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