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Hip Rotators, treatment and Pelvic stability issues ?

Hi all,
How often do you treat your clients hip rotators and how important do you view their ability to stabilize the head of the femur onto the Pelvis.
Its an intimate area to treat (I work through a towel side lying) does this cause you any problems?
Regards steve

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Comment by Stephen Jeffrey on January 6, 2011 at 4:07am

Hi Chris

thanks for commenting, I think its a matter of how each individual therapist prefers to work, but checking strength and stability first does make complete sense to me.

Since making this post, I have focused on this area alot more with my clients and had work done on myself, I can state that time spent resolving fibrosis, strength and flexibility issues in this intimate area is criticle for a complete recovery to hip, SI joint and spinal problems.

I am sure there is a direct link between the health and function of these small muscles( eg quadratus femoris) that directly effects/controlls core stabillity potential, via multifidus etc.   I cannot however find any researched evidence to support this theory.

Comment by Chris Watts on December 29, 2010 at 9:28pm

I have always been taught that the piriformis is the prime mover of the 6 external rotators and the rest are more involved with the stability of the femoral head into the acetabulum.

The gemellus superior is one of the most highly sensory of all the external rotators. Does it make sense to check their flexibility first and then to work on the strength and stability component next?

Do let me know if this makes any sense?

Comment by D L Williams on October 22, 2009 at 7:48am
I've used James Waslaski's Orthopedic Massage techniques for a long time and I will not use any other method especially for this area. It is strictly professional and pain free. If you're not familiar you can go to seminars are great, I highly recommend the 5day. I agree with Sims/Davich you have to let the client know the importance and get permission.
Comment by Bert Davich on October 8, 2009 at 7:49pm
If you don't check the rotators when there is a pelvic imbalance or low back pain, then you may be missing the solution to the problem. There are great ways to work to balance the rotators without any of the 'intimacy' issues. Assuming there are no issues that would contraindicate, you can drape the supine client in a 'diaper', flex the femur to 90 degrees with knee flexed 90 degrees. You move the hip into further flexion without pressure, and you can watch to see if the leg tracks straight back or if it 'tracks' medial or lateral as it moves toward the chest. That will tell you if there is constriction or tightness on the external or internal rotator of the femur. You can then move the femur in to internal or external rotation and move the knee toward the clients chest. Sometimes traction should also be employed to prevent pressure on the femoral triangle. This will lengthen the rotator. DO NOT USE THIS COMMENT TO PERFORM THIS MANEUVER. There are several cautions including hip abnormalities and pressure on the femoral triangle that must be observed. I recommend Art Riggs DVD "Deep Tissue & Myofascial Release" and accompanying book 'visual guide' for openers. Also James Wasleski shows a Prone method of working the rotators and psoas on one of his DVD's. These techniques are a learning process and you really have to thirst for the knowledge to get it. Additionally you can keep some bike shorts and sports bras around if draping is a problem. Most males now days wear underwear that is sufficient for these techniques. Then you can place them in side-lying position with hip & knee flexed which will reveal the trochanter and allow palpation access to the rotators without an intimacy issue.
Comment by Jeff Sims on October 6, 2009 at 3:38am
if posterior pelvic work is indicated:
1. ask for permission
2. explain as necessary
3. compression is under-rated -- slower when pain is acute
4. pincer grasp of gluteus maximus is quite effective
5. pin and stretch is very effective for fibers involved in rotation
6. careful drapping is important when muscle stripping is indicated (get permission again)
7. don't forget attachment sites
re-establishing functional mechanics (neuromuscular) is critical if the client wants to rehabilitate
Comment by Kathy Jo King on October 2, 2009 at 5:24am
I work on the hip jt mm all the time. It's the largest jt in the body and I find it very important to address the often tight rotators. I work through the sheet, or, as many of my clients wear shorts, through the shorts. I don't find it a problem at all. In fact, I find many therapists don't work this area at all, or do so superficially.

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