The role of the pelvis in recurrent groin,
knee and hamstring pain & injuries
General Information
This course is limited to physiotherapists
only. (for further information regarding LJ Lee and the Discover courses, please refer to www.discoverphysio.ca )
course description
Low back pain and pelvic girdle pain are
common in all levels of recreational and elite athletes. So too are lower
extremity injuries such as groin pain, osteitis pubis, clicking hips, recurrent
quadriceps and hamstring strains, and ITB syndrome. A challenge for therapists
is that often these problems are recurrent and chronic, and evidence to
indicate what the most effective treatment protocol for these injuries is still
lacking. The pelvis is a key area of load transfer between the lower extremity
and the spine. Poor control of the joints of the pelvis, suboptimal muscle
synergies, and altered alignment have the potential to affect efficiency and
length-tension relationships of all the muscles attaching to the pelvis, and
create excessive compression and tension loading through various structures of
the hip and knee. These altered biomechanics can predispose the athlete to
injury in the lower extremity, and if not corrected can precipitate re-injury.
Recent research has shown that patients with posterior pelvic girdle pain and
failed load transfer of the pelvis have altered timing and recruitment of the
biceps femoris. Studies have also shown that athletes with groin pain have
alterations in timing of the transversus abdominis muscle, one of the key
lumbopelvic stabilizer muscles. Clinically, different patterns of asymmetry and
dysfunction of the hip and local trunk muscles have been observed in patients
with sacroiliac joint dysfunction and a variety of hip and knee problems.
Although further research is still needed, it is apparent that treatment of
chronic, recurrent problems such as groin pain, osteitis pubis, iliotibial band
syndrome and hamstring strains require a careful assessment of the pelvis, with
particular attention to load transfer tests.
The purpose of this 3-day evidence-based
course is to review the recent advances in science and discuss the role of the
pelvis in common hip and knee problems. The clinical application for assessment
and treatment will be based the System-based Classification for Failed Load
Transfer (The Puzzle) and an integrated multi-modal approach will be highlighted and used extensively in this course.
Course outline/objectives
Theory to be covered:
* Current evidence on the known biomechanics
of the joints of the pelvic girdle & hip
* Current models of how the joints of the
trunk, pelvis and hips are stabilized during different loading tasks
* Common clinical patterns of altered hip and
knee function which occur as a result of failed load transfer (non-optimal
strategies for function & performance) through the pelvis
Practical – Demonstrate and/or Practice:
* Functional tests for load transfer through
the pelvic girdle, hip and knee (tests to identify non-optimal strategies)
* Joint mobility/stability tests for the
sacroiliac joint, pubic symphysis, and hip (articular system tests)
*Tests which analyse recruitment patterning
of the deep muscles and recognize common substitution strategies (Real-time
ultrasound imaging will be demonstrated for transversus abdominis and the
pelvic floor via video clips) (neural system tests)
* Tests which analyse myofascial deficits
(true hamstring, quadriceps and/or adductor strains etc) (myofascial system
tests)
Clinical Reasoning: Theory & Discussion
Pertaining to:
* Common patterns of pelvic dysfunction and
how these patterns relate to lower extremity injuries.
* How to develop a multi-modal treatment
program which includes manual therapy, dry needling, education and exercise.
How to use taping and external supports of the pelvis during sport to augment
training
Practical – Demonstrate and/or Practice:
* Specific mobilization and myofascial
release techniques for the sacroiliac and hip joints
* Motor control training for the deep muscles
– this training uses imagery and touch for facilitation. The focus will be on
how to find the optimal strategy and ensure that this strategy translates into
better loading and function for the lower extremity
* Specific hip stabilization and exercises
for motor control to ensure optimal balanced recruitment of the psoas, tensor
fascia latae, quadriceps, adductors, and medial/lateral hamstrings during
functional activities
* Exercise progressions and key components to
take the rehabilitation program from the acute stage to restoring full return
to sport and activity
This course is now FULL, so please register on the waiting list for your chance to attend.
You can also enrol on the next course, held on both August 5-7 and September 3-5 2010, as well as being on the waiting list.
