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NASM CES Chapter 13: Corrective Strategies for the LPHC 1

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    Chapter Goals:

    • Know the basic functional anatomy of the LPHC. 
    • Find the mechanisms for injuries common in the LPHC.
    • Talk about the influence of altered movement in the LPHC on the kinetic chain.
    • Find the right strategies of systematic assessments in the LPHC. 
    • Choose the right strategies for corrective exercise in the LPHC.

    Introduction

    The LPHC is a region of the body that has major influence on the structures that are above and below it. It has more than 30muscles attaching to the lumbar portion of the spine and pelvis. It is directly associated with both the lower extremities and the upper extremities. Dysfunction of either one may lead to some dysfunction of the LPHC. The fitness professional needs to understand this regional interdependence in relation to the LPHC and its proximal areas. 

    Review of LPH Functional Anatomy

    Bones and Joints

    The major bones here are going to be the lumbar spine, the pelvis, sacrum, and the femur. The LPHC area has the iliofemoral joint that is made up of the pelvis and the femur, and the sacroiliac joint made up by the sacrum and pelvis. The lumbar spine and the sacrum come together to form the lumbosacral joint. 

    Muscles

    The key muscles we will need to know are going to be the gastrocnemius and soleus, the adductor complex, hamstring complex, hip flexors, abdominal core complex, erector spinae, intrinsic core stabilizers, latissimus dorsi, tensor fascia latae and IT band, and the glute med and max. 

    Altered LPHC Movement

    Lower back pain is going to be one of the most common problems seen with all people and it creates a great person, community, and financial burden throughout the globe. The occurrences of it are well documented in adults, and there is a prevalence of it in kids that are growing, so it has become a public health concern. the incidence of low back pain in sports is pretty high also, especially so in the sports of lifting weights, wrestling, soccer, tennis, and golf. All together we see around 60 – 80 percent of the population struggling with low back pain at some point in their lives. 

    Low back injuries are well reported for those that have low back pain, which can give way to osteoarthritis and long term disability in the future. It has been shown that static malalignments, abnormal patterns of movement, and dynamic malalignments lead to this lower back pain. 

    Static Malalignments

    Optimal muscle performance is found by posture of the LPHC when doing functional movements and such. If the neural lordotic curve in the lumbar spine is not kept, the activation and the relative moment arm of the muscle fibers decreases. There are many injuries to the vertebral discs when the outer fibrous structure of the discs fail, which allows for the internal contents of said discs to extrude and irritate the nerves in the area.

    The injuries to vertebral discs are not well known as far as the cause, but the most likely culprit is that there is a combination of both motion and compressive loading that leads to these issues. Increases in the pressure of the discs and stress on them are going to have influence from the kinematics of our lower spine. Lumbar flexion increases these pressures and decreases in lordosis during activities does, too.

    Abnormal Muscle Activation Patterns

    Due to the LPHC musculature having its role in being a stabilizer, insufficiencies in these muscles will induce some dysfunction biomechanically and there will be alterations of the force couple relationships found. 

    Dynamic Malalignment

    Decreases in the control of the abdominal muscles may lead to increases in the valgus positioning of the lower body, and this is likely to lead to a greater incidence of knee injuries for people. Training the trunk has been found in many studies to increase the amount of hip adduction and internal rotation in the functional activities and also prevent the dynamic malalignments and possible injuries that come from these impaired patterns of movement. 

    LPHC Dysfunction and the Regional Interdependence Model

    Dysfunction of the LPHC may have some negative impacts on the other regions of the body. we discussed this somewhat when talking about the knee and also in the previous section. The LPHC allows us to move in three cardinal planes of motion and it is vital for our stability and transmission of forces in the lower and upper body. the LPHC has some influence on the joints superior and inferior to it, especially so with that of the knee, and even some degree of the ankle. The internal and external forces provide both direct and indirect influence in the kinetic chain in multiple tissues. 

    Influences Above the LPHC

    Above the LPHC we see injuries in the cervical spine occurring and also the cervicothoracic spine. The ability for us to recruit shoulder muscles, anteriorly use the humeral head, and even the elbow to a degree, will all be related to the dysfunction of the LPHC. Respiration is also negatively affected by the LPHC being positioned. Core stabilization training is known to increase the thickness of the diaphragm and improve the stability in the LPHC. The functioning of the appendicular skeleton is dependent on the attachments, force transmissions, stabilization, and interplay of many factors of neuromotor control of muscles. 

