hi everybody really excited to share with you today the first 25 slides of your hip pelvis and lumbar spine movement interventions or more commonly referred to as the lumbo-pelvic hip complex I love that name because it talks about the integration of all three of these joints and regions so I hope you watch the biomechanics and Anatomy video prior to this and so really now with this video I want us to really get after the high level view of anatomy and integrated ways that we should look at the body as we're designing movement interventions for the lumbar spine and for the pelvis but first let's talk about the pelvis in this video and in another video we'll talk about the lumbar spine so if you don't have your PowerPoint slides up and pop those open so you can take notes and let's get started and so from the previous slide I didn't mention this but you can already tell from that image of the anatomy that this is some really complex anatomy so with this slide though I really want to get us thinking about the big picture of the lumbo-pelvic ship complex and we said in the other video I used these blue terms that the pelvis is a fulcrum and a relay station of forces right another one I'll throw at you it's almost like a traffic circle how a traffic circle directs cars in different directions right I don't mean to imply that all the motion occurs in a circle only that the pelvis is directing force up and down the kinetic chain I really like to look at the pelvis that way but here you see also it's a keystone bullet point number one of the human movement system so anything happening here any lack of stability and mobility here is gonna have implications for the rest of the kinetic chain and I know we keep saying that like each joint and cover is really important but but the lumbo-pelvic hip complex is of essential importance and so this is the clear first order of business if you will in designing movement interventions and it can have critical influence over movement dysfunction in almost all individuals and again if we could start this joint off with just a couple pearls for you the kinetic chain needs of the hip is mobility because we know that the hip is a stable joint from a bony perspective right femoral head in the acetabulum that's a very stable ball and socket joint one of the most stable die are throttle or or synovial joints of the body very very stable it needs mobility from you okay and then the lumbar spine of course needs mobility because I'm sorry needs stability sergeant sorry confuse you there it needs stability because it has a lot of mobility I confused myself because I was on the wrong bullet points here right so the lumbar spine needs stability and the hips have stability and they need mobility but then the second bullet point Gary gray would take it even further and say you know what the hips really need most stability so you need to get a mobile first and then you need to learn to have them control that mobility so he calls that most ability I like that all right here we go you guys I spend a good deal of time on these slides and I'm gonna go through them quickly and really the point here is that I need you to go back and spend more time on these slides at a later date okay so I'm looking at you now I need you to spend a couple hours here making yourself familiar with the anatomy so for now what I want us to do is think bigger so this is all of us thinking more broadly about the body as an integrated system and you probably know where I'm going with that right here's the myofascial meridians again of the body I spent a good amount of time here and I'm gonna reference an article that I'm gonna post in canvas that has been so helpful for me because it's hard to get all of these myofascial meridians or Anatomy trains into one slide with all the muscles that are acting in those movements energies so you see here on the left side I've gotten the 12 meridians on which the anatomy trains are built these integrated right systems that provide tension and stability of the body but then on the right side you see is all of the anatomy trains or meridians with all the muscles that comprise them and so hopefully this is a nice system for you as you think about hmm what myofascial chain or train do I need to is the problem coming from and then what are the muscles that I need to influence okay so hopefully this is very helpful so for now in the next few minutes I want to talk about just a few of these and and it's these four but mostly it's the three on the right so what are the three on the right it's the functional back line here and then the the back spiral line here that includes the glutes and the hamstrings which we know and love as the posterior chain when you say posterior chain and I say it what we're really doing is combining this line with this superficial back line okay that gastroc hamstring through the sacral tuberous ligament and the erectors finding with the lats and the glutes makes sense so that's the posterior chain and then I want to talk about this deep anterior chain or line and then this superficial back line because the two of these anteriorly and posteriorly are interacting together to stabilize particularly in the sagittal plane okay told you I was gonna make us think deeper so here's the deep front line and I want you to appreciate this this is the best diagram I could get of when I when I show you this what do you see and what does this kind of bring up in you what is the function of these muscles that you're looking at I mean clearly they're overlapping in complex ways they're providing really key stability all from the lumbar spine through the pelvis to the femur right so you're seeing the hip flexors and the pelvic floor muscles deep muscles and the abductors all stabilizing that anterior chain in the frontal plane okay and all of these pictures are the same deep front line but I want you to see man when you're treating the adductors you're treating this whole deep front line together okay so you shouldn't think of the adductors