1. KatyFitness.com Seminar Series Pain Management : Lumbo-Pelvic Hip Complex (LPHC) Impairment

4. ©2006 Life Time Fitness Common Injuries Associated with LPHC Impairment Local Injuries Injuries Above LPHC Injuries Below LPHC Low Back Pain Sacroilliac Joint Dysfunction Hamstrings, Quadriceps, and Groin Strain Cervical Injuries and Headaches Knee Patellar Tendonitis (jumper’s knee) IT Band Tendonitis (runner’s knee) Medial, Lateral, and Anterior Knee pain Chondromalacia patellae Foot Plantar Fasciitis Achilles Tendonitis Posterior Tibialis Tendonitis (shin splints)

5. ©2006 Life Time Fitness Common Injuries Associated with Shoulder Impairment Local Injuries Injuries Above Shoulder Injuries Below Shoulder Biceps Tendonitis Supraspinatus Tendonitis Impingement Syndrome Anterior and Posterior Shoulder Pain Cervical Injuries and Headaches LPHC Low Back Pain Sacroilliac Joint Dysfunction Hamstring, Quadriceps, and Groin Strain Knee Patellar Tendonitis (jumper’s knee) IT Band Tendonitis (runner’s knee) Medial, Lateral, and Anterior Knee pain Chondromalacia patellae Foot Plantar Fasciitis Achilles Tendonitis Posterior Tibialis Tendonitis (shin splints)

6. ©2006 Life Time Fitness Common Injuries Associated with Knee Impairment Local Injuries Proximal Injuries Distal Injuries Patellar Tendonitis (jumper’s knee) IT Band Tendonitis (runner’s knee) Medial, Lateral, and Anterior Knee pain Chondromalacia patellae Low Back Pain Shoulder and Upper Extremity Injuries Hamstrings, Quadriceps, and Groin Strain Plantar Fasciitis Achilles Tendonitis Posterior Tibialis Tendonitis (shin splints)

7. ©2006 Life Time Fitness Common Injuries Associated with Foot & Ankle Impairment Local Injuries Proximal Injuries Plantar Fasciitis Achilles Tendonitis Posterior Tibialis Tendonitis (shin splints) Patellar Tendonitis (jumper’s knee) IT Band Tendonitis (runner’s knee) Low Back Pain Hamstring, Quad, and Groin Strain

8. ©2006 Life Time Fitness Functional Anatomy Probable Over- and Underactive Muscles for Shoulder Impairment Region Compensation Overactive Underactive LPHC Excessive Forward Lean Gastrocnemius Soleus Hip Flexor Complex Abdominal Complex (rectus abdominis & external oblique) Anterior Tibialis Gluteus Maximus Erector Spinae Intrinsic Core Stabilizers Low Back Arches Hip Flexor Complex Erector Spinae Latissimus Dorsi Gluteus Maximus Hamstrings Intrinsic Core Stabilizers Low Back Rounds Hamstrings Adductor Magnus Rectus Abdominis External Obliques Gluteus Maximus Hip Flexor Complex Erector Spinae Latissimus Dorsi Asymetrical Weight Shift Adductor Complex and TFL (same side) Piriformis and Bicep Femoris (opposite side) Gluteus Medius (same side) Adductor Complex (opposite side)

9. ©2006 Life Time Fitness Functional Anatomy Overactive Muscles for LPHC Impairment: Excessive Forward Lean Muscle Concentric Isometric-Stabilization Eccentric Gastrocnemius Plantarflex Ankle and Flex Knee Foot, Ankle, and Knee Decelerates ankle dorsiflexion and knee extension Soleus Plantarflex Ankle, Externally Rotate (supinates) lower leg and assists in knee extension Foot and Ankle Decelerates ankle dorsiflexion, internal rotation of lower leg and eversion of subtalar joint and knee flexion Hip Flexor Complex Flex hip and anterior tilt of pelvis LPHC and Knee Decelerates hip extension and posterior tilt of pelvis Abdominal Complex (Rectus Abdominus & External Oblique Flex spine and posterior tilt of pelvis LPHC Decelerates spinal extension and anterior tilt of pelvis

