Hip and Spine of the Athlete

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Prudence Preston
5 years ago
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1 Hip and Spine of the Athlete Kyle Turner, ATC Assistant Athletic Trainer Kansas City Royals Sean Bardenett, DPT Manual Therapist Kansas City Royals

2 Talk to DCs about spine..

3 Outline Regional Interdependence Approach Joint by Joint Hip mobility Thoracic mobility Scapula Assessment SFMA TPI Pain Education

4 Regional Interdependence

5 Regional Interdependence

6 Regional Interdependence

7 Bottom Up vs. Top Down site/articles/what_should_fitness_professional s_understand_about_pain_and_injury/

9 Hip Mobility Relationship Between Tightness of the Hip Joint and Elbow Pain in Adolescent Baseball Players. Ortho Journal of Sports Med. 2014; 2(5). Limited hip Flexion and IR at 90 related to elbow injury The Relationship between clinically measured hip rotational motion and shoulder biomechanics during the pitching motion. Journal of Sci and Med in Sport. 2014; 18(2015) Trail leg ER limitation significantly related to shoulder increase in motion needed during throwing.

10 Hip Mobility/ROM Lower (D, ND) Left Right Hip TA (Seated) Hip 90 (38-55, 38-55) TA= TA= D (72-95) Hip 90 (30-45, 31-49) ND (72-99) Gastrocnemius (4-13) Hip TA (Prone) Hip ER (35-54, 35-54) TA= TA= D (67-88) Hip IR (26-40, 27-43) ND (68-90) Hamstring ( , )

11 Hip Strength/Stability Lower Left #1 Left #2 Left #3 Right #1 Right #2 Right #3 90 Hip ER (34-50) 90 Hip IR (33-52) 90HER/90HIR ( ) Prone Hip ER (36-50) Prone Hip IR (30-45) PHER/PHIR ( )

12 Core Stability/Postural Control

13 Core Stability

14 Thoracic Mobility Shoulder elevation: 12.8 degrees T-spine extension Edmondston et al. Clinical and Radiological Investigation of Thoracic Spine Extension During Bilateral Arm Elevation. JOSPT 2012

15 Scapular Mobility Stability Conundrum

16 What we do

17 What we do

18 SFMA Multisegmental Rotation Contributing components: Tibial rotation Hip rotation Lumbar spine rotation Thoracic Rotation

19 Take out the hips & LE

20 Tibial Rotation

21 Hip Mobility or Motor Control?

22 Thoracic Mobility

23 Lumbar Mobility

24 TPI Screen Pelvic Tilt Pelvic Rotation Torso Rotation Overhead Deep Squat Toe Touch 90/90 Single Leg Balance Lat Length Test Lower Quarter Rotation Seated Trunk Rotation Bridge with Leg Extension Cervical Rotation Forearm Rotation Wrist Hinge Wrist Flexion / Extension Optional Reach Roll & Lift 2016 TPI Nevada Star I, LP - All rights are reserved

25 Would You Fix This?

26 Should We Fix Everything?

27 Is Something Missing?

Bottom Up vs. Top Down http://www.exercisebiology.com/index.

28 Bottom Up vs. Top Down site/articles/what_should_fitness_professional s_understand_about_pain_and_injury/

29 Pain fibers don t exist Eyes: light receptors, not vision receptors Ears: vibration receptors, not hearing receptors Tissue: nocioceptive/danger receptors, not pain receptors Adriaan Louw PhD, PT

30 Pain Tissue Damage WHY DON T ALL SURGERIES WORK? Phantom limb pain? Eliminate painful segment. Ever get a random Bruise? 33.3% of Lumbar spine surgery patients have persistent pain, disability, function loss Atlas et al. Long-term outcomes of surgical and non-surgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine. April Korres et al. Rsults of lumbar discectomy: a study using 15 different evaluation methods. European Spine Journal 1992;1: % of asymptomatic people have RTC tears Reilly, Macleoad et al Adriaan Louw PhD, PT

31 The Normal Abnormal MRI Findings in Lumbar spine of Asymptomatic, Adolescent Athletes 85% abnormal MRIs 30% pars lesion 70% early facet arthropathy 50% synovial cysts 40% disk bulging Alyas, F et al. MRI findings in the lumbar spine of asymptomatic, adolescent, elite tennis players. Br J Sports Med. Nov 2007;41(11)L: Adriaan Louw PhD, PT

32 Wording is Key Crumbling spine Wear and Tear Geriatric spine Deterioration Disc space loss Collapsing Bulging Unstable è Normal changes Expected findings Age-related changes No direct correlation between abnormalities and symptoms Good potential for complete resolution of symptoms No indication for surgical intervention Adriaan Louw PhD, PT

33 Patient Education Traditionally we educate those in PAIN about anatomy or biomechanics. Why not educate them about PAIN? Adriaan Louw PhD, PT

Louw, Diener, Puentedura 2014 SLR inc 9 Forward flexion increased 5 cm The short term effects of

34 Can Function Improve with Education Alone? Immediate Effect of Preoperative Neuroscience Education for Lumbar Radiculopathy: Case Series. Louw, Diener, Puentedura 2014 SLR inc 9 Forward flexion increased 5 cm The short term effects of preoperative neuroscience education for lumbar radiculopathy: a case series. Louw /10 inc toe touch> MDC of 4.5 cm 6/10 inc SLR> MDC of 5.7 Adriaan Louw PhD, PT

35 Would this hurt? Adriaan Louw PhD, PT

36 Would this still hurt? Adriaan Louw PhD, PT

37 Pain is an Interpretation

38 Fear Avoidance Model Increased fear, less active Emotional overload Knowledge Irrational Thoughts Threatening and provocative words, imaging, WebMD Adriaan Louw PhD, PT

39 Putting it all together. We don t treat everything we see adaptation Decrease the threat Educate Mobility, Stability Optimize Movement Don t Load Dysfunction Pain is personal FDM

40 Questions?

IFAST Assessment. Name: Date: Sport: Review Health Risk Assessment on initial consult form. List Client Goals (what brings you here?

IFAST Assessment. Name: Date: Sport: Review Health Risk Assessment on initial consult form. List Client Goals (what brings you here? IFAST Assessment Name: Date: Sport: Review Health Risk Assessment on initial consult form List Client Goals (what brings you here?) Cardiovascular Measurements Blood Pressure Resting Heart Rate Body Composition