All Posts tagged Hip Pain

Chronic Pain, Foot Pain, Hip Pain, Inflammation, Neck Pain, Shoulder Pain, & TMJ Pain

If you have any of the above, have you tried Pneumatic Lymphatic Pump Therapy?

One of the most neglected systems of the body is the Lymphatic system. An innovative treatment for chronic pain, foot pain, hip pain, inflammation, neck pain, shoulder pain, & TMJ pain is Lymph Drainage Therapy (DLT). In my office I use state of the art technology called LymphaTouch for DLT. Benefits of the LympaTouch Pump Therapy include reduction in limb circumference, pain, increase in range of motion, scar mobility and improved functioning of the immune system. The immune system is stimulated through increased lymph flow. The additional flow carries more antigens to the lymph nodes, thereby increasing antibody/antigen contact. This has been found to help with chronic or subacute inflammatory processes — chronic fatigue syndrome, autoimmune disease, bronchitis, sinusitis, tonsillitis, laryngitis, arthritis, acne and eczema.

Call 310-444-9393 to schedule an appointment

More

Sports Medicine

DMS can be a stand-alone treatment for sports injuries. Dr. Tucker literally wrote the manual with Dr. Jake (the inventor of the DMS).  DMS Method can be combined with numerous other modalities/therapies as a sports medicine approach to improve circulation of lymph, blood capillaries, veins, interstitial liquids, fascia and muscle. The DMS action helps to reroute stagnant fluid in the skin (i.e., edema, primary and secondary lymphedema), mucosa, muscles, viscera, joints, and periosteum.

Clinically we have observed:

Scars and healed surgical-incision sites become more supple.

Trigger points are eliminated.

Toxins are removed, making lymphatic drainage especially effective in tissue repair and regeneration.

Aids the reabsorption of swelling/edema.

The functioning of the immune system is stimulated through increased lymph flow.

Helps with chronic or subacute inflammatory processes.

Releases muscle spasms.

More

Chronic Pain

Dr. Jeffrey Tucker treats chronic pain patients using the most modern technology such as Piezo-electric shockwave. Shockwave therapy has the following effects:

1. Eliminate pain

2. Facilitate healing

3. Improve local microcirculation leading to improved tissue metabolism

4. Increase production of collagen

5. Reduce local muscle tension

6. Help dissolve calcific fibroblasts

7. Stimulate the “washing away” of Substance-P (a pain producing chemical)

Call 310-444-9393 to learn more about the latest chronic pain treatments.

 

More

Psoas Muscle Treatment

One of the main back stabilizers and hip flexors. If you sit all day the psoas becomes rounded like a banana; then, you stand up, the psoas pulls on your back, making you more prone to pain and lower back injury.

Most doctors neglect the psoas because it lies so deep below the surface of the skin, and therefore is hard to locate. Unlike other deep lying muscles, like the piriformis, stretching the psoas and trying to locate the psoas with your fingers is not easy. When you look at where it lies in relation to the pelvis and the role it has to play, you’ll understand that in both hip, groin and lower back injuries quality and feel of the psoas is paramount.

I have many techniques for effective self-treatment and in-office treatment of this troublesome hip flexor. I also use the DMS and laser on the psoas.

More

Hip Pain

There are two major problems with hip pain that I have to look for:

The first type of problem – and the easier to treat – is when the hip joint has restricted motion. This can produce local hip pain or cause dysfunction in the lumbar spine/sacroiliac joint or the knee, as a result of these structures attempting to compensate for the lack of movement at the hip joint.

The second type of problem is where the hip joint has an increased amount of movement arising from a lack of control of the femoral head (top of the thigh bone) in the hip socket; you will often feel or hear clicking or clunking, or a feeling of weakness in the region. A failure to correct this lack of control can lead to joint damage and subsequent long-term restriction of movement.

If only it were so simple that we could split the problem into one or other type of dysfunction. However in reality it will often be a combination of the two.

