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Hip Joint Lateral Manual Mobilization

Hip joint lateral manual mobilization is a form of hands-on therapy designed to improve the motion, flexibility, and alignment of the hip joint. It works to specifically mobilize the muscles and tissues surrounding the hip joint in order to restore mobility and improve strength and stability. Treatment involves skilled manual manipulation of the tissue, utilizing specific pressure and movements to target the affected area with the overall goal of reducing pain, restoring proper alignment and improving range of motion. This treatment can also be used in combination with

Transcript

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This is Brent of the Brookbush Institute, and in this
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video we're going to go over a joint
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based manual therapy technique. If you're watching this video I'm assuming you're
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watching it for educational purposes, and that you are a licensed professional
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with joint based techniques within your scope. That means osteopath's ,chiropractors,
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physical therapists you're probably all in the clear. Physical therapy assistants,
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athletic trainers, massage therapists, you need to check with your governing body
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in your state or region to see whether this is within your scope of practice.
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Personal trainers this is definitely not within your scope of practice. Of course
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all professions could use this video for purely educational purposes, to help with
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learning biomechanics anatomy and of course palpation. In this video we're
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going to go over lateral hip mobilization, this is a great general
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technique for reducing arthrokinematic stiffness of the hip joint. I'm going to
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have my friend Melissa come out, she's going to help me demonstrate. Now if I'm
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doing a joint mobilization for the hip there might be several indicators that
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led me to believe that a mobilization may be effective, and first and foremost
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we could use something like the overhead squat assessment; because the hip is so
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involved in several of our functional tasks and motions, something like the
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overhead squat is going to give me an indication with signs like knees bow in,
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knees bow out, anterior pelvic tilt, posterior pelvic tilt, maybe an excessive
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forward lean, or an asymmetrical weight shift all could be indicators that somethings
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up with a hip. I could then go to goniometery, something like internal
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and external rotation of the hip. If I have stiffness I may get a reduction in
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rotation, whereas I can almost be guaranteed that if rotation is normal
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hypomobility, arthrokinematic hypomobility is probably not an issue. The
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last thing I personally rely on is passive accessory motion exams in this
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case. I know that is the traditional method for determining whether we need a
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joint mobilization, but with the hip we're dealing with so much soft tissue
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and this is a very strong soft tissue, it makes it much harder to feel normal
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versus abnormal joint play. Now we could go to convex on concave rules and start
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talking about why this mobilization is traditionally
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used, but in reality we're dealing with femoral spin and a lateral distraction-
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our lateral mobilization is actually distraction. So convex on concave
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rules don't apply real well here, although these are generally this
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technique I'm showing you is generally used to increase flexion and internal
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rotation. I've personally found that this is such a general mobilization probably
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most affecting the posterior structures of the hip, which have a propensity
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towards adaptive shortening like our posterior capsule, that I have seen
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increases in external rotation, internal rotation, flexion. I've seen increases in
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adduction range of motion all from doing this one technique. Again with all the
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techniques we do we have to be careful getting too specific with our
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biomechanics and we should always assess, or address and then reassess. So I'm
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going to do whatever assessment I'm going to do -the overhead squat, goniometry,
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I'm going to do my mobilization, and then I'm going to go to
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my reassessment to see if that technique was effective.
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Now Anatomy in this case, you guys can't feel the hip, I'm sorry like you're not
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going to reach in and and palpate the hip joint. You'd have to get through
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a lot of tissue and and that would be problematic and probably painful, so
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let's not do that. A couple things you are going to want to be able to find
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though is you're going to want to be able to find that inguinal line right, so
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you got to find that crease because either the belt which we're going to
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show that technique, or your hands are going to end up there. You probably want
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to be able to find the ASIS right so that anterior superior iliac spine. I'm
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going to show you guys how to kind of palpate joint motion, in the sense that
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if you put your hand down on the ASIS and the greater trochanter, it makes it
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somewhat easy to feel how much joint play you're getting. Other than that
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we're going to find that this technique is more like hug the leg.
