An Integrated Approach to Treatment of Patterned Lumbo-Pelvic-Femoral Pathomechanics
An Integrated Approach to Treatment of Patterned Lumbo-Pelvic-Femoral Pathomechanics
"By far the best practical course I've ever taken for hip and pelvis dysfunctions."
See more testimonials below!
This advanced lecture and lab course explores the biomechanics of contralateral and ipsilateral myokinematic lumbo-pelvic-femoral dysfunction. Treatment emphasizes the restoration of pelvic-femoral alignment and recruitment of specific rotational muscles to reduce synergistic predictable patterns of pathomechanic asymmetry. Emphasis will be placed on restoration, recruitment, and retraining activities using internal and external rotators of the femur, pelvis, and lower trunk. Guidance will be provided on how to inhibit overactive musculature. This will enable the course participant to restore normal resting muscle position. Participants will be able to immediately apply PRI clinical assessment and management skills when treating diagnoses such as piriformis syndrome, ilio-sacral joint dysfunction, and low back strain.
Education Level: Advanced
Student Faculty Ratio 16:1
Cost: $495 (Early registration rate: At least 4 weeks before the course)
$545 (Late registration rate: Within 4 weeks of the course)
Participation is limited to ensure a low faculty to student ratio. Please register early. Courses will be canceled or rescheduled if fewer than 15 participants have registered by the early registration deadline of four weeks prior to the scheduled course date.
Special Needs Requests
If you have a disability and require accommodation in order to fully participate in this course, please contact us at least two weeks prior to the course date or prior to purchasing any online home study course so that arrangements can be made.
The course must be attended in full, and a course evaluation summary completed in order to receive a certificate of completion for 15 CE hours. If you arrive late, or leave early, your certificate of completion will be adjusted for the number of CE hours you were in attendance.
Cancellation and Refund Policy
Tuition is refundable less $50 if cancelled 14 days before the course date. Tuition is not refundable for registrations or cancellations within 14 days of the course. However, you may have someone attend in your place or attend on another date. If you choose to attend on another date, a $50 fee applies to transfer your registration. If you are a no show and we have no communication with you before the course you will forfeit your course tuition. PRI reserves the right to cancel a course and will refund the tuition fee only.
|March 2-3, 2019||Body Dynamics, Inc. Falls Church , Virginia||Jennifer Poulin||23 Open|
|March 2-3, 2019||IRG Center for Structural Medicine Seattle , Washington||Dan Houglum||0 Open|
|March 30-31, 2019||Rosencutter Ultra Fitness Greenfield , Wisconsin||Jennifer Poulin||40 Open|
|April 6-7, 2019||Swain Hall, Minot State University Minot , North Dakota||Jesse Ham||28 Open|
|April 27-28, 2019||Children's Health Specialty Center 2 Plano Plano , Texas||Dan Houglum||25 Open|
|May 18-19, 2019||Wellesley College Wellesley , Massachusetts||Mike Cantrell||35 Open|
|May 18-19, 2019||Slippery Rock University Slippery Rock , Pennsylvania||James Anderson||40 Open|
|June 1-2, 2019||Navy-Marine Corps Memorial Stadium Annapolis , Maryland||Dan Houglum||40 Open|
|July 20-21, 2019||University of Nevada Reno , Nevada||James Anderson||40 Open|
|August 23-24, 2019||Postural Restoration Institute Lincoln , Nebraska||Dan Houglum||40 Open|
|September 7-8, 2019||Missoula Bone & Joint PT & Sport Medicine Missoula , Montana||Dan Houglum||35 Open|
|September 21-22, 2019||Finish Line Physical Therapy New York , New York||Jennifer Poulin||38 Open|
|October 12-13, 2019||3 Dimensional PT Medford , New Jersey||Dan Houglum||32 Open|
|October 19-20, 2019||Elite Physical Therapy Cranston , Rhode Island||Jennifer Poulin||20 Open|
|November 2-3, 2019||Alta Bates Summit Medical Center Oakland , California||Jesse Ham||37 Open|
|7:30am - 8:00am||Registration and Light Breakfast|
|8:00am - 9:00am||Left Anterior Interior Chain (AIC) Pattern and Pelvic Joint Dynamics|
|9:00am - 10:00am||Lumbo-Pelvic-Femoral Capsuloligamentous Issues|
|10:00am - 10:15am||Break|
|10:15am - 12:00pm||Femoral Internal and External Rotators|
|12:00pm - 1:00pm||Lunch (on your own)|
|1:00pm - 2:00pm||Myokinematic Influences on the Pelvis and Femur|
|2:00pm - 3:00pm||Examination Tests and Assessment: Adduction Drop Test – Extension Drop Test – Femoral-Acetabular (FA) Rotation – Trunk Rotation – Hruska Adduction Lift Test – Hruska Abduction Lift Test – Standing Reach Test|
|3:00pm - 3:15pm||Break|
|3:15pm - 4:15pm||Examination Tests and Assessment (Lab)|