Muscle imbalance is related to two changes in muscle function: (1) a tightening of a “mobiliser” muscle and (2) the weakening of a “stabiliser” muscle.

  • So-called mobiliser muscles are those that produce movement; they are often big muscle groups with more fast-twitch fibres. Although they produce high power, these muscles have a tendency to shorten. The hamstrings and rectus femoris (one of the quadracep muscles) are the two main mobiliser muscles around the hip joint.
  • By contrast, stabiliser muscles control movement or joint position, often working against gravity. They are smaller, deeper muscles which often have more slow-twitch fibres. They should be well coordinated and have good endurance capacity, though they have a tendency to be under-active and weak. The gluteals are the key stabiliser muscles around the hip joint.

If your hip, scaroiliac joint area, or low back is bothering you, come in and I’ll check to see if this is your cause of the pain. Call 310-473-2911

More

Osteoporosis drugs are getting to be a joke!

The FDA has warned osteoporosis patients that the very drugs they take to strengthen their bones… may be making them even weaker. For the past several years I’ve talked to my patients about reports that suggest these drugs may increase risk of thigh-bone fracture. Especially in women taking these drugs for five years or more.

Finally the FDA is telling major drug makers to put a warning on their labels. So here’s the “joke” – The FDA is issuing its warning… and stresses that patients shouldn’t quit their drugs! Not unless they start to feel new thigh pain. And not even then. Not until their doctor tells them to quit the drug. But the real issue isn’t that these drugs may be dangerous… It’s that they may not actually do any good at all.

The research that promoted these drugs in the first place was funded by the drug companies that stood to gain the most. The results that prompted the FDA to initially approve the drugs don’t stand up to much scrutiny.

OK, let me get this straight – take one of the drugs listed below thinking you are doing something for osteoporosis, yet these drugs may actually increase the risk of bone fractures. 

  • Actonel
  • Actonel with Calcium
  • Atelvia
  • Boniva
  • Fosamax
  • Fosamax Plus D
  • Reclast and Boniva

Here’s  the FDA statement:

“While it is not clear whether [these drugs] are the cause, a rare but serious type of thigh bone fracture, has been predominantly reported in patients taking [them].”

The FDA has told the manufacturers to put a warning label on their drugs. But it’s told the public to keep taking them… unless their doctor orders them not to.

What is safe for bone nutrition?  I recommend the supplement Cal Apatite with Magnesium by Metagenics. If you already have osteopenia (bone loss) or osteoporosis then you need  Ostera by Metagenics. Order from www.DrJeffreyTucker.meta-ehealth.com

More

Knees, back, & hip pain – which supplements?

I’ve been taking glucosamine and chondroitin for a year and I don’t see any changes in my knee, back & hip pain. Do you recommend any other supplements for my joint pain? 

If you have been taking at least 1500 mg per day of those supplements, it’s time for a change. I’ve had good results with clients using UltraInflamX Plus 360 by Metagenics. They use 2 scoops twice daily in a shake. I also use EPA-DHA 720 by Metagenics. I dose them high, often at 3-6 grams daily. In addition, I see good results with Kaprex by Metagenics. The dose is usually 2 gel caps in the morning and 2 at night.

Order at www.DrJeffreyTucker.meta-ehealth.com

More

Advanced Functional Exercises For the Hips and Low Back

by Jeffrey H. Tucker, DC, DACRB

*This article was submitted to DC on 1-20-07. Accepted for publication 2-27-07. Printed May 2007.

