This is Brent and in this video we're going over self-administered hip
mobilization techniques. Now this fills a big gap in our exercise
selection, that is our self-administered exercise selection, as we move from just
looking at muscles in dysfunction and optimizing human movement, to start
looking at arthrokinematic dyskinesis and how we can improve the way
those joint surfaces move against each other. I'm going to have my friend
Melissa come out, she's going to help me demonstrate these techniques. Now i do
have to give a shout out to to Kelly Starrett for some of the innovation
behind these techniques, and the use of these monster bands as well as my
friends Erin Swanson and Pete Schultz over at dynamic sports physical therapy
for showing me some of their modifications, and then of course I got
my little twist on stuff based on what I think is happening at the hip. Now the
compensation pattern, the arthrokinematic compensation pattern that generally
happens at the hip is the femoral head moving superior and anterior in the
acetabulum. Now in order to correct that I have a couple options, I can start
pushing back posteriorly which we're definitely going to show you that
technique, although this is where those practical problems come in, that
technique doesn't work as well just for issues around the exercise itself. The
other thing that works really well though is a lateral distraction, so a
lateral distraction for the hip joint is a very general distraction that will
help aim at those posterior and inferior capsule fibers that have adaptively
shortened. So how do we do this, well we got to get a band around one leg and
it's got to be one of these thick monster bands, you guys try to do this
with a resistive band tube and it's going to it's going to hurt,
it's going to hurt a lot all right. So we take a thick band we got to put it all
the way up against the inguinal ligament, right all the way against that bikini
line, and then we're going to flip into quadruped position making sure that this
band is pulling directly laterally, and go ahead and adjust the band,
oops sorry, stole your pad. Now notice I have got a couple of airex pads set up here,
it's because this this techniques a little rough on the knees so get them as
much padding as they need to make sure that their kneecaps feel okay. Now
once she's in this position and she's got a good amount of tension on that
band, remember the hip joint is a big joint, we
don't want to pull them so far that they think their hip is going to pop out or
that there's going to be pain, but they need a good amount of pressure to get
those fibers around the hip capsule to stretch out a little bit. Once I get her
here all I'm gonna have her do is rock right. When she does this little rock I
want her whole body to rock and I want to make sure she's pushing with this
glute, all right. So it is her left glute that's pushing her into a position and
that way I get a little gluteus medius activity out of this too. I definitely
don't want her pulling with this leg and gearing up her adductors, chances are if
she has some lumbo-pelvic hip complex dysfunction or lower leg dysfunction
hence why I'm doing this exercise, those adductors are already a little geared up.
Once she's done this I know she knows how to find centre, I know she knows how
to put pressure on the band, she's good at these oscillatory techniques. I see
that she's getting some benefit from 15 to 20 repetitions, we can start taking
this up a notch by doing lateral distraction with some osteokinematic
motion that can start working on flexion, or start working on extension. Usually
I'll start with working on flexion if that's where the restriction is, so I'm
going to make sure she's moved to centre, she's got good pressure on the band, she
can actually kind of look between her knees, and what I'm going to have her try to
do is sit back on her feet, nice and centre. The thing you don't want them to
do is to lose all muscle activity, and then you come back up, lose all muscle
activity and just fall into their feet, because they'll shift with the band and
there won't be any tension on their hip. Alright so she's just going to sit
back, keep a tension, keep centre, and then come back. Now as I discussed in the
other self-administer mobilization video we did, there's a couple of ways we could do
this here; we could go back and forth through this nice large osteokinematic
motion. Or let's say she was stuck at 1:10 and
had no pain, well I could just do that one to two oscillations per second for
30 seconds right there in that little little tiny area, just kind of going up
against that stiffness just like the mobilization techniques we learned in
school, or let's say she was somebody who had a little bit of impingement a little
bit of pain, well if that was the case I would only have her go back as far as
she could pain-free, maybe just touching into that
pain a little bit and then coming back out of it. Remember I don't want to
exacerbate pain, I don't exacerbate the inflammatory process and all of a sudden
she gets up from this technique and she's got a limp because I just made her
pain worse, I want to improve her arthrokinematics.
So even just doing this through her pain free range is going to help. Now after that
we can get really really fancy and we can go all the way from flexion of the
hip, all right keeping centre, and then she can
start working on a little bit of extension with lateral distraction by
going from Child's Pose to that modified push-up position,
squeeze her glutes, get all the way down into hip extension, all right and then go
all the way back. She does 15 or 20 of these with that nice lateral distraction
and you guys will see a lot of that stiffness alleviated. Once again if I
thought she had was stuck in one position I could work in that range, but
usually by the time you got somebody here you're just cleaning up the very
last bits of that arthrokinematic dysfunction. Now the next technique I
want to show you guys is every once in a while somebody with with like hip
impingement, or a really stubborn hip flexion restriction will get a huge
benefit from a self-administered anterior to posterior mobilization, and
then I'll explain why this doesn't work out as well as this technique does. What
she's going to do is she's going to straighten herself out so that the band
is now pulling her femur, that way she's going to stay
in this, this quadruped position, but this time I'm going to have her get out as
far as she possibly can, assuming that there's no pain, she's going to
keep up the band nice and high. Alright can you get out any further or no good.
Alright so sit back, alright and you guys can see I have a nice anterior to
posterior hip mobilization. The only problem with this is this isn't
where the maximal tension is, which that would be nice but that's just not how
bands work. So we can have go ahead and have her work a little bit on let's
activate our glutes with that anterior to posterior mobilization, but then as I
go back to where I really need the tension it's actually backing off. I
don't want to say that this technique doesn't work because it absolutely does
work and I absolutely do use it, but you guys can kind of see how just the
practicality of this exercise. I don't use this one as much as that lateral hip
distraction which works wonders it really does. I find that the carry over
I get from manual techniques done during a session is incredible for all of my
PT's ATC's DC's out there, and for physical for my personal trainers you
can try these techniques a little bit and I think for those of you guys who've
been working on your corrective exercise strategies, that will help get you to
that next point. Now it would make sense that from this position that I could
progress to like a kneeling or half kneeling, or even a standing lateral hip
distraction or A-P distraction. You can go ahead and sit up. I don't want you to go
to make yourself gumby today. It would make sense that I could get into this
half kneeling position or maybe a standing position, but what I find is is
that as soon as I don't have all points on the floor, all four points on the
floor, rather than this being a hip mobilization that actually distracts the
hip, it starts just kind of being resistance right. So if I'm in a kneeling
position and it's pulling this way it doesn't pull my hip out before I just
shift. When I have all four points down I think there's enough restriction in the
body, you're creating enough friction with the floor that that mobilization
happens first. Something for you guys to work on,
something for you to try. So now we got a couple new mobilization techniques, we
did the ankle in the last video, hip in this video, I think knee is coming up next.
I hope you guys get great outcomes using these self-administered techniques.