|4:15pm - 5:00pm||Repositioning Through Integrated Isolation (Demonstration and Lab)|
|7:45am - 8:00am||Sign-In and Light Breakfast|
|8:00am - 9:00am||Myokinematic Functional Relationships|
|9:00am - 10:00am||
Examination and Assessment
|10:00am - 10:15am||Break|
|10:15am - 11:00am||
Examination and Assessment (Lab)
|11:00am - 12:00pm||Treatment Considerations and Myokinematic Hierarchy|
|12:00pm - 1:00pm||Lunch (on your own)|
|1:00pm - 2:00pm||
|2:00pm - 3:00pm||Left AIC Myokinematic Hierarchy (Lab)|
|3:00pm - 3:15pm||Break|
|3:15pm - 4:00pm||Left AIC Related Pathomechanics: Piriformis Syndrome, Ilio-Sacral Joint Dysfunction, Low Back Strain|
|4:00pm - 5:00pm||Myokinematic Restoration Inhibition Programs|
Muscular Structures of the Pelvis
IC Adductor (Ischiocondylar portion of the adductor magnus)
Internal and External Femoral Rotators
Lower Half Pelvic Musculature (Gluteus Maximus, Levator Ani, Coccygeus, Pubococcygeus, Adductors, Obturators)
Upper Half Pelvic Musculature (Piriformis, Gluteus Maximus, TFL, Psoas)
Sacroiliac Ligaments (anterior/posterior) Anterior Ligaments: Iliolumbar, Sacrospinous Posterior Ligaments: Interosseous, Long Dorsal, Sacrotuberous
Femoral Acetabular Ligaments: Iliofemoral, Pubofemoral, Ischiofemoral
Anterior Interior Chain (AIC)
Muscles: Diaphragm, Psoas, Iliacus, TFL, Vastus Lateralis, Biceps Femoris
Opposition Muscles: Hamstrings, Gluteals, Internal Obliques
There are two anterior interior polyarticular muscular chains in the body that have a significant influence on respiration, rotation of the trunk, ribcage, spine and lower extremities. They are composed of muscles that attach to the costal cartilage and bone of rib seven through 12 to the lateral patella, head of the fibula and lateral condyle of the tibia. These two tracts of muscles, one on the left side of the interior thoraco-abdominal-pelvic cavity and one on the right, are composed of the diaphragm and the psoas muscle. With the iliacus, tensor fasciae latae, biceps femoris and vastus lateralis muscles this chain provides the support and anchor for abdominal counter force, trunk rotation and flexion movement.
FA = Femoral Acetabular (femur moving on the acetabulum)
AF = Acetabular Femoral (acetabulum moving on the femur)
Left AIC = Left Anterior Interior Chain
FA IR = Femoral Acetabular Internal Rotation
AF IR = Acetabular Femoral Internal Rotation
The patient lies on his or her side with the lower leg and hip flexed (90 degrees). Stand behind the patient and passively flex, abduct and extend the hip to neutral while maintaining 90 degrees of knee flexion. Passively stabilize the pelvis from falling backward and allowing femoral internal rotation to occur. Make sure the top innominate is positioned directly over the bottom innominate so the frontal plane starting position does not give any false positives (top innominate too cephaled) or false negatives (top innominate too caudal).
A positive test is indicated by a restriction from the anterior-inferior acetabular labral rim, transverse ligament, and piriformis muscle or impact of the posterior inferior femoral neck on posterior inferior rim of acetabulum that does not allow the femur to adduct; possibly secondary to an anteriorly rotated, forward hemipelvis. Usually seen on the left especially if left Extension Drop Test is positive in a Left AIC oriented patient.
The patient is positioned in supine with both thighs on the table. Both hips and knees are flexed to the chest. Passively lower one leg over the edge of the table while helping the patient hold the untested knee close enough to the chest to maintain the low back against the table. Do not allow hip abduction to occur past zero degrees on the tested extremity while passively dropping the FA joint into extension.
A positive test is indicated when the tested lower extremity (usually the left) is restricted in hip extension because of the forward orientation of the tested side compared to the other. If both femurs do not approach the edge of the mat or table the patient is tested on, the innominates are rotated forward bilaterally and the psoas muscles are on slack. Placing the femur in “neutral” is actually placing the patient’s femur in external rotation. This tightens the TFL and VL and restricts hip extension.
There is also a rotary component to this issue, especially seen with limitation in hip extension on one side. Since the forward, anteriorly rotated pelvis accompanies sacral rotation to the contralateral side (right rotation on a right oblique axis or left rotation on a left oblique axis) the iliofemoral ligament will also limit extension when the femur is externally rotated by the therapist, through testing with the femur in a “neutral” position.
