you can figure out what each joint is doing at what moment

36
Q

D1 LE Flexion Pattern

A

starting position - extended
terminal position - flexed

Hip: flexion, adduction, external rotation

Ankle: dorsiflexion, inversion

Toes: extension

37
Q

D1 LE Extension Pattern

A

starting position- flexed
terminal position - extended

Hip: extension, abduction, internal rotation

Ankle: plantar flexion, eversion

Toes: flexion

38
Q

D2 LE Flexion Pattern

A

starting position - extended
terminal position - flexed

Hip: flexion, abduction, internal rotation

Ankle: dorsiflexion, eversion

Toes: extension

39
Q

D2 LE Extension Pattern

A

starting position- flexed
terminal position - extended

Hip: extension, adduction, external rotation

Ankle: plantar flexion, inversion

Toes: flexion

40
Q

Pelvic PNF Pattern

A

D1:
Elevate & retract
Depress & protract

41
Q

Hip Biomechanics of Gait (initial contact)

A

Initial contact (other foot about to toe off into swing phase):

  • Hip stays in the 25 degrees of flexion obtained in terminal swing
  • Hamstrings contract in reaction to hip flexion torque
  • all hip extensors are active in preparation for LR
42
Q

Hip Biomechanics of Gait (Loading Response)

A
  • Hip remains in 25 degrees of flexion
  • Glut max, hamstrings, and adductor magnus contract due to flexion torque (when pushing over onto standing leg)
  • Glut med, glut min and posterior TFL contract to stabilize in frontal plane

if someone limped for a while, glut max and hamstrings will need strengthening –> work pnf patterns to get gait sequencing right to actually fix the problem

43
Q

Hip Biomechanics of Gait (Midstance)

A
  • Hip extends to neutral
  • No muscle activity in the sagittal plane
  • Contralateral swing limb causes ext torque
  • The pelvis is stabilized in the frontal plane by the hip abductor group, primarily gluteus medius (JUST like in trendelenburg, glute med must activate to stabilize hips in swing phase of contralateral limb)
44
Q

Hip Biomechanics of Gait (Terminal Stance)

A
  • Hip extends 20 degrees (angle is important*)
  • Ext torque keeps hip stable
  • Adduction torque decreases
  • TFL fires to restrain hyperextension of the hip
45
Q

Hip Biomechanics of Gait (PreSwing)

A
  • Thigh falls forward (this motion is aided by adductor longus)
  • hip appears to be in neutral but is actually in 5 degrees of ext
  • Hip ext torque diminishes
  • Limb advancement begins
46
Q

Hip Biomechanics of Gait (Initial Swing)

A

15 degrees of hip flexion is achieved

Iliacus, gracilis, sartorius, and adductor longus are active concentrically

47
Q

Hip Biomechanics of Gait (MidSwing)

A
  • 25 degrees of hip flexion is achieved
  • The iliacus, gracilis, and sartorius, stop firing in late midswing
  • Hamstrings fire eccentrically late midswing to control hip flexion (on to slow down leg swing/control motion)
48
Q

Hip Biomechanics of Gait (Terminal Swing)

A
  • Hip falls to 20 degrees of flexion
  • Hamstrings peak to decelerate the limb
  • Glut max and adductor magnus prepare to stabilize at IC

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