0:05 This is Brent and in this video we're going over self-administered hip 0:10 mobilization techniques. Now this fills a big gap in our exercise 0:14 selection, that is our self-administered exercise selection, as we move from just 0:18 looking at muscles in dysfunction and optimizing human movement, to start 0:23 looking at arthrokinematic dyskinesis and how we can improve the way 0:28 those joint surfaces move against each other. I'm going to have my friend 0:32 Melissa come out, she's going to help me demonstrate these techniques. Now i do 0:36 have to give a shout out to to Kelly Starrett for some of the innovation 0:41 behind these techniques, and the use of these monster bands as well as my 0:44 friends Erin Swanson and Pete Schultz over at dynamic sports physical therapy 0:48 for showing me some of their modifications, and then of course I got 0:52 my little twist on stuff based on what I think is happening at the hip. Now the 0:58 compensation pattern, the arthrokinematic compensation pattern that generally 1:02 happens at the hip is the femoral head moving superior and anterior in the 1:09 acetabulum. Now in order to correct that I have a couple options, I can start 1:13 pushing back posteriorly which we're definitely going to show you that 1:17 technique, although this is where those practical problems come in, that 1:21 technique doesn't work as well just for issues around the exercise itself. The 1:26 other thing that works really well though is a lateral distraction, so a 1:30 lateral distraction for the hip joint is a very general distraction that will 1:34 help aim at those posterior and inferior capsule fibers that have adaptively 1:40 shortened. So how do we do this, well we got to get a band around one leg and 1:46 it's got to be one of these thick monster bands, you guys try to do this 1:49 with a resistive band tube and it's going to it's going to hurt, 1:53 it's going to hurt a lot all right. So we take a thick band we got to put it all 1:57 the way up against the inguinal ligament, right all the way against that bikini 2:01 line, and then we're going to flip into quadruped position making sure that this 2:08 band is pulling directly laterally, and go ahead and adjust the band, 2:14 oops sorry, stole your pad. Now notice I have got a couple of airex pads set up here, 2:20 it's because this this techniques a little rough on the knees so get them as 2:23 much padding as they need to make sure that their kneecaps feel okay. Now 2:28 once she's in this position and she's got a good amount of tension on that 2:32 band, remember the hip joint is a big joint, we 2:35 don't want to pull them so far that they think their hip is going to pop out or 2:38 that there's going to be pain, but they need a good amount of pressure to get 2:42 those fibers around the hip capsule to stretch out a little bit. Once I get her 2:47 here all I'm gonna have her do is rock right. When she does this little rock I 2:53 want her whole body to rock and I want to make sure she's pushing with this 2:58 glute, all right. So it is her left glute that's pushing her into a position and 3:03 that way I get a little gluteus medius activity out of this too. I definitely 3:07 don't want her pulling with this leg and gearing up her adductors, chances are if 3:13 she has some lumbo-pelvic hip complex dysfunction or lower leg dysfunction 3:17 hence why I'm doing this exercise, those adductors are already a little geared up. 3:21 Once she's done this I know she knows how to find centre, I know she knows how 3:27 to put pressure on the band, she's good at these oscillatory techniques. I see 3:31 that she's getting some benefit from 15 to 20 repetitions, we can start taking 3:36 this up a notch by doing lateral distraction with some osteokinematic 3:42 motion that can start working on flexion, or start working on extension. Usually 3:46 I'll start with working on flexion if that's where the restriction is, so I'm 3:50 going to make sure she's moved to centre, she's got good pressure on the band, she 3:54 can actually kind of look between her knees, and what I'm going to have her try to 3:58 do is sit back on her feet, nice and centre. The thing you don't want them to 4:04 do is to lose all muscle activity, and then you come back up, lose all muscle 4:09 activity and just fall into their feet, because they'll shift with the band and 4:12 there won't be any tension on their hip. Alright so she's just going to sit 4:16 back, keep a tension, keep centre, and then come back. Now as I discussed in the 4:22 other self-administer mobilization video we did, there's a couple of ways we could do 4:26 this here; we could go back and forth through this nice large osteokinematic 4:31 motion. Or