The femur in this case will not approach the patient support surface without femoral internal rotation and or through luxation (i.e., “click”) of anterior superior femoral head moving forward under the superior anterior condyloid labral rim of acetabulum.
The patient is positioned supine with knees maximally flexed and together, and feet flat on the table. Passively rotate the legs to the trunk’s resting state with one hand, while stabilizing the trunk with the other hand (placing it on the anterior lower ribs and sternum). A yardstick may be used to measure the distance from the mat to the upper-most point of the superior knee, while maintaining the opposite posterior thorax contact with the mat. Repeat the test in the other direction.
A positive test is indicated when the legs do not rotate in one direction as compared to the other. For example, the legs are restricted in rotation to the left (i.e., the legs do not rotate to the left as they do to the right as measured through the use of an upright ruler). This means that trunk rotation is limited more to the right secondary to probable left hip anterior rotation and sacral-lumbar orientation of the spine to the right. Therefore, postural restoration should be initiated at the left lower extremity to address left mechanical instability and maintain proper restored pelvi-femoral neuromechanics.
This test is used as a Myokinematic measurement with each grade reflecting muscle position, strength, and neuromuscular ability. The test is named for the leg, which is placed on the examiner’s shoulder. (Patient is lying on their right side with left ankle placed on examiner’s shoulder – “Left” Hruska Adduction Lift Test.)
Patient sidelying – back rounded
Uppermost lower extremity resting on therapists shoulder (neutral hip, extended knee)
Lower leg in flexed position
Maintain pelvis in a neutral position (do not allow upper pelvis to rotate forward or backward)
Step 1: ask patient to raise ankle of flexed lower leg to upper knee
Step 2: have patient raise flexed lower knee while keeping ankle to the knee
Step 3: patient will then raise lower hip while maintaining the above positions
Discontinue test at the step patient is unable to perform
Inability to raise lower ankle off mat or table.
Obturator weakness of flexed extremity.
Ability to raise lower ankle to upper knee.
Inability reflects either weakness of FA external rotators or AF stability of active extremity.
Ability to raise lower knee and ankle.
Inability reflects instability of AF and weakness of adductor magnus and obturators or an anterior tilted and forwardly rotated pelvis with accompanying FA IR weakness secondary to long position of ischiochondylar adductor and short position of gluteus minimus, medius and TFL.
Ability to maintain above position while lifting lower hip off table slightly.
Inability reflects weakness of FA stabilizers on extended extremity including the short head of the biceps femoris and adductor magnus and possibly bilateral AF stabilizers including muscles of the pelvic diaphragm and lower gluteus maximus.
Ability to raise hip completely off mat or table to level of patients shoulder and examiner’s shoulder.
Inability reflects lack of core lumbopelvic femoral strength and more than likely the internal obliques on side of extended leg and external obliques on side of flexed leg.
Ability to raise hip above level of the patients shoulder and equal to examiners shoulder.
Inability reflects patient’s strength and neuromotor proprioceptive skills to shift hips.
This test is used as a Myokinematic measurement with each grade reflecting muscle position, strength, kinesthetic awareness, and neuromuscular ability. The test is named for the leg, which is placed on the wall (Patient is lying on their left side with right foot placed on the wall – “Right” Hruska Abduction Lift Test).
Patient sidelying with upper leg extended and aligned with hip and shoulder.
Adjust position of knees to wall, so that top knee is above the level of the ipsilateral shoulder.
Lower leg is flexed with lower toes positioned on the wall directly under the top foot and placed on 4 to 6” bolster.
Top palm should be placed flat on surface in front of chest and upper hand under head.
Mechanics (Discontinue test at the step the patient is unable to perform)
Step 1: ask patient to press bottom toes into wall to stabilize pelvis
Step 2: instruct patient to press bottom hip into the surface to engage lower abs and lower adductors
Step 3: ask patient to turn and raise bottom knee up or inwardly using lower ischiocondylar adductor and anterior gluteus medius, without moving top hip backwards.
Step 4: turn top heel up or top toes down without lowering bottom knee or moving top hip forward.
Step 5: attempt to raise top leg off wall while trunk and hips are stabilized in previous positions.
Inability to position top leg in alignment with top shoulder and hip and with top knee above top shoulder without experiencing top hip impingement, sacral iliac pain or low back pain.
Malaligned pelvis and poor integration of adductors, abductors and FA rotators in frontal plane.
Ability to push bottom hip into surface.
Inability reflects weakness in bottom internal oblique and transverse abdominis or bottom quadratus lumborum or top external obliques.
Ability to raise or turn “in” bottom knee without moving top pelvis backwards.
Inability reflects poor strength or kinesthetic awareness of ischiocondylar adductor or anterior gluteus medius; or lax iliofemoral – pubofemoral ligament.