    Influences Below the LPHC

    There is a lot of evidence showing that weakness of the abdominal core being a significant part of risk for lower body overuse injuries. Common injuries of the knee that relate to the LPHC will be patellar tendinopathy, tendonitis, IT band syndrome, ACL tears, and patellofemoral syndrome. 

    In the foot and ankle complex, we see injuries relating to the LPHC dysfunction like plantar fasciitis, Achilles tendinopathy, and also medial tibial stress syndrome. 

    If we use the regional interdependence model, we see that if the ankle is restricted and not able to move while descending in the squat, the hip is the needed to move more than optimally. This is a major way that we see someone’s movement in the ankle limiting the body in our movement assessments. 

    Assessment Results for the LPHC

    The LPHC is one of the more regionally interdependent joints in the body. make sure to read the table on the various assessment types and the results for those that are likely to come from them. 

    Static LPHC Posture

    The static posture will be the first to show some of what that regional interdependence model means for the LPHC. Every one of the postural distortion patterns will contain some form of bad alignment in the LPHC. Lower crossed and layered crossed syndromes have anterior tilts in the pelvis along with excessive lordosis of the lumbar spine. The sway back and flat back postures both do this too, except with the opposing form of pelvic tilt being present. 

    Look into those two pictures to see how the LPHC and specifically the lower back are affected when put into those two problems. 

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    Transitional Movement Assessments

    Since all movements will have some form of interaction going through the LPHC, these transitional assessments will give some of the more objective info as to which design is best for the programs of corrective exercise. The overhead squat, again, is going to be the one that we start with and it gives the best look at the state of a client’s LPHC. We can also look into the modified overhead squat and the use of the single leg squat to really benefit this. 

    Overhead Squat Assessment

    Due to the squat needed optimal hip mobility, many common impairments of movement will be seen in this overhead squat. There is definitely a reason as to why the overhead squat is so highly valued in these lower body assessments. The LPHC might be the cause of the dysfunctions that we find, or it is also possible that it is the cause of other parts of the body, and we will take this into account. 

    Some focus should be on the LPHC and the anterior pelvic tilt here. It would signify that there are overactive and shortened hip flexors, along with underactive abdominal muscles. 

    Single Leg Squat Assessment

    The single leg squat will be important as a transitional assessment for those that are able to do the overhead squat well. It works well at assessing and narrowing down the things found in the overhead squat, and it really works to show anything that won’t show itself when we are using two legs. It increases the demand for stability in the frontal and transverse planes. 

    Pay attention to the various rotations being shown throughout these pictures in this section. This is what we are looking for with our clients when they are performing. 

    Loaded Movement Assessment

    Like the other kinetic chain checkpoints, knowing the look of dynamic posture for the LPHC during all of the major movements allows the professional to look at the client and assess them with every workout they do. The clients that have shown they have good alignment when they are just using their body weight will need to be progressed to some form of loaded assessment to see how their musculature and body will react when resistance is added. 

    The loaded squat is going to be the ideal move for LPHC assessment when it comes to these loaded assessments. Clean performance of the overhead squat has shown that muscle length deficits have been remedied through flexibility training, and the impairment of movements surfacing here will relate more to underactive muscles within the LPHC. 

    Dynamic Movement Assessments

    These assessments will help the professionals  see the impairments of movement in the LPHC and how those will impact out patterns of functional movement. since the pelvis and lumbar spine are influencing the movement of the structures present below and above, these assessments will be quite beneficial for those clients that have more athletic goals set. 

    Mobility Assessments

    The main assessments for mobility are used to confirm the presence of dysfunction in lumbar flexion and extension and the Thomas test. Confirmation of the anterior and posterior pelvic tilt comes from identified probable overactive and underactive muscles. 

    Clients that have one or more distortion of static posture should definitely seek doing the modified Thomas test and the lumbar extension and flexion test. 

