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Unlocking the Secrets of the Pelvis Part 4

In this series of “Unlocking the Secrets of the Pelvis” we have discussed how asymmetries will affect lumbo-pelvic-femoral alignment starting with a chain of muscles on the left side with too much tone that include the diaphragm, illiacus, psoas, TFL, biceps femoris and vastus lateralis and is called the L AIC or Anterior Interior Chain. The diaphragm is important because the most common movement dysfunction is breathing and breathing dysfunction affects entire chains of muscles in the body. (1)

Assessing the ability to breathe in a functional manner needs to be part of our evaluation and education process for every patient. Combining breathing with a corrective exercise strategy will provide a powerful tool for expanding your clinical competency and providing more effective patient care.

What makes breathing so important is that the diaphragm, or “Big D”, is responsible for not only respiration but is a major player in stabilization and positioning of the lumbo-pelvic-femoral region. Big “D” has right and left leaflets as discussed in this series and the left side is notable since it tends to have more “tone” or tends to be more flattened in an over-activated state.

Patients with this Left AIC pattern present with too much tone in that entire chain of muscles and just want to relax them. (And with focused breathing the rest of their body as well!) When that polyarticular chain relaxes, other muscles as described in Part 2 of this series can be recruited in a way that restores a more functional pelvic positioning and alignment which then affects the entire musculoskeletal system.

The reason breathing with corrective exercise is important is that you need to start influencing the diaphragm, especially the left leaflet, if the rest of the Left AIC is going to be addressed. The left leaflet needs to relax and dome (Remember the ZOA or Zone of Apposition from Part 1 of this series and Part 3 of “Breathe Well and Breathe Often” by this author) during exhalation while you are activating the left anterior abdominal wall. The rest of the muscles in the L AIC will relax and help facilitate activation of inhibited of muscles that help to restore symmetrical pelvic alignment and position of the acetabulum over the femurs.

The dysfunctional Left AIC pattern has “tri-planer” consequences to the lumbo-pelvic-femoral region and our thinking and correction needs to affect the sagittal, frontal and transverse planes. The goal is to restore neuromusculoskeletal symmetry that provides a rotational shift of the pelvis back to the left providing for a more equal acetabular/femoral (AF) position on each side.

Many of the muscles that influence positioning and control of the pelvis were mentioned in Part 2 of this series. The following exercises are a beginning step to correct the L AIC pattern. The findings of the “Adduction Drop Test” and the “Extension Drop Test” from Part 3 will give you direction and proper sequencing of a corrective strategy as outlined by Postural Restoration Institute.

Let’s look at a few of the many exercises that combine breathing with myokinematic repositioning of the pelvis. If the patient presents with a positive left adduction drop test and a positive left extension drop test, we start with an exercise designed for lumbo-pelvic-femoral control quoted from the PRI Home Study Course on Myokinematic Restoration.(2)

I. 90-90 Hip Lift

1. Lie on your back with your feet flat on a wall and your knees and hips bent at a 90-degree angle.

2. Place a 4-6 inch ball between your knees.

3. Inhale through your nose and exhale through your mouth performing a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back flat on the mat.

4. Hold this position while you take 4-5 deep breaths in through your nose and out through your mouth.

5. Relax and repeat 4 more times.

II. 90-90 Hip Lift with Hip Shift

1. Lie on your back with your feet flat on a wall and your knees and hips bent at a 90 degree angle.

2. Place a 4-6 inch ball between your knees.

3. Inhale through your nose and exhale through your mouth performing a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back flat on the mat.

4. As you maintain a hip lift, shift your left hip down and your right hip up so that your right knee is slightly above the left.

5. Slowly take your bent right leg on and off the wall so that your right thigh comes toward your chest. You should feel the muscles behind your left thigh engage.

6. Perform 3 sets of 10 repetitions, 1-2 times a day.

III. 90-90 Hip Lift with Medial Hamstring

1. Lie on your back with your feet flat on a wall and your knees and hips bent at a 90-degree angle.

2. Place a 4-6 inch ball between your knees.

3. Move your left foot and ankle slightly outward while gently squeezing the ball.

4. Inhale through your nose and exhale through your mouth performing a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back flat on the mat.

5. Slowly take your bent right leg on and off the wall so that your right thigh comes toward your chest. You should feel the muscles behind your left thigh and left outer hip engage.

6. Perform 3 sets of 10 repetitions, 1-2 times a day.

The breathing component is essential and can be taught with the patient on their back asking them to take a full relaxed breath in through the nose then breathe out through their mouth in a long, relaxed sigh then holding it at the end of the breath for just a second before breathing in through the nose again. It helps to have the right hand overhead since this allows the right ribcage to expand more while the patient inhales and is still flattening their lower back with sacrum elevated off floor or table.

Any one of these three exercises is a starting place for a progression of more exercises (with pictures) by PRI that are designed to provide muscular realignment of the lumbo-pelvic-femoral region.

These exercises are designed to inhibit muscles that have too much tone, like the ones that comprise the Left AIC, and recruit muscles that have been reciprocally inhibited causing a chronic pelvic position asymmetry. We are simply reversing the roles of antagonist and agonist, lengthening tight muscles, shortening over-lengthened and weak muscles thereby providing more AF internal rotation on the left and AF external rotation on the right. You can help this process along with a standard L AIC pattern with a precise adjustment to the inominate bones that facilitate a balanced alignment and positioning.

These exercises should not be performed if they are creating additional pain or discomfort during or after the exercise. Also, these exercises work best if done in a relaxed fashion with the patient mastering the many parts of each exercise with breathing and gentle activation of muscles and position.

The purpose of this series of four articles on “Unlocking the Secrets of the Pelvis” is to introduce a basic overview of “Myokinematic Restoration” of the lumbo-pelvic-femoral region and describe common pathomechanics combined with a path to assessment and correction.

Mastery of any approach to patient care requires more than an overview and for a complete understanding of pelvic myokinematics attending a PRI course or studying their home courses is recommended.

PRI provides “power tools” that will make your adjustments more effective and provide lasting results beyond “That last adjustment was great Doc but it just didn’t hold very long!”

Chiropractic has been just like the basic landline telephone many of us baby boomers grew up with. That is, chiropractic has been safe, effective and reliable.

Today think of your practice like a smart phone or “Pad”. It is still like a phone and always will be but now you can add “app’s” or functions that enhance and make it more powerful. For your chiropractic practice, PRI is a critical “app” to include in your treatment toolbox.

References

1. Myokinematic Restoration Home Study Course, Anterior Interior Chain, Page vi.

2. Myokinematic Restoration Home Study Course, Myokinematic Repositioning Techniques, Page 2

Robert “Skip” George, D.C., CCSP, CSCS also owns La Jolla Sport and Spine where he integrates chiropractic, rehabilitation and sport performance training. He is also a Certified Functional Movement Screen Instructor. For questions or comments he can be contacted at dr.george@sbcglobal.net

 

 

 

Robert “Skip” George, D.C., CCSP, CSCS owns Optimum Fitness and Health, where he integrates Chiropractic, Rehabilitation and Fitness/Performance Training. He is a certified Functional Movement Screen (FMS) and Selective Functional Movement Assessment (SFMA) provider as well as a Functional Movement Screen Instructor. He can be contacted at Dr.George@sbcglobal.net

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