Ability to rotate top extremity inward (FA IR) without moving top pelvis forward.
Inability reflects poor strength or kinesthetic awareness of ipsilateral gluteus minimus and anterior gluteus medius, or impingement of medial femoral head on anterior medial cotyloid labral rim secondary to forward, anteriorly rotated contralateral pelvis.
Ability to raise top leg completely off the wall and hold without using lateral trunk muscle.
Inability reflects poor integration between contralateral hip adductors, and ipsilateral hip abductor (gluteus medius).
Ability to move correctly abducted top lower extremity into extension without extending low back or flexing knee or rotating leg externally (FA ER).
Inability reflects inability to extend leg with gluteus maximus during concomitant abduction and FA stabilization provided by adductors (IR’s) and anterior gluteus medius and TFL.
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Physical Therapists and PT Assistants
Occupational Therapists and OT Assistants (Classification Codes)
Strength & Conditioning Coaches
Other Healthcare Professionals
PRI welcomes any interested healthcare professional to attend our courses. Attendees are responsible for following their state statutes regulating their professional practice. A certificate will be awarded to registrants upon completion of this course or any of the other PRI courses.
Accessible Learning Environments
All participants in Postural Restoration Institute™ (PRI) continuing education courses are entitled to an accessible, accommodating, and supportive teaching and learning environment. Participants have the right to request accommodations and the responsibility to provide disability documentation that supports those requests. PRI has the right to establish eligibility guidelines in accordance with both law and policy regarding disability and provide those accommodations that appropriately provide equal access to the programs and activities it sponsors.
A Certificate of Completion for 15 contact hours is awarded to attendees upon the successful completion of this course. Before attending a course, please verify CEU acceptance with your profession’s regulating body.
Physical Therapists and PT Assistants
In the states where PRI is sponsoring courses and where approval through state American Physical Therapy Association (APTA) or licensing agencies is required, PRI will apply for approval for CEUs for Physical Therapists and Physical Therapist Assistants.
In the states where PRI is sponsoring courses and where approval through state licensing agencies is required, PRI will look into applying for CEUs for Chiropractors (upon request). Requests must be made at least 90 days prior to the course date.
Occupational Therapists and OT Assistants
The American Occupational Therapy Association (AOTA) recognizes PRI as an Approved Provider of continuing education. AOTA Provider #6596. Please note that the assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA. This course awards 1.5 AOTA CEUs/15 Contact Hours.
Athletic Trainers & Athletic Therapists
Postural Restoration Institute (BOC AP# P2376) is approved by the Board of Certification, Inc. to provide continuing education to Certified Athletic Trainers. This program is eligible for a maximum of 15 EBP Category hours/CEUs. ATs should claim only those hours actually spent in the educational program.
This course is approved by the Canadian Athletic Therapists Association (CATA) for 6 CEU's. Approval valid December 4, 2017 - December 4, 2019.
Strength and Conditioning Coaches
This course is approved by the Collegiate Strength and Conditioning Coaches Association (CSCCa) for 7.5 CEU's.
Since continuing education courses are not required to have pre-approval through the National Strength and Conditioning Association (NSCA), this course is not currently approved through the NSCA. NSCA certificants interested in completing this course may contact the NSCA to inquire about CEU eligibility.
PRI is approved by the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) as a continuing education Approved Provider. Provider number 451877-12. *Approval not valid for New York licensed massage therapists.
Other Healthcare and Fitness Professionals
PRI Welcomes any interested healthcare or fitness professional to attend our courses. Attendees are responsible for following their state statues regulating their professional practice as they integrate interdisciplinary PRI concepts.
The most dramatic cases include an elderly woman, 3 month post lumbar fusion, 6 year post bilateral hip replacement with pain of 8/10 VAS in her low back and hips. She was unable to stand from a chair without pulling herself up with her arms. In under 10 minutes, not only was she reporting pain of 0/10 VAS, but she was also able to stand from chairs of many different heights independently!
Another patient was a 20 y.o. female, hurt her back at work and had received chiropractic and exercise therapy for 8 weeks without any improvement. Pain of 8/10 VAS when I first evaluated her Tuesday morning. When she left my office, after using the repositioning techniques and 2 exercises, her pain was 0/10 VAS and it held through her day of work! She SKIPPED into my clinic this morning for her 2nd appointment. Her worst pain since Tuesday was a 1/10 VAS. We are now working on getting her into better shoes (no more flip flops) and today she was able to walk with improved stride, stance, and even demonstrated arm swing; all with pain ratings of 0/10 VAS.
Thank you doesn’t seem enough at this point. Thank you for validating our concerns with the status quo. Thank you for helping us be the physical therapists we wanted to be! We look forward to taking more of your courses in the near future. | Anchorage, Alaska, October 2011