Movement assessments have become a clear and comprehensive evaluation and approach to my Chiropractic therapy. It begins with me looking at each clients standing posture. I then ask my client to perform a series of postures. You know this portion as ‘range of motion’ evaluation. For example, I say to the client, “Bring your chin to your chest”, etc., or “bend forward to touch your fingers to the floor” or “raise both arms over your head” bla bla bla! It is old school, but I realize I need to document how far they move and if any sensations present themselves. I have become a keen observer of these movements, one who is not just interested in how far they move, but more interested in the way they move and what there movement pattern can tell me. The evaluation continues with a series of dynamic and static postures to observe how the muscles and joints move. Through this process I generate a sequence of home exercise programs for my clients. Please realize, the movement assessments can be performed prior to any hands on work that you do, or the assessments can conclude with a mobilization or manipulation that you feel is necessary.

If you have read my previous articles you will know that I start with the squat assessment. Observe the client perform a squat several times. Simple say “Let me see you do a squat with your arms out in front of you.” The benchmarks that I look for on this evaluation are that the:

  1. Upper torso is parallel with the tibia or toward vertical (back is relatively upright).
  2. Femur below horizontal.
  3. Knees aligned over feet.
  4. Toes point forward.
  5. Knees don’t turn in.

If they cannot accomplish the above criteria I start the correction process with the following training: I call this the supine120 degree knee to chest maneuver. Client lays supine in the 90/90 position. The knees are over the hips and the legs are parallel to the floor. Doctor stands at the feet of the client and uses a knife edge contact along the clients ankle crease. The Doctor resists at the ankle crease while the client is instructed to “pull your knees to your chest.” The Doctor allows the client to move into a knee to chest position. The doctor is providing resistance, not overpowering the client. The client’s lumbar region should remain in the neutral spine. Instruct the client to focus using the lower abdominals, especially the area slightly above and below the inguinal region. Allow the hips to get to at least 120 degrees. This maneuver is a great way to get clients to re-awaken this area. Bring awareness of tightness to this area while you tell the client to release tension or resistance in other areas such as the neck or shoulders that are not needed for this maneuver. Repeat this maneuver as many times to client tolerance.

The next progression is a pose called ‘Find your stance’. This is used as a foundation of all standing postures and movements. I want this to become the natural way to stand. It cultivates a sense of strength and stability. Begin with your feet (shoes off) between your hips and shoulders – go with what feels natural and comfortable. Slightly angle your feet outwards with your weight evenly spread through the balls, lateral edge and heel. Avoid your arches collapsing inwards. Try to feel the medial and longitudinal arches lift up.

Assisted Squats: Doctor and client face each other. ‘Find your stance’, or spread feet to shoulder width or slightly wider if needed; client holds arms and hands out in front of there body; Doctor holds hands with client and assists client to squat. The command is “pull your butt down.” The Doctor is providing assistance so the client doesn’t fall down. However, the client may fall to the floor the first or second time and that is perfectly normal and O.K. to do. Simple get back up and attempt it again. The idea is to allow them to go as deep as possible. Get the client to engage the groin crease muscles to pull them down. The goal of doing this squat is to reach back with the buttocks and down, ex. Sit back on a chair with control. If you have a rope or Theraband (at least the strength of a black theraband), you can wrap it around the clients back and underarms while you hold the ends in the front of the client and ask then to “sit down against” that resistance. Doctor coaches the client to keep the back straight, in this case as vertical as possible. FIGURE 1 Rubber tubing under the arm pits and you assist client to sit down against this resistance. The knee should not bow inward.

“Pull the hips out of the socket” routine to squat. This maneuver requires two assistant partners (the doctor plus an assistant). The client is instructed to squat down in a wider than shoulder stance. The Doctor is to the left of the client and the assistant on the right side. Each assistant places one flat hand behind the posterior leg just below the knee crease. The other hand is placed in the inguinal fossa/ligament crease with a knife edge contact. Assistants use enough pressure to guide the client into a deeper squat. Ask the client to feel like they are pulling the hips out of the socket as they descend. This allows the client to understand and feel the proper joints and muscles to use to accomplish this squat. Allow the client to learn in a wide stance and go as low as they can. As they improve strength they can get into a more narrow stance. Less core muscle is required in a wide stance than a narrow stance. Repeat this maneuver several times. Do a simple test on yourself. Stand in a wide stance and go narrower and narrower until you are in a one legged stance. Feel how the core is participating. Eventually we will get clients to have there feet closer and closer together and this will demand greater core strength.

