The hip: Built for endurance and mobility

Transcription

1 The hip: Built for endurance and mobility

2 The hip joint

3 Some anatomical landmarks Innominate Ilium, pubis, ischium Sacrum Iliac crests Asis Psis Pubic tubercle Acetabulum

4 Femur Head of femur Neck of femur Shaft of femur Greater trochanter Lesser trochanter

5 Hip joint location Find ASIS and Pubic tubercle. Find the midpoint between these two points. Then move down 1cm. This is where your hip joint is! Flex the hip, rotate it... FEEL IT!

6 Are all hips the same? Do they come as standard? Depth of acetabulum Position of acetabulum Neck to shaft angle Ante/retroversion angle

7 Anteverted hips

8 Retroverted hips

9 What about tadasana? What would be the effect of anteverted hips? What would be the effect of retroverted hips? Can you think of postures that would be affected? Anteverted think about warrior 2 or cobbler or any pose where the hips are abducted Retroverted think about eagle pose, cow s head or any pose where the hips are adducted

10 Joint surfaces = Hyaline cartilage White and shiny and VERY durable...

11 How does cartilage gets its nutrition? It has no blood supply (and no nerve supply luckily!) By compression and release... Like a very hard sponge, soaked in synovial fluid That gets pushed out on compression And sucked in on release...

12 Hip joint built for endurance A deep socket To contain the head of the femur What would happen if the boney socket was deeper to increase stability? Yes, mobility would be lost. So how does the anatomy of the hip ensure that mobility is not sacrificed for stability? Anyone know?

13 It is the labrum of the hip It increases the depth of the hip socket, but it is cartilage, not bone, so it has a little more give.

14 Next layer synovial membrane Synovial membrane circles the base of the head of femur and seals in the synovial fluid that feeds the joint

15 Next layer - hip capsule Anterior Posterior

16 Next layer... Ligaments Front Back

17 What limits movement at a joint? 2 Major things Bone on bone restriction Soft tissue restriction

18 Let s look at how this feels Bend and straighten your elbow Feel the different end feel? Bend and straighten your knee Feel the different end feel? The hip is a little more complicated because of the potential variety of movement...

19 Try this Sit with feet wide apart Roll both knees in same direction Notice which way hips are rotating Notice the end feel of each movement.

20 Should we push bone on bone restriction? Potential joint surface damage Potential labral damage

21 Can we push soft tissue restriction? Yes, but muscles only stretch so far (genes!) Guided by discomfort and pain levels.

22 Our advice to students must be... If you can feel discomfort in the hip joint itself, BACK OFF If you feel discomfort in the surrounding tissues, GO GENTLY

23 What does a functional hip need? Two things Stability Mobility What provides stability? The structure of the hip itself (bones & ligs) And? Muscles

24 And mobility? Also provided by muscles... Loads of them!

25 Let s do some yoga!

26 Vrakasana The Tree All stand on the right leg How is the level pelvis maintained? By gluteus medius on the right

27 People with hip pain often have weakness in gluteus medius

28 Gluteus medius is a stability muscle How do we strengthen it? The tree strengthens it too, as long as the pelvis is held level by muscular effort, not geometry!

29 Setu bandha the bridge Which hip muscle is working to hold the pelvis up?

30 Gluteus maximus When we press our feet down into the floor, gluteus maximus is activated to extend the hip and continues to work to hold it there. Are yours working?!?!

31 Gluteus medius and maximus Important hip stabilisers Do they tend to be weak or strong? Weak! A common problem. So we need to strengthen them To support the pelvis/si jts well And to support the hip and the back

32 What about wide legged poses Which is more common?

33 To achieve the pose at the hip We need long adductors (inner thigh) And long hamstrings (posterior thigh)

34 Both groups are primarily mobilisers Mobilisers = action muscles Do they tend to be short or long? Short So we need to stretch them!

35 Recap so far.. Stability muscles, like gluteus medius and maximus, tend to be weak Need to be strengthened. Mobility muscles, like adductors and hamstrings, tend to be short Need to be stretched. A win win situation! NB muscle v. nerve...

36 Hip flexors iliacus and psoas

37 Hip flexors with Rectus Femoris

38 What about the hip flexors? Important muscles in relation to the hip and the back Are these primarily mobilisers or stabilisers? Mobilisers So do they tend to be weak or tight? Tight! So we need to stretch them.

39 What effect does psoas have on the spine? Psoas is attached to T12 anteriorly all way down to L5, to the discs as well as the vertebral bodies. It inserts into the lesser trochanter of the hip. Its actions are therefore to: Compress the lumbar spine by increasing the lordosis And flex the hip

40 So to s-t-r-e-t-c-h psoas, we have to: Decrease the lordosis of the lumbar spine Increase hip extension Which is the right psoas stretch?

41 What do you think Warrior 1 is for?

42 Let s all do Warrior 1 Right foot forward Left foot back how far? How does the posture change if the foot is far back? How does it change if the foot is much further forward? Bringing the foot forwards frees the pubic bone to come forwards, otherwise the pubofemoral ligaments tension so much that the pubic bone cannot come forwards. This in turn compresses the lumbar spine.

43 What position is the heel in? And that s not all! Feel the difference between the heel up in the air and the heel down with the foot laterally rotated. Feel the difference between the heel being low and being high Sink the back knee The key is the back knee, flexed & going downwards to keep the lumbar free. The lordosis is decreased and hip is extended Feel the right buttock! Working eccentrically to control the pelvis Feel the left buttock! Working concentrically to keep the hip extended.

44 Looking closely at the hip in Warrior 1... What do we have? A hip flexor stretch for the mobiliser A pose that decreases compressive forces on both the hip and the back A hip extensor (gluteus maximus) strengthener for the stability of the hip

45 Common hip problems Osteoarthritis By stretching the mobilisers, we decrease the compressive forces on the joint. By strengthening our stabilisers, we limit excessive movement at the joint By moving the hips in yoga, we increase the nutrition to the joint surfaces. If we don t engage the whole hip in movement, the cartilage dries up and dies...

46 Comparative hip: normal v. OA

47 Xrays of normal & OA hip

48 How does OA affect hip movement? Classic loss of movement = Loss of internal (medial) rotation (biggest clue) Loss of abduction Loss of extension Stand up and imitate that position. So what is going to be the most comfortable position for someone with OA hip?

49 Total hip replacement

50 Hip resurfacing v. total hip

51 One last thing! Imagine a person with very weak gluts. How do they stay upright? The body is very clever and will find a strategy to cope. Can you think of what that strategy is?

52 Compensation strategy... Which muscles attach to the pelvis that could help stabilise the pelvis and hip... The hamstrings! The adductors! The hip flexors! Quadratus lumborum!

53 So is stretching the answer? Hamstrings might be tight to hold the pelvis up. What is the answer to that problem? Strengthening the pelvic stabilisers! Do you do enough strengthening yourself and in your classes?

54 Get them gluts working!!!!! And that s my final word!