as a vacuum as stress stabilizing the femur yes they're doing that but this is with the femur acting on a pelvis that's being influenced by the hip flexor okay now let's go to the back spiral and the back functional line so at the same time that all that deep anterior line is acting then you've got this posterior chain that's why I included them together the posterior chain influencing this posterior side through the pelvis right the the glute max here acting on the pelvis with the hammies and the contralateral or the opposite erectors I'm sorry lats with the essaouira column bar fascia okay oh my goodness we're thinking big here right and so when you have people do Superman's or bird dogs you're influencing this entire back functional line and the spiral line yeah all right moving on complex synergies to stabilize the core now we're flowing right now when I tell you the lumbo-pelvic hip complex is key to core to core stability you know why right and all these muscles 29 that attach onto the pelvis they are all acting on the pelvis to influence it in three dimensions so what does the lumbo-pelvic hip complex need from these muscles and from you right as you're training folks well you need the core to produce force and to explode so that we can you know accelerate the overhead throwing motion or accelerate the kicking or stabilize the walking motion okay you also need the quarter reduce and decelerate and control forces coming from the ground reaction forces right gravity any drivers that the person has like hands feet eyes pelvis whatever implements in their hands and any load they might be trying to move yeah and then you need the pelvis to dynamically stabilize joints above and below and if the pelvis doesn't do that if you have a weak core these patients athletes clients will have decreased stability and inability or lessened ability to produce force and of course you're like duh Jeff this is why all of your patients and clients are coming to you in the first place right they're they're unstable or they have pain because they have too much mobility or not enough mobility okay so let's look at the component parts quickly the femur is a strong femoral acetabular joint the hip joint is the most stable joint in the body like we said the most stable synovial joints definitely the SI joint is more stable but that's fixed yeah and this is prone to immobility because it's so stable and so any immobility coming out of the hip this very very critical that you understand this because the hips lack mobility any immobility in the hips then therefore just translate that lack of mobility up and down from up to the lumbar spine and to the SI joints okay and so the lumbar spine an SI joint have to pick up the slack and have to get motion there and then therefore if you have tight hips you get back pain I just pause there for a minute because some of you just need to realize that many of your clients have back pain and it's got a whole lot to do with their hips and a whole little to do or very little to do with their lumbar spine okay hip musculature let's hit these pretty quickly so the posterior chain as we know now is comprised of let's go from the ground up so it's comprised of the gastroc and the hamstring through the sacred tubers ligament attaching onto the pelvis right to the contralateral thoracolumbar fascia erector spinae and extensors so there you have it that's the posterior chain where we get stability from the ground up and the posterior chain as we know from previous lectures can be a key indicator of dysfunction in the glute max the SI joint in the lumbar spine very specifically when the glute max is under active it leads to tight dominant overactive lats on the opposite side and hamstrings right so people with under active gluts are prone to type blasts and hamstring strains okay let's let's do a deeper dive into the glutes as we said as I was showing you during gate the glutes particularly the max is a hip extensor primarily but it also eccentric lis decelerates hip flexion right so it drives hip extension and AV duction and external rotation but it decelerates the opposite the medius is a strong decelerator of the femur going into a deduction right and concentrically it drives the femur into a deduction and external rotation but then again as its break breaking in gate it decelerates femoral internal rotation I know that's a lot of words but perhaps at home you can walk and you can mimic and personify your glute medius and kind of talk yourself through what is the glute medius doing and all phases of gates so any weakness in the glute meat increases frontal plane and transverse plane stresses at the knee and at the foot and as I say that to you ladies and gentlemen what I want to say is a lot of times glute medius weakness is responsible for patellofemoral syndrome as the patella grinds on the femurs confirmer akan dives right any other pathologies you can think of related related to a glute medius weakness I can think of medial tibial stress syndrome shin splints right minor fasciitis etc etc okay remember the glutamine works in synergy with the hamstring so if it's weak they stand the hamstrings will become overactive and prone to strain okay let's talk about other hip muscles the hamstrings so in the sagittal plane we said the hamstrings drive hip extension right but they also decelerate hip flexion we knew that in the transverse plane remember we said the hamstrings rotate the tibia right the lateral hamstrings rotate the tibia and fibula outwards right and the toes go outward the medial hamstrings the semitendinosus and member knows to strive internal rotation right so is the biceps Pham when we're fully in mid stance of gait the biceps femoris are actually breaks so that you don't go into femoral internal rotation they prevent valgus collapse and they decelerate the hip and knee in three planes of motion as gravity loads the hip as we're weight bearing again walk feel your hamstrings contract as you're going through the various phases of walking and this