Podcast
Questions and Answers
In acetabular protrusion, where is the femoral head in relation to Kohler's line?
In acetabular protrusion, where is the femoral head in relation to Kohler's line?
- Posterior
- Medial (correct)
- Lateral
- Anterior
What is the defining characteristic of protrusio acetabuli?
What is the defining characteristic of protrusio acetabuli?
- Shallow socket (correct)
- High alpha angle
- Normal acetabular anatomy
- Femoral head lateral to Kohler's line
What does the alpha angle measure in the context of femoral neck deformity?
What does the alpha angle measure in the context of femoral neck deformity?
- Femoral head radius
- Transition of femoral head into neck (correct)
- Size of bony anomaly
- Curvature of acetabulum
What does an alpha angle greater than 60 indicate in a patient?
What does an alpha angle greater than 60 indicate in a patient?
Why should a high alpha angle in an asymptomatic patient be considered an incidental finding?
Why should a high alpha angle in an asymptomatic patient be considered an incidental finding?
What is the recommended duration to hold a sub-maximal contraction when correcting an anterior rotated pelvis?
What is the recommended duration to hold a sub-maximal contraction when correcting an anterior rotated pelvis?
What is the primary reason for activating transverse abdominis to facilitate multifidus activation?
What is the primary reason for activating transverse abdominis to facilitate multifidus activation?
Which type of muscle activation is preferred for lumbar stabilization according to the text?
Which type of muscle activation is preferred for lumbar stabilization according to the text?
Why is an anterior neutral spine important in lumbar stabilization?
Why is an anterior neutral spine important in lumbar stabilization?
What is the goal of using an assistive device to correct a posterior rotated pelvis?
What is the goal of using an assistive device to correct a posterior rotated pelvis?
Which type of training is lumbar stabilization described as in the text?
Which type of training is lumbar stabilization described as in the text?
What is the primary goal of performing repeated movements during assessment or treatment for stenosis?
What is the primary goal of performing repeated movements during assessment or treatment for stenosis?
During a prone press up, what instructions are typically given to the patient?
During a prone press up, what instructions are typically given to the patient?
Which special test is considered indicative of adverse neural tension when back pain is triggered during leg raise?
Which special test is considered indicative of adverse neural tension when back pain is triggered during leg raise?
What is the purpose of strapping a patient to an iron board as part of home exercise?
What is the purpose of strapping a patient to an iron board as part of home exercise?
In what position might a patient experience pain while performing a special test involving different positions like 'C' and 'D'?
In what position might a patient experience pain while performing a special test involving different positions like 'C' and 'D'?
Which nerve is involved in knee extension, plantar flexion, and inversion according to the SLR variation described in the text?
Which nerve is involved in knee extension, plantar flexion, and inversion according to the SLR variation described in the text?
What is the goal of therapy intervention when dealing with radicular pain?
What is the goal of therapy intervention when dealing with radicular pain?
Which technique can help reduce adverse neural tension according to the text?
Which technique can help reduce adverse neural tension according to the text?
What is neural tension defined as in the context of the text?
What is neural tension defined as in the context of the text?
Why should one be cautious with nerve pain according to the text?
Why should one be cautious with nerve pain according to the text?
What is the recommended starting position for treating radicular pain according to the text?
What is the recommended starting position for treating radicular pain according to the text?
In the context of acetabular inclination, what is considered normal for the angle in degrees?
In the context of acetabular inclination, what is considered normal for the angle in degrees?
What are some contributing factors to hypomobility in the lumbar spine and pelvis?
What are some contributing factors to hypomobility in the lumbar spine and pelvis?
Why is hypermobility considered a contraindication for manipulation in the lumbar region?
Why is hypermobility considered a contraindication for manipulation in the lumbar region?
What should be done with hypermobility in the lumbar area before proceeding with mobilization?
What should be done with hypermobility in the lumbar area before proceeding with mobilization?
Which technique involves imparting a force on the low lumbar region or SI?
Which technique involves imparting a force on the low lumbar region or SI?
What intervention should be used for a patient experiencing directional preference for extension?
What intervention should be used for a patient experiencing directional preference for extension?
Which factor is NOT considered a contributing factor to hypomobility in the lumbar spine and pelvis?
Which factor is NOT considered a contributing factor to hypomobility in the lumbar spine and pelvis?
Study Notes
Hip and Pelvis Abnormalities
- DDH (developmental dysplasia of the hip): characterized by acetabular inclination >25 degrees
- Acetabular protrusion: femoral head is medial to Kohler's line (ilioischial line)
- Protrusio acetabuli: shallow socket with femoral head medial to Kohler's line
- Alpha angle: formed by a line parallel to femoral neck axis and a line from the center of the femoral head to the transition of the femoral head into the femoral neck
- Alpha angle >60 indicates a bony anomaly
Femoral Neck Deformity and Cam Impingement
- Femoral neck deformity: excessive curvature of the femoral neck
- Cam impingement: femoral head/neck profile exceeds the radius of curvature of the acetabulum
Chronicity and Contributing Factors
- Chronicity: duration of symptoms
- Contributing factors:
- Adjacent joint mobility (too mobile or too stiff)
- Occupational hazards
- Posture
- Psychosocial factors (fear of movement, fear of getting better, fear of coming in)
Prognosis and Exercise Prescription
- Prognosis: determined by knowledge of stages of healing
- Exercise prescription:
- Choose exercises the patient will do (e.g., walking, sit-to-stand)
- Make exercises specific to the current presentation (not diagnosis)
- Provide accountability techniques (diary, check-ins)
- Consider aquatic exercise as an alternative
Hypermobility and Hypomobility
- Hypomobility: lack of movement contributing to pain and stiffness
- Contributing factors:
- Facet issues
- Muscle tension
- Neural tension
- Inflammatory issues
- Pain
- Lifespan/age considerations
- Compensatory movements
- Mobilization and manipulation techniques:
- Treat with appropriate grade III and IV moves
- Combine movements
- Screen for hypermobility contraindications
- Get consent and screen for lumbar roll
Lumbar and Pelvic Mobilization
- Pelvis mobilization: mobilize the hemipelvis in sidelying
- Lumbar mobilization: impart a force on the low lumbar region or SI joint
- Be specific with mobilization techniques (e.g., gapping between vertical segments, rotation of thoracic spine)
- Stepping up/down curbs, stairs) - self-correction (e.g., thumb closer to the ground when checking ASIS)
Anterior and Posterior Rotated Pelvis
- Anterior rotated pelvis: pull leg up on the side that is anteriorly rotated
- Posterior rotated pelvis: want to activate hip flexors
- Provide resistance with the hand as you push out toward the wall
- Hold sub-maximal contraction for 10 seconds, repeat 3 times
Local and Global Muscles
- Muscle activation should be segmental (local)
- Global muscles will not assist segmental instability
- Teach in various positions
- Activation of transverse abdomens will then facilitate multifidus
- Emphasis should be 'up & in' not flat back or posterior pelvic tilt
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Description
Test your knowledge on techniques for correcting pelvic misalignments including anterior and posterior rotated pelvis and maintaining an anterior neutral spine. Questions cover methods like palpating ASIS, providing resistance, and activating hip flexors.
