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Objectives
Lecture
Attendees will understand the importance of hip
mobility and how a lack of hip motion can affect
function within the kinetic chain
Attendees will be able to assess hip joint mobility to
determine the appropriateness for therapeutic
intervention
Attendees will be able to discuss the indications,
contraindications, and application of joint
mobilizations to improve mobility
GLATA 2013 WHEELING, IL
Objectives
Lab
Attendees will be able to perform static and dynamic
joint mobilizations for the hip in both weightbearing
and non-weightbearing positions
Attendees will be able to demonstrate and instruct a
mobility exercise program to allow for maximal gain
following joint mobilization
Neurodevelopment
As babys we have tremendous
amount of joint mobility
We maintain this as children
through play
As adults we start to loose
mobility mostly due to
positional and postural habits
Causes:
Decreased length in hip
flexors
Reciprocal inhibition of
the gluteal muscles
Football: 2.14
Mens Soccer: 1.20
Volleyball: 1.42
Womens Soccer: 1.75
Increased muscular
activation in hamstrings,
piriformis, erector spinae
GLATA 2013 WHEELING, IL
Movement Assessment:
Squat Test
Table Assessment:
Pelvic Alignment/Hip Extension
Table Assessment:
Supine Mobility
But
Do these really treat ALL of the problem?
GLATA 2013 WHEELING, IL
History
Hippocrates (4th century BC physician) may have
been first recorded to perform joint
manipulations and spinal traction
English physicians in the 1700 and 1800s
believed in strict rest after a joint injury, while
bonesetters would treat patients with
manipulations
Dr. Wharton Hood wrote the first medical book
on manipulation in the 1870s
GLATA 2013 WHEELING, IL
History
Kaltenborn - Scandinavian who merged what he
considered the best of chiropractic, osteopathy,
and physical medicine
Maitland - Australian PT who focused primarily
on mobilizations rather than manipulation, and
has meticulous examination skills that heavily
guide his treatments
Terminology
Mobilization passive joint movement for increasing
ROM or decreasing pain
Movement Types
Physiologic movement: movements the patient
can perform voluntarily
Accessory movements: movement the patient
cannot perform actively, but are necessary for
normal ROM
Roll
A series of points on one articulating surface
come into contact with a series of points on
another surface
Rocking chair analogy; ball rolling on ground
Example: Femoral condyles rolling on tibial
plateau
Roll occurs in direction of movement
Slide (Glide)
Characteristics of one bone
sliding on another
For a pure slide, the surfaces must be
completely congruent
Car hitting brakes analogy
Surfaces must be congruent for this to
occur
Spin
Occurs when one bone rotates around a
stationary longitudinal mechanical axis
Same point on the moving surface creates an arc of a circle as
the bone spins
Car spinning its wheels analogy
Example: Radial head during pronation/supination
Convex/Concave Rule
Basic concept of correct mobilization application
Is this the whole
picture?
Realize:
1. This is only a tool
2. This is a helpful method to understand where to
mobilize
3. This does not take into account dynamic forces
GLATA 2013 WHEELING, IL
Stretch
Indications
Grades I and II - primarily used for pain
Pain must be treated prior to stiffness
Painful conditions can be treated daily
Neurophysiological effects
Stimulates mechanoreceptors to decrease pain
Nutritional effects
Improved synovial fluid movement and nutrient
exchange in articular cartilage
Treatment Direction
Treatment plane lies on
the concave
articulating surface,
perpendicular to a line
from the center of the
convex articulating
surface
Patient Response
May cause soreness
Perform joint mobilizations on alternate days to allow
soreness to decrease & tissue healing to occur
Patient should perform ROM techniques
Patients joint & ROM should be reassessed after
treatment, & again before the next treatment
Pain is always the guide
Posterior Glide
Used to increase hip flexion and internal rotation
Anterior Glide
Used to increase hip extension and external rotation
Inferior Glide
Used to increase hip flexion or rotation
GLATA 2013 WHEELING, IL
Summary
Mobilize joint based on convex/concave rule
Select appropriate grade of mobilization to
perform
Always follow static mobilization with dynamic
mobilization
Always issue home exercise mobility exercises if
able to take advantage of ROM gains
Questions?
Lab Set-up
Please find a partner(s) of similar build to work
with during lab
You will need a mobilization belt
If you do not feel comfortable with any of the
mobilizations being performed on you, please do
not do them!
If you need help or have a question, please ask us
Lab
Summary
Practice mobilization to refine technique
Apply according to treatment parameters and
patient goals
Use good body mechanics to apply the most
effective treatment and protect yourself
Follow up with mobility exercises to maximize
benefits
Acknowledgements
Performance Rehab Products
Mobilization Belts
Questions?
Thank you for attending our Learning Lab session!
Scott Lawrance, DHS, ATC, MSPT, CSCS
University of Indianapolis
1400 East Hanna Avenue
Indianapolis, IN 46227
(317) 788-3248
lawrances@uindy.edu