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So I'll never forget my one of my clinical
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instructors coming up in school and of course an instructor for the the
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Maitland Institute Rob Flugel, telling me that manual therapy is a full-contact
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sport, and I think the biggest mistake I see with with this particular
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mobilization is people will use the strap and then stand about this far away,
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and start trying to do the mobilization. You're not going to feel anything, you're
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not going to get a real controlled motion that way, and we want to be as
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specific as we possibly can. So I'm going to show with the strap
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first because this is the technique I prefer, and then I'll show it again of
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course using just my hands for those people who the strap is actually
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uncomfortable on them, and or for those who just don't have a strap -for example
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maybe you do home care and you forgot your strap at home that day. Alright so
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I'm going to wrap this around my backside not my low back, alright we
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want to make sure that I'm not putting myself at risk here, and then I'm going
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to clip it around Melissa's side. Melissaf if you could
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scoot a little closer to me that would be great.
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Alright I'm going to have Melissa go ahead and position this strap all the
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way down as far as she can, because we want to be as close to the joint line as
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we possibly can. Now obviously the strap is close to some sensitive tissues, my
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guys know this is the adjust and guard technique. You might have to ask people
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to kind of use a hand to kind of move some stuff over and then they can block
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if they need to, that's especially handy when you personally are using your hands
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on this technique, you know that that way they they feel safe and comfortable and
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trust me if you get any of your sensitive skin underneath this strap or
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somebody's hands doing a lateral mobilization, you will have them talking
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falsetto. We are going to use a fairly large amount of force the hip is a
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fairly large joint. Now what I'll usually do is bring somebody into flexion, and
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then I'm going to go ahead and hug Melissa's leg like this. Alright so you
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guys can see here I kind of like like you were doing a headlock
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around the knee, but I'm going to have her thigh against my chest have her leg
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underneath my arm, and what this allows me to do is I can control not only how
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much flexion but how much rotation as well, and I mentioned in one of the other
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videos we seem to have a bit of research coming out that states that maybe we
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should be doing mobilizations at the end of the range that we're trying to get. So
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if I want more internal rotation maybe I shouldn't be doing it in open packed
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position, but doing this mobilization at the end of their pain-free internal
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rotation. Well I can do all that now right like I have her leg completely
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locked up, I'm good I'm in control here. Now I'm going to apply all the force
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with the strap by just sitting back here in a second, so that gives me an open
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hand. What am I going to do with this hand, well just like I explained in the
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knee mobilization video this is a great chance for you to try to be able to
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palpate joint motion, which is going to make it easier to follow through with
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those protocols that we talked about a couple times where you're trying to get at
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about 50 percent, well 50 percent between initial resistance and end of arthro-
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kinematic range. In this case what I usually do is I'll go thumb on ASIS -or
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maybe I'll turn that around I'll go fingers on ASIS and then thumb on
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greater trochanter, and I think if you guys kind of get them in to end range
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here and this is just first resistance barrier I'm not pushing her too hard,
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remember we want pain free alright first resistance barrier, and then if I sit
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back into the strap I can actually feel the greater trochanter moving into my
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finger while the ASIS stays in place right, so that's all arthrokinematic
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range I'm getting. So now I can kind of pull back on the strap and go oh
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there there it's started moving, and now it's stopped moving and it seems like no
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matter how far I sit back now if I keep pulling her ASIS comes with me. I'm not
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I'm not increasing the distance between greater trochanter
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ASIS anymore. Alright so that that helps me feel beginning of resistance
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and end of arthrokinematic range and now I can back off to 50%, and here's the
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tough part guys, how do i do my oscillations? I don't want to be like
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trying to manhandle her thigh and I have this strap here, but what I see people do
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with the strap is they start like throwing their butt back like they're
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twerking or something, like that that's not going to be good for your
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back don't twerk for mobilizations. It does help if you have a mirror in your
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office to watch yourself. What you want to do is get into a staggered stance and
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you want to try to rock, and you want all of you to rock so as the the the straps
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coming back you also want the knee to come back with you,, otherwise this isn't
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completely a lateral distraction, it would end up being like a lateral
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distraction with anterior rotation and adduction of the femur. We want pure
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lateral distraction. So what I'm doing here is I'm pushing back with my front
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leg onto my back leg right, and I'm just kind of going back and forth between my
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two legs. So this isn't this isn't twerking, this isn't using my upper body.