10. ©2006 Life Time Fitness Overactive Functional Anatomy Gastrocnemius Abdominal Complex Hip Flexor Complex Soleus

11. ©2006 Life Time Fitness Functional Anatomy Underactive Muscles for LPHC Impairment: Excessive Forward Lean Muscle Concentric Isometric-Stabilization Eccentric Anterior Tibialis Invert Ankle, Dorsiflex Angle Foot and Ankle Decelerates ankle plantarflexion and eversion Gluteus Maximus Abduct, Externally Rotate, and Extend Femur and Posterior Tilt of Pelvis LPHC and Knee Decelerates femoral (hip) adduction, internal rotation and flexion and anterior tilt of pelvis Erector Spinae Extend Spine and anterior tilt of pelvis LPHC Decelerates spinal flexion and posterior tilt of pelvis Intrinsic Core Stabilizers n/a LPHC n/a

12. ©2006 Life Time Fitness Underactive Functional Anatomy Anterior Tibialis Erector Spinae Gluteus Maximus Intrinsic Core Stabilizers

13. ©2006 Life Time Fitness Assessment Findings Probable Assessment Observations for LPHC Impairment: Excessive Forward Lean Assessment Observation Overhead Squat Excessive Forward Lean (of Trunk) Single Leg Squat Foot flattens and/or knee moves inward adduct and internally rotate Goniometric Measurement Decreased dorsiflexion Decreased hip extension Manual Muscle Testing One of more of the following muscles tested “weak”. Anterior Tibialis, gluteus maximus,erector spinae, and/or intrinsic core stabilizers

15. ©2006 Life Time Fitness

16. ©2006 Life Time Fitness Corrective Exercise Strategy Sample Corrective Exercise Program for Excessive Forward Lean Phase Modality Muscle(s) Acute Variables Inhibit SMR Gastrocnemius/soleus Hip flexor complex (TFL & rectus femoris) Hold on Tender Area for 30 seconds Lengthen Static Stretching or NMS Gastrocnemius/ soleus Hip Flexor complex 30-sec hold OR 7-10-sec isometric contract, 30-sec hold Activate Positional Isometrics and/or Isolated Strengthening Gluteus Maximus Intrinsic core stabilizers 4 reps of increasing intensity 25, 50, 75, 100% OR 10-15 reps with 2-sec isometric hold and 4-sec eccentric Integrate Dynamic Movement Ball Wall Squat 10-15 reps under control

17. ©2006 Life Time Fitness Functional Anatomy Overactive Muscles for LPHC Impairment: Low Back Arches Muscle Concentric Isometric-Stabilization Eccentric Hip Flexor Complex Flex hip and anterior tilt of pelvis LPHC, and Knee Decelerates hip extension and posterior tilt of pelvis Erector Spinae Extend spine and anterior tilt of pelvis LPHC Decelerates spinal flexion and posterior tilt of pelvis Latissimus Dorsi Extend, adduct, and internally rotate humerus and anterior tilt of pelvis LPHC and Shoulder Decelerates humeral flexion, abduction and external rotation and posterior tilt of pelvis

18. ©2006 Life Time Fitness Overactive Functional Anatomy Erector Spinae Latissimus Dorsi Hip Flexor Complex

19. ©2006 Life Time Fitness Functional Anatomy Underactive Muscles for LPHC Impairment: Low Back Arches Muscle Concentric Isometric-Stabilization Eccentric Abdominal Complex Flex and rotate spine and posterior tilt of pelvis LPHC Decelerates spinal extension and anterior tilt of pelvis Gluteus Maximus Abduct, Externally Rotate, and Extend Femur and Posterior Tilt of Pelvis LPHC and Knee Decelerates femoral adduction, internal rotation& flexion and anterior tilt of pelvis Hamstrings Flex knee and extend hip and posterior tilt of pelvis LPHC and Knee Decelerates knee extension & hip flexion and anterior tilt of pelvis

20. ©2006 Life Time Fitness Underactive Functional Anatomy Abdominal Complex Hamstrings Gluteus Maximus