Right after this maneuver, it will help your client if the Doctor rubs his/her index fingers along the spinous processes while the client does several more squats. This is performed starting at approximately the middle of the back with both index fingers. At the same time rub one finger headward and the other caudal along the spinous process while the client squats down and up. While you rub the spine, instruct the client to stay in a “tall spine” posture. They need to imagine creating more room in the hip socket. Tell the client to think of one thing and only one thing on the way up and that is “gluteals.” You don’t need to suck the stomach in if you elongate the spine, it will automatically come in if they are working to resist extension.

Squat against the wall. This is such a new take on the old school method of a wall squat. Once a person can accomplish the “static wall squat” also known as the “wall sit”, “wall chair,” “airbench” or “back against the ball squat” for one minute, they are ready for this maneuver. Find the distance away from the wall so that when you squat down your sacrum stays in contact with the wall. The key is to keep the sacrum touching the wall. Squat down with arms on the inside of the thighs until the elbows can push against the inner thighs. Put your hands in a prayer pose and push the elbows against the inner thighs. Pry the hips apart as you wiggle side to side going lower and lower. Continue this gentle rocking side to side and attempt to go lower and lower opening the hips. You should feel this in the most proximal attachments of the adductor muscles and hamstrings. Hold this pose for as long as you can and then concentrate on getting back up using the gluteals and keeping the sacrum in contact with the wall. Try this maneuver several times. One minute in this pose really gets you feeling warm. Attempt this with a narrow stance compared to when you are away from the wall. The next progression is to repeat the squat away from the wall.

PIVOTS: These help open the hips. Standing with your feet more than 3 feet apart, with outstretched arms (abduction) to your sides away from the body (the feet should be under the wrists distance). The feet will need to be angled slightly outward approximately 15 degrees. Keep the torso facing forward. Lunge gentle to the left until your knee is bent in a right angle above your left foot. Lengthen the spine upward (“tall spine” concept). Move side to side going more and more lateral (lower). The opposing forces of your legs provide balanced stability. Don’t lean the body towards the bent knee, try to keep the torso upright as much as possible. Imagine the hands pulling further side to side. Allow the sitting bone to be pulled backwards. The legs, both pushing forwards and pulling backwards, allow the hip to hinge and become stable at the same time, two opposing forces balancing one another. Shoulder blades should be kept down.

I recommend clients practice these maneuvers daily. I want my clients to observe subtle changes in posture, decreased pain, increased range of motion, feelings of stability, and a greater capacity for work and sport. As individuals vary in strength, flexibility, and coordination so the practice of functional exercises will be unique to each individual. Using progressive movement as assessments in your practice will tell you where the client is strong or weak, symmetrical or asymmetrical, balanced or imbalanced, coordinated or incoordinated, and which areas need more practice.

References

  1. Bergmark A 1989 Stability of the lumbar spine. A study in mechanical engineering. Acta Orthopaedica Scandinavia 230(60):20-24.
  2. Caterisano A, Moss RF, Pellinger TK, Woodruff K, Lewis VC, Booth W, Khadra T. The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles. J Strength Cond Res 2002 Aug; 16(30: 428-32
  3. Comerford M 2003 and 2006 Lumbo-pelvic Stability. Course notes. Copyright Comerford.
  4. Tsatsouline, Pavel 2007 Stretch Course. Copyright Tsatsouline.
  5. Vermeil A 2005 Sports & Fitness. Course notes. Copyright Vermeil.
  6. All the coaches, sports medicine, and sports scientists who have shared their knowledge with me.
More

Neuromobilization – femoral

by Jeffrey H. Tucker, DC, DACRB

Neuromobilization is a technique that details the assessment and analysis of radiculopathy. It involves specific maneuvers for upper and lower extremity sensory disturbances.1 Most musculoskeletal pain and dysfunction represents the result of a failure of adaptation.