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You guys can see here like I'm just rocking back and forth and I could do
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this all day, maybe not all day but I could do this
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for quite a long time. I'm just using the strength in my legs in kind of this
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quasi-lunge position or split-stance position to get all of my force. Alright
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So now that I've got this rocking motion down let's go back to where I was, I'm
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going to hug Melissa's leg, first resistance barrier, flexion and internal
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rotation. I'm going to use this hand to feel ASIS and greater trochanter. I'm
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going to sit back, alright so there's my first resistance barrier, there's arthro-
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kinematic end range right there, back off to 50%, and now I can either do
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my grade three or my grade four mobilization, lets do grade three at this
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point. So I'm going to come back to first resistance barrier alright this is my
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larger amplitude oscillation, and I'm going to keep doing that one to two
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oscillations per second until I feel a decrease in joint stiffness. So notice
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guys like I'm very relaxed, I can keep talking to you there's no problem okay
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could do this all day. Now if you happen to use other protocols, you don't use the
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1 to 2 oscillations per second like the the Maitland protocols that I use that's
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okay, just make sure that you are looking for first resistance barrier, you know
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where arthrokinematic end range is, your setup is good and that you follow
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through with your protocols. As I've mentioned in several videos that's the
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the biggest mistake I see, is people kind of start and then like halfway through a
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protocol they just kind of go yeah, and then they move the leg around and they
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go that's good. Right I'm going to assess, I'm going to pay close attention to my
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technique, because I want to make sure that if I didn't get the result I was
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looking for, that it was the wrong technique and I need to pick something
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else, and not just bad form on my part. So let me review this technique one more
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time, and I'm going to show you guys the hand version of this technique. So again
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I took the leg up, wrapped around right I'm kind of hugging the leg with one arm,
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I can get as much internal rotation I need, I could even get some extra
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rotation if you guys thought you wanted that, and I can go into as much flexion
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as I want. I'm going to get myself all straightened out, I'm going to palpate my
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ASIS and my greater trochanter, and I'll show you guys that in the close-up recap,
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and then find my first resistance barrier, my arthrokinematic end range, and
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then I'm just going back and forth between my front and back legs in a
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split stance position. Hand position for this if you don't have a strap, or let's
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say every time I put that strap down Melissa was like that pinches right, and
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we know we have like the obturator nerve in there, we have some cutaneous nerves
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in here, maybe no matter what I do with the strap I keep pinching
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down on that nerve, okay we need to figure something else out. Some people
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just, like it pinches and digs into their skin and the straps not comfortable. So
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Melissa can guard if she wants all right, so we can, go ahead and put your hands
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down over yourself alright, and then I'm going to get my hands down as close
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to that joint line as I possibly can. You guys can't be bashful on this, obviously
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explain to your patient client what you're doing and why you're doing it, and
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make sure that you're coming down from the thigh to get into position so that
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you don't act, you know purposely brush up against anything, but you have to get
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as close to the joint line as you possibly can, if you get up here you're
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going to pull into horizontal abduction, adduction and not get your mobilization.
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But once you're here, notice that my position is not that much different than
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it was before, I'm still hugging the leg, now I don't have this extra hand
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unfortunately, but I'm going to use my legs to pull back to arthro-
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kinematic end range, you know find my first resistance barrier, kind of figure
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out where I'm going, and then once I get there I can do my rock between my legs.
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Notice I'm not hugging, this is the biggest mistake I see on the hands only
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technique, is people just start hugging the thigh,
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we're not hugging the thigh. Alright stay tuned for the close-up recap.