21. ©2006 Life Time Fitness Assessment Findings Probable Assessment Observations for LPHC Impairment: Low Back Arches Assessment Observation Overhead Squat Low Back Arches (excessive extension in lumbar spine) Single Leg Squat n/a Goniometric Measurement Decreased shoulder flexion Decreased hip extension Decreased hip internal rotation Manual Muscle Testing One of more of the following muscles tested “weak”. Gluteus maximus, hamstring and/or abdominal complex

22. ©2006 Life Time Fitness Corrective Exercise Strategy Sample Corrective Exercise Program for Low Back Arches Phase Modality Muscle(s) Acute Variables Inhibit SMR Hip flexor complex Latissimus Dorsi Hold on Tender Area for 30 seconds Lengthen Static Stretching or NMS Hip Flexor complex Latissimus Dorsi Erector Spinae 30-sec hold OR 7-10-sec isometric contract, 30-sec hold Activate Positional Isometrics and/or Isolated Strengthening Gluteus Maximus Abdominal Complex 4 reps of increasing intensity 25, 50, 75, 100% OR 10-15 reps with 2-sec isometric hold and 4-sec eccentric Integrate Dynamic Movement Ball Wall Squat w/Overhead Press 10-15 reps under control

23. ©2006 Life Time Fitness Functional Anatomy Overactive Muscles for LPHC Impairment: Low Back Rounds Muscle Concentric Isometric-Stabilization Eccentric Hamstrings Flex knee, extend hip, and posterior tilt of pelvis LPHC and Knee Decelerates knee extension, hip flexion, & anterior tilt of pelvis Adductor Magnus Adduction, internal & external rotation, extension of femur and posterior tilt of pelvis LPHC and Knee Decelerates abduction, internal & external rotation, flexion of femur and anterior tilt of pelvis Abdominal Compex (rectus abdominus & external obliques) Flex and rotate spine and posterior tilt of pelvis LPHC Decelerates spinal extension & anterior tilt of pelvis

24. ©2006 Life Time Fitness Overactive Functional Anatomy Adductor Magnus Hamstrings Abdominal Complex

25. ©2006 Life Time Fitness Functional Anatomy Underactive Muscles for LPHC Impairment: Low Back Rounds Muscle Concentric Isometric-Stabilization Eccentric Gluteus Maximus Abduct, Externally Rotate, and Extend Femur and Posterior Tilt of Pelvis LPHC and Knee Decelerates femoral adduction, internal rotation& flexion and anterior tilt of pelvis Hip Flexor Complex (Psoas) Flex hip and anterior tilt of pelvis LPHC and Knee Decelerates hip extension and posterior tilt of pelvis Erector Spinae Extend spine and anterior tilt of pelvis :LPHC Decelerates spinal flexion and posterior tilt of pelvis Latissimus Dorsi Extend, Adduct, and Internally rotate humerus and anterior tilt of pelvis LPHC and shoulder Decelerates humeral flexion, abduction, and external rotation and posterior tilt of pelvis

26. ©2006 Life Time Fitness Underactive Functional Anatomy Hip Flexor Complex (Psoas) Latissimus Dorsi Gluteus Maximus Erector Spinae

27. ©2006 Life Time Fitness Assessment Findings Probable Assessment Observations for LPHC Impairment: Low Back Rounds Assessment Observation Overhead Squat Low Back Rounds (excessive flexion in lumbar spine) Single Leg Squat n/a Goniometric Measurement Decreased hip flexion 90/90 position Decreased hip extension Decreased hip internal rotation Manual Muscle Testing One of more of the following muscles tested “weak”. Gluteus maximus, hip flexors and/or erector spinae

28. ©2006 Life Time Fitness Corrective Exercise Strategy Sample Corrective Exercise Program for Low Back Rounds Phase Modality Muscle(s) Acute Variables Inhibit SMR Hamstrings Adductor Magnus Hold on Tender Area for 30 seconds Lengthen Static Stretching or NMS Hamstrings Adductor Magnus 30-sec hold OR 7-10-sec isometric contract, 30-sec hold Activate Positional Isometrics and/or Isolated Strengthening Gluteus Maximus Hip Flexors Erector Spinae 4 reps of increasing intensity 25, 50, 75, 100% OR 10-15 reps with 2-sec isometric hold and 4-sec eccentric Integrate Dynamic Movement Ball Wall Squat w/Overhead Press 10-15 reps under control