It is easy to imagine that nerves can become stuck from disc pathology, lateral canal stenosis, fascial glue or any other structure that wraps, invests, supports, separates, connects, divides or may become sticky. The ground substance can become thick and sticky. It is likely that a nerve can become “held” or “stuck” in an area of ground substance that has become viscous or gel-like, or in areas of inflammation.

Neuromobilization is one of the least invasive therapeutic interventions that can start the healing and repair of radiculopathy. The femoral nerve, sciatic nerve, median nerve, radial nerve and ulnar nerve have lines of pull. Neuromobilization procedures are directed at multiple joints, and it is difficult to determine exactly where the nerve may be stuck.

The techniques are taught with two people simultaneously making the correction on the patient. Since it is not always possible for practitioners to have an assistant available to aid in the correction, I have found that a deep muscle stimulator (DMS) device is extremely useful. The hand-held device provides percussion and concussion vibration that allows specific point pressure to increase circulation and oxygenation to the tissues. The stimulator device will allow the muscle to achieve a new resting length. Fascia is stretched and will change length and hold the new form. The stimulator device also relieves joint irritation and inflammation to the surrounding area and nerve; a fixation or joint stiffness may cause a nerve to be hypomobile and irritated every time it is pulled.

Once the patient is comfortable doing at-home stabilization protocol exercises for the neck and back, it is time for them to progress to more advanced corrective exercises. For example, with the patient relaxed in the centrated side-lying posture, you can use a stimulator device in the sciatic-notch region for sciatic-nerve radiculopathy while the patient is talked through actively moving the top leg into abduction, hip flexion, and foot dorsiflexion/plantarflexion.

Advanced Exercises for the Femoral Nerve

Reverse lunge: Stand with feet hip-width apart in front of a mirror with a resistance band wrapped/tied around the knees. Ensure your lumbar spine is in neutral and your back is tall, with your shoulders back and head up. Slide backward with your right leg and bend your left knee only halfway down. Ensure that your front knee is in line with your toes and your back has remained upright, with your lumbar spine in neutral and your hips level. Allow a stretch in the right iliopsoas muscle region. Push back up with the right leg. Your back should remain totally still and your hips level as you performed the push-back. The idea is to slide your right foot back until your left leg bends at 90 degrees. Slide your right foot up to start position, pulling up with the glute of your left leg. Keeping your abs tight will help you keep balance. Finish all reps on one side and then switch sides. Perform 10-15 reps per side.

Prone hip flexor stretch: Lie prone on the floor with the involved-side knee flexed to 90 degrees. The opposite leg is straight on the floor with both ASIS pressed into the floor. Wrap a resistance band around the bent-knee ankle and grab the other end with both hands. Actively extend the hip and pull on the band so the thigh is raised off the floor. Make sure the ASIS stay in contact with the floor. Hold this for a 30-second count while performing diaphragm breathing. Perform three to five reps.

Resistance-band side walk: Place a resistance band around your ankles. Stand with your feet hip-width apart and get into a small knee-bend position. Step to the side with your left leg, then bring your right leg toward the left leg, but not all the way, so you keep some tension on the band. Continue across the room, stepping out with your left leg. Return to the other side of the room, facing the same way stepping out with your right foot. Make sure the foot doesn’t get out from under the knee. Move five steps to the right and five steps to the left. This can be repeated until felt in the gluteus medius.

Resource

  1. Based on a technique course taught by Dr. Kim Christensen.
More

Functional Evaluation of the Hips, Part 2

by Jeffrey H. Tucker, DC, DACRB

In my experience, I have found it useful to measure internal and external hip rotation in a prone rather than a supine position. I was taught this technique by Mark Comerford in 2006 and use it on a daily basis.

