NETWORK FITNESS FACTS THE PELVIS

Transcription

1 NETWORK FITNESS FACTS THE PELVIS The Pelvis The pelvis has 3 joints connecting it together 2 sacro-iliac joints at the back (posterior) and the pubic symphysis joint which is at the front (anterior). A number of muscle teams cross over these joints helping to ensure that they are stabilised. These muscles include: Latissimus Dorsi Gluteus Maximus Quadratus Lumborum Gluteus Medius Oblique Abdominals Adductors Hamstrings Image: 1. Anterior Oblique System 2. Posterior Oblique System 3. Lateral System Images: (l) (centre) (r)

2 PELVIC MUSCLE TEAMS 1. Anterior Oblique System = obliques and adductors 2. Posterior Oblique System = latissimus dorsi and glut maximus 3. Lateral System gluteus medius and quadratus lumborum The 3 muscle teams act together to provide stability across the lumbar spine and pelvis. They enlist the co-ordination of all outer unit muscles to ensure correct movement patterning whilst maintaining stability. If all the muscles in the team do NOT work efficiently, other members are overworked which leads to early fatigue, poor performance and increased risk of injury. EXERCISE FOR LUMBAR AND PELVIC STABILITY The pelvic muscle teams must work on a stable base. When retraining stability for the lumbar spine and pelvis, it is recommended that low and medium core control is addressed first, prior to pelvic stability training. Athletes who are prone to pelvic injuries include: Soccer players, rugby, AFL any sports involving a kicking action Tennis players, hockey players, basketball players, sports involving lots of lateral agility and dynamic rotations through the pelvis Dancers and ice skaters imbalance between leg strength and upper body strength Martial arts/ kick boxers repetitive kicking, single leg movements Remember that core control (control of the lumbar spine vertebrae and hence, posture) and pelvic stability are two separate issues. However, they rely totally upon the simultaneous functioning of each other to ensure optimal movement quality. See the Video Presentation Exercises for Pelvic Stability in this Topic. There are 100 s of exercises which incorporate the muscles above and below the pelvis simultaneously including: Prone: Supine: Ball: Standing: Flitter, alternate arm/ leg transfers in 4pt position i.e. swimming Oblique crunch with medicine ball squeeze, pilates 100 s exercises Ball bridge with cushion squeeze/ add band pull-down or pullover Sitting glut squeeze with lat pull-downs on ball Cross trainer at the gym, sumo squat on wobble board/ bosu with band pulling downwards, lunges with med ball upper body twist Page 2

3 COMMON INJURIES TO THE PELVIS OSTEITIS PUBIS Osteitis Pubis is characterised by inflammation of the pubic symphysis which is the joint at the front of the pelvis between the two ends of the pubic bone. This inflammation leads to sclerosis and bony changes of the pubis symphysis, causing both acute and chronic groin pain. The condition can render sufferers incapable of sustained physical activity. The initial rehabilitation phase will take some months to work through. Once a good solid core and pelvic stability regime on both legs has been established a slow progression of unloaded to standing strengthening exercises should be included. Once this has been achieved then dynamic movements, speed and agility training can be included prior to going back to specific sport training. INCLUDE: Management strategies initially may involve modification of activity, physiotherapy and anti-inflammatory medication Non-weight bearing cardio rower best option due to both legs activating simultaneously Core stability start with isolated transverses, work on building core endurance in supine Pelvic stability glut medius strengthening i.e. standing band around knees abduction isometrically not single leg step downs Adductor strengthening (both legs) i.e. supine med ball squeeze, not standing cable adduction Glut maximus strengthening (both legs) i.e. light leg press not lunges AVOID: Single leg work Side lying work Impact work Dynamic balance work i.e. bosu Image: Page 3

4 ITB FRICTION SYNDROME The ilio-tibial band (ITB) is a sheath of connective tissue attaching from muscles in the gluteal region to the lateral (outside) surface of the tibia or shin bone. It functions in extending the knee joint and abducting the hip. As the ITB passes over the femur bone it is prone to friction on the lateral epicondyle. The greatest friction on the ITB occurs approximately degrees of knee bend which is the angle of the knee during running. Signs and Symptoms of Ilio-Tibial Band Friction Syndrome: Decreased strength in hip abduction - glut medius Decrease external hip rotation strength Pain at or around the lateral epicondyle of the femur Pain normally aggravated by running, particularly downhill Pain during flexion or extension of the knee Tenderness in trigger points in the gluteal / piriformis area Tightness in the iliotibial band Tight rectus femoris INCLUDE: Core control Exercises to strengthen the hip adductors and lateral system (QL/Glut Medius/Adductor combinations) Single leg balance exercises focus on correcting leg alignment ITB, Rectus Femoris, Achilles and Bicep Femoris stretches Check pronating feet may need to refer for orthotics Ilio-Tibial Band Friction Syndrome may require longterm rehabilitation and frequent ITB stretches are usually indicated even when symptoms have lessened Images: iliotibial-band.jpg Page 4

5 ADDUCTOR STRAINS AND OBLIQUE MUSCLE STRAINS Like any muscle strain, the initial management will be R.I.C.E.R. and referral to a physiotherapist for acute treatment Slowly introduce exercises from isometric contractions, progressing to small range activation, progressing to resistance throughout range Stretches for the area will be gentle initially with care not to over stretch and re-injure the muscle Focus on core control and anterior oblique system exercises Example of a Progressive Adductor Strengthening Program: Supine adductor pillow squeeze (isometric) Seated med ball squeeze (isometric) Sidelying leg raise (small range) Sidelying leg raise with weights around ankle Seated adductor machine Standing cable pull ins weighted through range Side lunges Zig Zag plyometric bounding / hopping HIGHLY RECOMMENDED Work closely with a physiotherapist that is re-assessing the injured client at least once every 6 weeks This will reduce the likelihood of the injury re-occurring and ensure the client is ready to progress. TOP TIPS FOR PELVIC STABILITY Liaise with a health professional Perform a good postural assessment Observe your clients perform a dynamic assessment of every exercise your client does in the gym Assess core control Pelvic stability over 6-12months Phase 1 activate the muscles responsible for pelvic stability in isolation Phase 2 combine muscles above and below pelvis and start non-weight bearing exercises (isometric contractions are easier to begin with) Phase 3 - start incorporating some weight bearing such as sitting and resistance to exercises Phase 4 incorporate standing functional exercises such as bringing in single leg loaded exercises, lateral movements and plyometric exercises Always Ensure the eccentric phase (active lengthening of a muscle) is well controlled throughout the exercise Be patient give your client approximately 6 months to progress through the training Page 5

6 Read the following article Hip pain in athletes from the East Carolina University School of Medicine: cybertherapist/front/knee/irunnersknee.html Muscles Function and Testing Florence Peterson Kendall and Elizabeth Kendall McCready Lippincott Williams and Wilkins 2 nd Ed Clinical Sports Medicine Peter Brukner and Karim Khan McGraw-Hill Education 2 nd Ed Histopathology of Tendinopathies: Update and implications for clinical management Karim M. Khan, MD, Ph.D, and Jill L. Cook, PT, Ph.D, Finoa Bonar, Peter Harcourt, Mats Astrom MD, Ph.D. Sports Med 1999 Page 6