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Alright guys showing you another view, notice that the the strap here is around
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my backside, not my lumbar spine. I don't want to be giving myself a posterior to
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anterior mobilization everytime I try to loosen up somebody's hip. The strap is
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also down on Melissa's inguinal line here as close to her hip joint as I can
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possibly get it. We're then going to take this hand wrap it around the thigh,
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bringing the thigh close to the torso, so essentially we're given the thigh a hug
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here. This allows us to control all of the weight of this limb just by rocking
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back and forth and swaying back and forth, rather than trying to muscle it
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with our arms. I know some of you guys treat individuals a lot
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larger than yourselves, if any of you guys are working with professional
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athletes it's not real easy to muscle a very large leg. So you guys are using
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your body, you got the hugged in position here, you now have a free hand; you can
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use this free hand as a barometer like we were talking about, fingers on the
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ASIS thumb over the greater trochanter, that allows you to feel the greater
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trochanter move into your thumb against the relatively stable ASIS. So as soon as
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I sit back into the strap I can feel the greater trochanter move, even though the
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ASIS is staying totally stable. So as I go into my protocol here I can feel
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first resistance barrier, it's already starting to move a little bit right
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there, and then I can pull all the way in to my arthrokinematic end range, and
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then I can back off to 50% where I'm going to do my oscillations. If you guys
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are using 25% or 75% that's fine, but you can use this hand to kind of guide how
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much you're going to pull into that resistance. Now as I mentioned in the
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other take you want to try to sway between your front leg and your back leg,
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you're not doing rows, you're just front leg back leg, front leg back leg, front
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leg back leg, allowing your whole body and their thigh to essentially move as
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one as you shift your weight between your feet. Now if I was going to do this
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technique at a normal tempo here, again first resistance barrier,
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arthrokinematic end range, back off the 50% and then 1 to 2 oscillations per
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second right about here, and I'm going to keep doing this probably for about 30
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seconds, but essentially until I feel a decrease in arthrokinematic resistance.
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Once I feel a decrease if I really wanted to keep working on internal
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notation I could pull this way, if I was working on hip flexion I could come up a
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little further this way, and then maybe do a second set. Now you don't want to
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push too far before you reassess and see if you've regained normal range of
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motion, but that does give you guys an idea that if you have good control of
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this limb, you can kind of adjust as you go to try to get the most benefit from
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this technique. Now I understand that a strap doesn't always work, like I said
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some people feel pinching when they use a strap and sometimes you just don't
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have a strap handy, so you can use your hands -you do lose your barometer here,
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because what you're going to end up doing is taking this hand, lacing it
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underneath the lower leg dropping that hand right down on the thigh as close to
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the hip joint as you can possibly get, putting this hand over the top and now
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you're using the same technique. Make sure you're trying to get your your
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chest pretty close to vertical with your hands right, making sure that that the
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leg itself is vertical; and once you're all kind of hugged in and that leg is
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right up next to your torso, you're going to do the same front leg back leg, front
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leg back leg, front leg back leg with your body wave. None of this, this will
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wear out your arms. We want to make sure that we use our bodyweight so that we
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can keep mobilizing for as long as we need to do this technique, to feel a
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decrease in arthrokinematic resistance. So there you have it,
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assess, address, reassess. Make sure that everytime you choose a joint based
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manual therapy technique it is based on an assessment, and that you return to
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that assessment after you've finished the intervention to see if it was
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effective, for the individual, the patient or client that you had in front of you.
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Ensure that you continue to learn your Anatomy, because your Anatomy is going to
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help you with your hand placement, with understanding
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what a joint can do, with understanding what you may gain from
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this particular technique; and of course practice, you have to practice these
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techniques. Hopefully not for the first time on a patient or client who just
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walked in the door. If you can, find a more senior instructor or a mentor to
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give you some really good hands-on instruction. Use your peers for some good
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feedback, and of course always look for live education to help with your manual
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therapy techniques. I know these videos make education very convenient, but there
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is no substitute for learning manual therapy in a live setting. I look
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forward to talking to you guys again soon.