    Corrective Strategies for the LPHC

    The common exercise programming selections for the LPHC will look like this:

    The inhibition phase will use SMR and it will focus on the muscles of the gastrocnemius and soleus, the hip flexor complex, the hamstrings, the adductor complex, the glutes, and the piriformis. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

    The lengthening phase is second and it uses static stretching of the muscles of the calf, hip flexor complex, hamstrings, adductor complex, glutes, piriformis, erector spinae, and the ab complex. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

    The activation phase follows next and it uses isolated strengthening on the muscles of the anterior tibialis, the glute med and max, hamstrings, erector spinae, and the abs and intrinsic core muscles. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

    Integration is the final phase and it uses integrated dynamic movement with exercises like the ball wall squat with an overhead press, cable squat to row, and reverse lunge to balance. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

    Follow the steps as they are shown in the pictures to look at what that will look like specifically for the LPHC now. 

    The Excessive forward leaning of the body will look like this:

    Inhibiting of the gastrocnemius and soleus, as well as the hip flexor complex through the use of myofascial rolling. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

    Lengthening of the gastrocnemius and the soleus, as well as the hip flexor and abdominal complexes through the use of static stretching. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

    Activation of the anterior tibialis, the glute max, erector spinae, and the intrinsic stabilizers through the use of isolated strengthening. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

    Integration with use of the integrated dynamic movement with use of the exercise of the ball wall squat with an overhead press. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

    Follow the steps as they are shown in the pictures to look at what that will look like specifically for the LPHC now. 

    For an exercise program focused on helping the Low back arches use these:

    Inhibition of the hip flexor complex and the latissimus dorsi through the use of myofascial rolling on them. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

    Lengthening of the hip flexor complex, the latissimus dorsi, and the erector spinae through the use of static stretching. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

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    Activation of the gluteus maximus, and the ab complex and the other intrinsic core stabilizers with use of isolated strengthening. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

    Integration with use of the ball wall squat with an overhead press and integrated dynamic movement. You should follow the guidelines laid out by the previous parts of the book in regard to the acute training variables of this phase. 

    Follow the steps as they are shown in the pictures to look at what that will look like specifically for the LPHC now. 

    An exercise program focusing on the Low back rounding would look like this:

    Inhibition of the hamstring complex and the adductor magnus with the use of SMR. Follow the guidelines we learned earlier in the book for this phase.

    Lengthening of the hamstring complex and the adductor magnus through the use of static stretching and NMS. Follow the guidelines we learned earlier in the book for this phase.

    Activation of the gluteus maximus, hip flexors, and erector spinae through the use of the isolated strengthening. Follow the guidelines we learned earlier in the book for this phase.

    Integration of integrated dynamic movement with the ball wall squat with an overhead press exercise. Follow the guidelines we learned earlier in the book for this phase.

    Follow the steps as they are shown in the pictures to look at what that will look like specifically for the LPHC now. 

    For an exercise plan looking into the Asymmetric Weight Shift:

    Inhibit the Adductors and the tensor fascia latae and IT band, as well as the piriformis, biceps femoris, and the calf muscles through use of SMR. Follow the guidelines we learned earlier in the book for this phase.

    Lengthen the Adductors and tensor fascia latae, piriformis, calf muscles, and the biceps femoris with static stretching or NMS. Follow the guidelines we learned earlier in the book for this phase.

    Activate the gluteus medius, the adductors, and the intrinsic core with isolated strengthening. Follow the guidelines we learned earlier in the book for this phase.

    Integrate with the reverse lunge to balance exercise and the ball wall squat with an overhead press. 

    Follow the steps as they are shown in the pictures to look at what that will look like specifically for the LPHC now. 

    Common Issues Associated with the LPHC

    Low back Pain

    35% of people experience reduced activity due the presence of low back pain and chronic conditions, and 7 percent of those persist for greater than 6 months at a time. the clients with severe pain need reference to a physician or health professional. 

    Sacroiliac Joint Dysfunction

    This describes symptoms coming from the sacroiliac joint. Pain generates from this joint to other parts of the hip and pelvis, and then sometimes down the leg. Muscle imbalances, neuromotor weakness, trauma, overuse, poor sitting, and pregnancy are all mechanisms that may lead to this condition. 

    Muscles Strains

    These are injuries to the muscles or the muscle tendon unit. These strains happen if the muscle goes beyond its normal capacity and it results in tears of the fibers. These tears can vary from grade one to grade three. one is mild and three is severe and a complete tear of the muscle.

    NASM CES Chapter 13: Corrective Strategies for the LPHC 2
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    NASM CES Chapter 13: Corrective Strategies for the LPHC 4

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