29. ©2006 Life Time Fitness Functional Anatomy Overactive Muscles for LPHC Impairment: Asymmetrical Weight Shift Muscle Concentric Isometric-Stabilization Eccentric Adductor Complex (side of shift) Adduction, internal rotation, and flexion of femur (Adductor Magnus will extend femur) LPHC and Knee Decelerates abduction, external rotation, and extension of femur (Adductor Magnus will decelerate flexion of femur) TFL (side of shift) Flex, abduct and externally rotate femur (hip), externally rotate lower leg, and extend knee LPHC and Knee Decelerates femoral extension, adduction and external rotation of LPHC, and internal rotation of lower leg Piriformis (side opposite of shift) Externally rotate, abduct, and extend femur/hip. LPHC Decelerates femur/hip, internal rotation, adduction and flexion Biceps Femoris (side opposite of shift) Flex knee, extend, adduct, and external rotation of hip and lower leg, and posterior tilt of pelvis LPHC and Knee Decelerates knee extension, hip flexion, adduction, and internal rotation of hip and lower leg, and anterior tilt of pelvis

30. ©2006 Life Time Fitness Overactive Functional Anatomy Piriformis TFL Biceps Femoris Adductor Complex

31. ©2006 Life Time Fitness Functional Anatomy Underactive Muscles for LPHC Impairment: Asymmetrical Shift Muscle Concentric Isometric-Stabilization Eccentric Gluteus Medius (Side of Shift) Abduct, Externally Rotate, and Extend Femur (hip) LPHC and Knee Decelerates femoral (hip) adduction, internal rotation, and flexion Adductor Complex (side opposite of shift) Extend spine and anterior tilt of pelvis LPHC Decelerates spinal flexion and posterior tilt of pelvis

32. ©2006 Life Time Fitness Underactive Functional Anatomy Gluteus Medius Adductor Complex

33. ©2006 Life Time Fitness Example: Asymmetrical Weight Shift Left Side Overactive: Piriformis Biceps Femoris Underactive: Adductor Complex Right Side Overactive: Adductor Complex TFL Underactive: Gluteus Medius

34. ©2006 Life Time Fitness Assessment Findings Probable Assessment Observations for LPHC Impairment: Low Back Rounds Assessment Observation Overhead Squat Asymmetrical Shift of LPHC to one side Single Leg Squat Knee moves inward and/or feet flatten and/or trunk rotates on one side more than the other Goniometric Measurement Decreased hip flexion 90/90 position (opposite side biceps femoris) Decreased hip extension (same side TFL) Decreased hip internal rotation (either of both sides – piriformis opposite side, adductor magnus same side) Decreased hip adduction (same side adductors) Manual Muscle Testing One of more of the following muscles tested “weak”. Adductors (opposite side) Gluteus Medius (same side)

35. ©2006 Life Time Fitness Corrective Exercise Strategy Sample Corrective Exercise Program for Low Back Rounds Phase Modality Muscle(s) Acute Variables Inhibit SMR Adductors & TFL/IT band (same side); Piriformis (opposite side) Hold on Tender Area for 30 seconds Lengthen Static Stretching or NMS Adductors, TFL (same side); piriformis, biceps femoris (opposite side) 30-sec hold OR 7-10-sec isometric contract, 30-sec hold Activate Positional Isometrics and/or Isolated Strengthening Gluteus Medius (same side) Adductors (opposite side) 4 reps of increasing intensity 25, 50, 75, 100% OR 10-15 reps with 2-sec isometric hold and 4-sec eccentric Integrate Dynamic Movement Ball Wall Squat w/Overhead Press 10-15 reps under control

36. Final Thoughts / Questions ©2006 Life Time Fitness

37. Contact Us ©2006 Life Time Fitness Jason Hodge [email_address] 281-536-6415 Doniece Russell [email_address] Marcia Noyes [email_address] Patrick Richardson [email_address] www.KatyFitness.com