Monday, January 14, 2019

Improving Movement When It Matters - Part IIID

Last week we continued our discussion about the importance of single limb training and how ankle range of motion and control can impact that.  As we continue that discussion and move up the chain, we now start to look at the knee. 

When performing movement assessment, we often get hyper focused on frontal plane motion only at the knee.  As described in the above example, this can often lead to missing the "root cause" of the dysfunction and less effective treatment strategies.  If we treated the two examples above exactly the same, then we might have a less effective treatment and potentially not address the true "root cause".

If we look at this example more closely, what we see is that the knee begins to cross midline prior to:

  • Movement of the foot into a pronated position - root cause being more at the foot and ankle
  • Movement of the pelvis into a trendelenburg or corkscrewing position - root cause being more at the core
When we are seeing this motion being driven from the hip complex (frontal plane motion of the knee in the absence of excessive pelvic motion or pelvic motion) this can indicate is weakness in the gluteal region, specifically the gluteus medius and maximus.   This is where exercise targeted to this region can be very effective. 

Glut Med Series:

Use of this exercise allows us to target to the glut medius specifically.  As indicated in the video, position of the feet is critical for those with weak gluts will toe out during this exercise which will limit the strengthening that occurs at the hip.

Single Leg Lumbar Hip Disassociation:

Due to the fact that we don't know if this is associated with weakness/endurance issues in the muscles of the hip or proprioceptive issues in the hip, using this exercise targets both strength/endurance as well as proprioception.  When done properly with proper hip positioning, we find this results in significant increase in EMG activity of the gluteus medius.

Next week, we will conclude this discussion on single limb training with our examination of what is going on at the hip. If you enjoy this blog, please share with your colleagues and follow us on instagram @ bjjpt_acl_guy and twitter at @acl_prevention.  #ViPerformAMI #ACLPlayItSafe

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment and ACL injury prevention.  He is the founder | developer of the ViPerform AMI, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent has also been training and a competitive athlete in Brazilian Jiu Jitsu for 5 years. 

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