will make perfect sense to you okay little little friends on the side the TfL and the IT band I see little friends the IT band of course is not a muscle that it can have profound effects laterally well what is the tensor fasciae Latta do well it flexes the hip and it rotates the hip right we're gonna talk about the TfL a little bit more in a minute but think about it as a companion muscle with the glutes because they both attach onto the IT bands okay so the tensor fasciae latae out here attaches onto the IT band with the glute meet and glute max and then the IT band of course dense faster that runs all the way to the knee and can become tight and lead to runners knee here or snapping hip syndrome when it snaps over the latter trochanter or the greater trochanter okay moving on let's talk about anterior and lateral chains so the anterior Chane best picture I can find of the hip flexor because what does it show you about the hip flexor shows you that the hip flexor attaches onto the lumbar spine right l2 to l4 my goodness it is a strong puller for lack of a better word of the lumbar spine forward okay so what is the hip flexor it's the psoas major and the iliacus so the iliopsoas is the hip flexor so it's major attaches onto one more spine iliacus attaches onto the top of the ilium right and it pulls the pelvis forward so forward rounded pelvis with trunk falling forward the major culprit is the hip flexor so it's driving hip flexion and external rotation of the hip actually the hip flexor through the psoas major and the iliacus see see this angle of pull right here wrapping around the femoral neck when they pull they rotate the hip out okay that's their concentric function so you know what I'm gonna say their eccentric function is to slow down hip internal rotation and extension and as we know when that when the hip flexor is tightened dominant they reciprocally inhibit the glutes and the deep erector spinae that whole posterior chain and we know and love that as the lower cross syndrome okay one last thing about the TfL again we said it's action is to flex the hip and also to rotate the hip internally and then to a be duck the hip but it's not nearly as powerful as your other hip AV ducktor and rotators okay let's talk quads on the anterior chain so the quad is a via articular muscle like the hamstrings that influences the hip and knee in mid stance the quads are obviously the quad concentrically contracts the knee right and extends the knee sorry should say extends Vinnie so in mid stance the quad rectus family has a very short concentric phase that assists with that knee extension most of the time it's doing the opposite and it's eccentric ly contracting to control knee flexion so that your knee doesn't buckle it's the it's the brakes of knee flexion and in the transverse plane is controlling internal rotation of the femur on the tibia so it's also preventing valgus collapse so if you want to prevent valgus collapse we know you're strengthening the hip flexors you're strengthening the quads that might be counterintuitive for some of you but it's nonetheless true that that should be your approach and then I'm in tow off phase in the sagittal plane the quad lengthens with hip extension along with the hip flexor so it's storing energy in that face all right our friends the adductors we did a decent job of explaining what the adapters do instability on our anatomy video but I just want to reiterate that the adductors are constantly active in the frontal plane to stabilize the pelvis and the femur on the lumbar spine okay so think of them as frontal plane movers that cause adduction but also that decelerate a deduction and as they do that they're stabilizing they're always active in the swing phase of gait when the hip is flexed the Magnus can act as a knee extensor so the adductor Magnus the broadest one and also it helps to eccentric we control internal rotation as the calcaneus eavers in toe off when the hip goes into an extension extended position the adductors acts to help in flexion of the knee and the hip okay particularly the hip right not the knee remember the adductors attached down here on the adductor tubercle so only the gracilis influences all the way down at the tibia the rest only influence the femur important and then on the anatomy video I showed you what could happen with an asymmetrical weight shift in which the right adductor and the left a B dr. act in sync across the body to control frontal plane motion so revisit that if you need some more guidance there okay finally our sorts are friends to start aureus and gracilis act very much like the adductor group at least the gracilis does and the Sartorius is this long skinny funky muscle that flex and rotates externally the femur such as all the way down here on PES anserine so it has a good amount of transverse plane influence of internal rotation of the femur on the pelvis and then not to be forgotten our friends the deep external rotators particularly the piriformis can become tight and can need to be inhibited and they predominantly externally rotate the femur on the pelvis and then we've got our internal rotators glute Meade and minimus of the pelvis all right that is functional and applied anatomy as quickly as I can do it I know we were deep in the weeds there and I hope that I inspired you to think about these complex synergies of movement and not muscles acting as unique planar muscles and now as I go back to our Anatomy trains as we meet in class next week let's think about designing movement interventions to improve these muscle synergies and so I went and captured a picture online of what I think that could look like just for starters and here's is what it could look like right so just to get our juices flowing these are complex movement synergies that are asking this client to stabilize her spine and her pelvis and her hips as she drives her levers right to use that terminology in three planes of motion alright I hope that got you thinking and I look forward to sharing more with you soon