In the prone position with the client on the table or floor, grasp the foot gently, maintain the knee at 90 degrees, and slowly rotate the hip internal and external until you feel resistance. Make sure you are isolating the hip and not allowing pelvic rotation to occur. Take measurement of either excessive or decreased motion. (In Part 1 of this article (Jan. 15, 2009 issue), you will find the description and interpretation of the tests for medial and lateral hip rotation.)

If you find an asymmetry in internal hip rotation in the prone position, you can demonstrate the asymmetry in internal rotation by having the patient perform the “windshield-wiper position” in the supine position. Patient is supine lying in the 90/90 pose with both fists together (thumbs touching each other) between the knees. Slowly move the feet outward while maintaining pressure between the knees. Compare left and right internal rotation. This method should confirm what you find in the prone position, and allows the patient to see and feel any discrepancy.

The importance of proper hip range of motion and motor control is that the hip muscles either stabilize or produce power. During gait, the glutes and hamstrings produce hip extension. When the hamstring muscle is more dominant than the glutes during hip extension, the proximal femur / greater trochanter can create stress on the anterior joint capsule by anteriorly gliding during the hip extension movement. Ideally, the greater trochanter is maintained in the acetabulum by coordination and fine control of the surrounding muscles. Anterior gliding of the proximal femur / greater trochanter is a form of “uncontrolled translation” that can create a friction rub or repetitive microtrauma.

Many structures pass over the anterior femur head, such as the labrum, capsular fibers, bursa and soft tissues. It is reasonable to imagine that dysfunctional muscle control at the hip can cause synovitis, bursitis and soft-tissue contracture. If the iliopsoas is stretched or weak, and is not providing normal restraint on the femur head, the anterior gliding will be worse.

Reviewing the anatomical attachments of the hamstrings provides a plausible reason why hip joint motion becomes altered. The hamstring muscles, with the exception of the short head, do not attach into the femur. They attach to the ischial tuberosity. Because the hamstrings do not attach directly into the proximal femur, they cannot provide precise control of the movement of the proximal end of the femur during hip extension.

The short head of the biceps femoris starts at about the mid femur. It has a continuous origin from the lateral lip of the linea aspera on the posterior surface of the femoral shaft, the upper half of the lateral supracondylar line and from the lateral intermuscular septum. Distally, the long and short head of the biceps femoris give rise to a tendon that inserts into the lateral surface of the fibular head. In my experience, the short head of the biceps femoris is consistently one of the most overactive muscles in the body. The hamstrings simply cannot provide local fine motor control of the femur head.

There is another side to this whole hip movement pattern story. When the gluteus max and piriformis muscles are the prime movers for hip extension, the greater trochanter will either maintain a constant position or move slightly posteriorly.

If your patients experience cramps in the hamstrings during the bridge maneuver, they are overutilizing the hamstring muscle and not firing the glutes properly. If the patient has anterior hip pain while performing the bridge exercise up and down, they may not be controlling the proximal femur / greater trochanter.

Hip/pelvic complex dysfunction, especially the gluteal/hamstring relationship, can further impact the kinetic chain distally, such as excessive femoral medial rotation with respect to the tibia. The knee often gets caught between a dysfunctional hip and/or a dysfunctional ankle. The knee can easily become the site of greater flexibility between the ankle, hip and knee joints. Excessive uncontrolled motion is instability. The ankle has a tendency to lose dorsiflexion, while the hip loses extension.

A likely source of muscle impairment is the concept of relative stiffness/flexibility. One structure increases its flexibility to accommodate the relatively stiffer structure. We don’t always know how the muscular impairment begins, but compensation is normal. The nature of our society forces long-term habitual use patterns. A common muscular impairment starts with recruitment issues of the hip lateral rotators. A weakness or recruitment problem of the hip lateral rotators can lead to the short head of the biceps femoris becoming overactive.

