lumbar-pelvis-hip compex overhead squat, one leg squat 검사결과와 치료법 - 정리중

[문형철]

와우 재미있는 논문이다. 

LPHC impiarment 논문.pdf

재미있는 논문 하나더.

abnormal Hip mechanics on knee injury.pdf

탐구 목표

➤ Understand basic functional anatomy for the lumbo-pelvic-hip complex.

➤ Understand the mechanisms for common lumbo-pelvic-hip complex injuries.

➤ Determine common risk factors that can lead to lumbo-pelvic-hip complex injuries.

➤ Incorporate a systematic assessment and corrective exercise strategy

INTRODUCTION

THE lumbo-pelvic-hip complex (LPHC) is a region of the body that has a massive influence on the structures above and below it. The LPHC has between 29 and 35 muscles that attach to the lumbar spine or pelvis (1,2). The LPHC is directly associated with both the lower extremities and upper extremities of the body. Because of this, dysfunction of both the lower extremities and upper extremities can lead to dysfunction of the LPHC and vice versa.

- 요추골반고관절 복합체는 인체 위아래 구조에 큰 영향을 미치는 중요한 부위. 

- 29~35개의 근육이 척추에서 골반까지 연결됨. 

REVIEW OF LPHC FUNCTIONAL ANATOMY

As previously stated, the LPHC has a great influence on the rest of the kinetic chain. There are many bones, joints, and muscles involved in the dysfunction of the LPHC; however, the purpose of this section is to provide a general review of the most pertinent structures. This is not intended to be an exhaustive and detailed review.

Bones and Joints

In the LPHC region specifi cally, the femur and the pelvis make up the iliofemoral joint and the pelvis and sacrum make up the sacroiliac joint ( Figure 14-1). The lumbar spine and sacrum form the lumbosacral junction (Figure 14-1). Collectively, these structures anchor many of the major myofascial tissues that have a functional impact on the arthrokinematics of the structures above and below them. Above the LPHC are the thoracic and cervical spine, rib cage, scapula, humerus, and clavicle. These structures make up the thoracolumbar and cervicothoracic junctions of the spine, the scapulothoracic, glenohumeral, acromioclavicular (AC), and sternoclavicular (SC) joints (Figure 14-2).

As mentioned in earlier chapters, below the LPHC, the tibia and femur make up the tibiofemoral joint, and the patella and femur make up the patellofemoral joint (Figure 14-3). The fibula is also noted as it is the attachment site of the biceps femoris, which originates from the pelvis. 

Also mentioned in previous chapters, the tibia, fibula, and talus help to form the talocrural (ankle) joint (Figure 14-4). Collectively, these structures anchor the myofascial tissues of the LPHC such as the biceps femoris, medial hamstring comoplex, and rectus femoris. These bones and joints are of importance in corrective exercise because they will also have a functional impact on the arthrokinematics of the LPHC.

Muscles

There are a number of muscles in the upper and lower extremities whose function may be related and have an effect on the LPHC (Table 14-1). As with all muscles, it is important to restore and maintain normal range of motion and strength as well as eliminate any muscle inhibition to ensure joints are operating optimally (3–5). See chapter two for a detailed review of the location and function of these muscles.

COMMON LPHC INJURIES AND ASSOCIATED MOVEMENT DEFICIENCIES

Many of the common injuries associated with the LPHC include low-back pain, sacroiliac joint dysfunction, and hamstring complex, quadriceps, and groin strains (Table 14-2). However, the body is an interconnected chain, and compensation or dysfunction in the LPHC region can lead to dysfunctions in other areas of the body (3–8). Moving above the LPHC, common injuries are often seen in the cervical-thoracic spine, ribs (9–11), and shoulder (12–14), which can stem from dysfunction in the LPHC. 

Moving below the LPHC toward the knee, common injuries include patellar tendinosis (jumper’s knee) and iliotibial band (IT-band) tendonitis (runner’s knee) (15–17) as well as anterior cruciate ligament (ACL) tears (18,19). At the foot and ankle, common injuries that can stem from LPHC dysfunction include plantar fasciitis, Achilles tendinopathy, and medial tibial stress syndrome (20,21).

Applying this concept practically, if the ankle is restricted and unable to move during the descent of a squat, the hip will be required to move more (relative flexibility) (22). If there is a lack of sagittal plane dorsiflexion at the ankle owing to an overactive or tight gastrocnemius and soleus, the LPHC will be forced to increase forward flexion to alter the body’s center of gravity to maintain balance (Figure 14-5). 

- 아래 그림

- 만약 비복근 가자미근이 tight해서 발목의 dorsiflexion 이 안되면 몸통은 forward flexion 되면서 중력균형을 잡음. 

The under activity of the erector spinae and gluteus maximus to maintain an upright trunk position produces the compensation of an excessive forward lean. The gluteus maximus and latissimus dorsi along with the thoracolumbar fascia work synergistically to form the posterior oblique subsystem (Figure 14-6) (23,24). 

As a compensatory mechanism for the underactivity and inability of the gluteus maximus to maintain an upright trunk position, the latissimus dorsi may become synergistically dominant (overactive or tight) to provide stability through the trunk, core, and pelvis (4). Because the latissimus dorsi crosses the inferior angle of the scapulae and inserts onto the humerus it can alter the rotation of the scapula and instantaneous axis of rotation of the humeral head within the glenoid fossa (4). The erector spinae, sacrotuberous ligament, biceps femoris, peroneus longus, and anterior tibialis work synergistically to form the deep longitudinal subsystem (Figure 14-7) (23,25,26). 