let's say she was stuck at 1:10 and 4:36 had no pain, well I could just do that one to two oscillations per second for 4:42 30 seconds right there in that little little tiny area, just kind of going up 4:46 against that stiffness just like the mobilization techniques we learned in 4:50 school, or let's say she was somebody who had a little bit of impingement a little 4:55 bit of pain, well if that was the case I would only have her go back as far as 4:59 she could pain-free, maybe just touching into that 5:03 pain a little bit and then coming back out of it. Remember I don't want to 5:07 exacerbate pain, I don't exacerbate the inflammatory process and all of a sudden 5:12 she gets up from this technique and she's got a limp because I just made her 5:15 pain worse, I want to improve her arthrokinematics. 5:19 So even just doing this through her pain free range is going to help. Now after that 5:23 we can get really really fancy and we can go all the way from flexion of the 5:30 hip, all right keeping centre, and then she can 5:33 start working on a little bit of extension with lateral distraction by 5:36 going from Child's Pose to that modified push-up position, 5:41 squeeze her glutes, get all the way down into hip extension, all right and then go 5:45 all the way back. She does 15 or 20 of these with that nice lateral distraction 5:52 and you guys will see a lot of that stiffness alleviated. Once again if I 5:58 thought she had was stuck in one position I could work in that range, but 6:02 usually by the time you got somebody here you're just cleaning up the very 6:07 last bits of that arthrokinematic dysfunction. Now the next technique I 6:12 want to show you guys is every once in a while somebody with with like hip 6:15 impingement, or a really stubborn hip flexion restriction will get a huge 6:22 benefit from a self-administered anterior to posterior mobilization, and 6:28 then I'll explain why this doesn't work out as well as this technique does. What 6:33 she's going to do is she's going to straighten herself out so that the band 6:36 is now pulling her femur, that way she's going to stay 6:41 in this, this quadruped position, but this time I'm going to have her get out as 6:46 far as she possibly can, assuming that there's no pain, she's going to 6:50 keep up the band nice and high. Alright can you get out any further or no good. 6:57 Alright so sit back, alright and you guys can see I have a nice anterior to 7:03 posterior hip mobilization. The only problem with this is this isn't 7:09 where the maximal tension is, which that would be nice but that's just not how 7:13 bands work. So we can have go ahead and have her work a little bit on let's 7:18 activate our glutes with that anterior to posterior mobilization, but then as I 7:23 go back to where I really need the tension it's actually backing off. I 7:27 don't want to say that this technique doesn't work because it absolutely does 7:30 work and I absolutely do use it, but you guys can kind of see how just the 7:34 practicality of this exercise. I don't use this one as much as that lateral hip 7:39 distraction which works wonders it really does. I find that the carry over 7:45 I get from manual techniques done during a session is incredible for all of my 7:49 PT's ATC's DC's out there, and for physical for my personal trainers you 7:55 can try these techniques a little bit and I think for those of you guys who've 7:59 been working on your corrective exercise strategies, that will help get you to 8:01 that next point. Now it would make sense that from this position that I could 8:06 progress to like a kneeling or half kneeling, or even a standing lateral hip 8:12 distraction or A-P distraction. You can go ahead and sit up. I don't want you to go 8:16 to make yourself gumby today. It would make sense that I could get into this 8:21 half kneeling position or maybe a standing position, but what I find is is 8:25 that as soon as I don't have all points on the floor, all four points on the 8:29 floor, rather than this being a hip mobilization that actually distracts the 8:32 hip, it starts just kind of being resistance right. So if I'm in a kneeling 8:37 position and it's pulling this way it doesn't pull my hip out before I just 8:41 shift. When I have all four points down I think there's enough restriction in the 8:47 body, you're creating enough friction with the floor that that mobilization 8:51 happens first. Something for you guys to work on, 8:54 something for you to try. So now we got a couple new mobilization techniques, we 8:58 did the ankle in the last video, hip in this video, I think knee is coming up next. 9:02 I hope you guys get great outcomes using these self-administered techniques. 9:13