Here is how you check the length of the short head of the biceps femoris: Visual postural analysis will reveal a prominence of the biceps femoris muscle. It will simply look bulged behind the knee. To check the length of the right short head of the biceps femoris muscle, put the client’s right leg in the supine 90/90 position. The left leg is held straight and resting on the table. Try to straighten the right leg. Normal for women is a “straight” raised leg (no bend at the knee). Normal length for men is within 10 degrees of a raised straight leg (10 degrees at the knee). If it is short, they may be using the biceps femoris as the primary lateral rotator of the hip instead of the intrinsic hip lateral rotators – the gemelli, obturators, piriformis and quadratus femoris.

The obvious problem with the biceps femoris muscle becoming the dominant muscle is that it attaches to the mid femur proximally and to the fibula distally, allowing the femur to rotate inward and the tibia/fibula to rotate outward. By eccentrically controlling femoral internal rotation, the hip abductors and external rotators are maintaining stability not only at the hip, but also at the patellofemoral region. Weakness of the hip abductors and external rotators may allow increased femoral medial rotation and valgus knee moments, putting excessive compressive forces on the patellofemoral joint and leading to a diagnosis of patellofemoral pain syndrome.

How many of your patients have had knee surgery without any trauma to the knee? Can you see how this knee problem began from the hip and caused a repetitive microtrauma to the knee? Hip abduction strength is key to movement control.

In order to activate the key stabilizers and prime movers of the hip (glute max, posterior glute med, deep-six rotators), I recommend you train your clients in both low-load exercises and high-load exercises. This will improve the performance of the glute medius and maximus, piriformis, obturator externus and internus, gemellus and quadratus femoris. Here is an example of a hip stability exercise prescription progression:

Side-lying clam progressing to side-lying straight-leg hip abduction (going from short- to long-lever exercises). The hip and knee of the bottom leg should be flexed. The top leg should be in the same alignment, supported on a pillow placed between the knees. The patient slowly rotates the hip of the top leg laterally, being sure not to allow the pelvis to rotate, holds this position for 10 seconds and then returns to the starting position. Repeat for 10 reps. Once the exercise looks and feels easy, progress to the long-lever exercise and repeat the same 10-second holds for 10 reps.

Glute max bridges. Starting with double-feet-on-floor glute raises, progressing to one-leg-at-a-time bridges. For single-leg raises, assume the bridge position, lock the right hip into flexion (knee-chest position, holding the knee inward with both hands); this makes it hard for the patient to hyperextend the lumbar spine, so they use the glutes. Bridge up and down 20 times per side. Keep the hips level and isolate the glutes.

Band walk. Begin with tubing at knees, progress to tubing at ankles. Wrap a band around both knees, slightly externally rotate the hip and walk sideways one leg at a time. Walk six steps left and six steps right. Perform as many sets of six reps per side until the patient feels the targeted glute muscle fatigue.

Single-leg bend-over. This is a deadlift hinging at the hip. Begin with hands on hips, progress to a reach with the hand opposite of stance leg. Progress further to use a dowel or a bar across the shoulders or held horizontal along the spine. Perform 10 reps per side.

Resources

  1. Van Dillen LR, Sahrmann SA, Norton BJ, et al. Reliability of physical examination items used for classification of patients with low back pain. Phys Ther, 1998;78:979.
  2. Brody LT, Thein JM. Non-operative treatment for patellofemoral pain. J Orthop Sports Phys Ther, 1998;28:336-44.
  3. Witvrouw E, Lysens R, Bellemans J, et al. Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med, 2000;28:480-9.
  4. Cesarelli M, Bifulco P, Bracale M. Study of the control strategy of the quadriceps muscles in anterior knee pain. IEEE Trans Rehabil Eng, 2000;8:330-41.
  5. Fredericson M, Cookingham CL, Chaudhari AM, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med, 2000;10:169-75.
  6. Comerford M. Lumbo-Pelvic Stability. Course notes.
  7. NASM Corrective Exercise Specialist (CES) course notes.
More