With both the anterior tibialis and erector spinae working at a submaximal level, the biceps femoris may become overactive to help maintain stability of the LPHC (4,27). This, however, will alter the position of the pelvis and sacrum and affect the sacroiliac and iliofemoral

joints. The latissimus dorsi may also become overactive or tight to provide stability through the pelvis and extension of the spine for the inability of the erector spinae to maintain an upright trunk position. The latissimus dorsi attaches to the pelvis and will anteriorly rotate the pelvis, which causes extension of the lumbar spine (4,27).

From an injury perspective, the increased hip or spinal fl exion can lead to excessive stress being placed on the low back, resulting in low-back pain. It can also lead to increased stress in the hamstring complex and adductor magnus, which may be trying to compensate for a weakened gluteus maximus and erector spinae complex to stabilize the LPHC, and result in hamstring complex and groin strains (4). The rectus femoris, being one of the primary hip flexors,  tends to be overactive in this scenario. This can decrease its ability to lengthen

during functional movements and lead to quadriceps strains as well as knee pain. As mentioned earlier, overactivity or tightness of the latissimus dorsi can affect the shoulder and upper extremities leading to a variety of shoulder and upper-extremity injuries (4,27).

ASSESSMENT AND CORRECTIVE EXERCISES FOR LPHC IMPAIRMENTS

➤ SYSTEMATIC PROCESS TO DETERMINE LPHC IMPAIRMENTS

Because of the freedom of movement at the LPHC and its association with the upper and lower extremities, there are a number of key elements to assess for LPHC dysfunction. This section will review key areas to be assessed when performing an integrated assessment for LPHC impairments.

STATIC POSTURE

A key static postural distortion syndrome to look for to determine potential movement dysfunction at the LPHC is the lower crossed postural distortion syndrome. As mentioned in chapter five, this is characterized by an anterior pelvic tilt (excessive lumbar extension). This position of the pelvis and lumbar spine can place excessive stress on the muscles and connective tissue associated with the LPHC during dynamic movement.

2) TRANSITIONAL MOVEMENT ASSESSMENTS

There are several LPHC compensations to look for when performing an overhead squat assessment.  As outlined in chapter six, these compensations include excessive forward lean, arching of the low back, rounding of the low back, and an asymmetric weight shift. The table below provides a review of the potential overactive and underactive muscles for each compensation.

When performing a single-leg squat, some key compensations to look for would include the knee moving inward and inward or outward trunk rotation as well as the hip hiking and dropping. The table also provides a review of potential overactive and underactive muscles for each compensation.

3) DYNAMIC MOVEMENT ASSESSMENTS

Dynamic movement assessments can also help to determine whether LPHC movement deficiencies exist while performing more dynamic movements such as gait (chapter six). When performing a gait assessment, observe the individual’s LPHC for excessive arching and excessive pelvic rotation as well as hip hiking. These compensations could be indicative of poor neuromuscular control of the LPHC and will need to be addressed in the corrective exercise program.

4) RANGE OF MOTION ASSESSMENTS

The range of motion (ROM) assessments performed for LPHC impairments will be dependent on the compensations seen during the overhead squat assessment. The table provides a summary of key joints to be measured on potential observations on the basis of the movement compensation(s) seen in the movement assessment. See chapter seven to view proper execution of these assessments and average ROM values.

5) STRENGTH ASSESSMENTS

As with the ROM assessments, the manual muscle tests that are selected will also be dependent on the compensations seen during the overhead squat assessment. The table provides a summary of key muscles to be tested on the basis of the movement compensation(s) seen in the movement assessment. See chapter eight to view proper execution of these assessments.

SYSTEMATIC CORRECTIVE EXERCISE STRATEGIES FOR LPHC IMPAIRMENTS

The following section provides sample programming strategies using the Corrective Exercise Continuum for LPHC impairments. The photos provided illustrate the exercises that can be done for each component of the continuum to help address the issue of LPHC impairments as they relate to the overhead squat assessment (excessive forward lean, low back arches, low back rounds, and asymmetric weight shift). Which exercises are used will be dependent on the findings of the assessments and the individual’s physical capabilities (integration exercises).

SUMMARY • The LPHC operates as an integrated functional unit, enabling the

entire kinetic chain to work synergistically to produce force, reduce force, and

dynamically stabilize against abnormal force. In an effi cient state, each structural

component distributes weight, absorbs force, and transfers ground reaction

forces. This integrated, interdependent system needs to be appropriately trained

to enable it to function effi ciently during dynamic activities. Because of the

many muscles associated with the LPHC, dysfunction in this region can potentially

lead to dysfunction in both the upper and lower extremities, and dysfunction

in either the upper or lower extremities can lead to LPHC dysfunction. For

this reason it becomes a crucial region to assess and will most likely be a region

that will need to be addressed in most individuals with movement defi cits.

[이주운]

좋은자료 감사합니다~ 잘볼께요^^

[문형철]

네 아주 재미있는 논문입니다. 유익하구요

[문형철]

2012년 10월 20일.. 아직도 완전한 이해를 바탕으로 한 평가가 안되는구나!! 언제나 될까?

[육동일]

TFL과 중둔근이 외전기능으로 서로 같이 actvate될거라고 생각했는데.. 서로 반대네요^^;;
TFL의 내회전 기능 때문에 그런건가요 교수님??

[문형철]

그렇지. tfl은 내회전, 중둔근은 외전기능이 main이기때문에 상황에 따라 반대로 activation된다고 할 수 있음 ㅎㅎㅎ
굿잡...

[pt-재훈]

정말 유익한 자료 감사합니다.~

[sonny]

다시 봐도 역시 좋은 자료입니다.~~!