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Day: March 30, 2015

Hip Mobility & Strength Assessment

Tiffany Cruikshank demonstrates how to evaluate hip mobility and pain through the Yoga Medicine Hip Assesment test.  This test is used to evaluate PROM & AROM in clients.

Supine test for hip mobility and pain.
Image 1 – Lying supine testing for pain in the hip joint. Checks for issues in the labrum including pain and inflammation.
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Image 2 – Lying supine Figure 4 tests external rotation of the hip joint by stabilizing opposite ASIS and gently pressing the knee toward the ground.
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Image 3 – Lying supine testing adduction of the hip by asking client to hold leg 2 inches off ground and asking them to strongly push into hand on the outside of foot. Legs should be straight.
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Image 4 – Lying supine testing abduction of the hip by asking the client to hold leg 2 inches off ground and asking them to strongly push into the hand on the inside of the foot. Opposing hand holds opposing leg down. Legs should be straight, tests glute medius and minimus.
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Image 5 – Lying supine testing flexion of the hip, the leg should be straight.
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Image 6 – Lying prone testing extension of the hip by placing one hand on the SI joint for stabilization and bending leg to hold knee and press leg up to view the range of motion.
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Image 7 – Lying prone testing hamstring strength by stabilizing PSIS and bending the leg and lightly pressing down on hamstring asking the client to resist you.
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Image 8 – Lying prone Nachlas/Ely’s bring one heel from to opposite glute to test LS, SI and psoas sheath.
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Image 9 – Lying prone Nachlas/Ely’s bring one heel to glute to test LS, SI and psoas sheath.
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Image 10 – Lying prone testing external rotation of the hip joint.
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Image 11 – Lying prone testing internal rotation of the hip joint.
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Image 12 – Side lying Ober test: hip and knee flex, hold medial knee and top hip in place as take the leg into extension, flexion and adduction by letting the knee tap down. Tests tight TFL/ITB
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Image 13/14 – Yeoman’s test, lie on a table and hold one knee into the belly, tests passive hip extension by letting hanging leg press back in extension. Tests SI joint and iliopsoas and rectus.
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Image 13/14 – Yeoman’s test, lie on a table and hold one knee into the belly, tests passive hip extension by letting hanging leg press back in extension. Tests SI joint and iliopsoas and rectus.
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Image 15/16 – Standing test the sacroiliac joint movement by making placing hands on the PSI and asking client to slow march while you feel for symmetrical shifts or drops in the leg and pelvis.
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Image 15/16 – Standing test the sacroiliac joint movement by making placing hands on the PSI and asking client to slow march while you feel for symmetrical shifts or drops in the leg and pelvis.

Hip Pain Without Clear Cause: Case Study

Nadia is a yoga teacher who has been experiencing hip pain, and pain in her left leg for several months. Presently, she is unable to fully abduct the leg and has had constant pain in her inner groin area. Nadia has had scans done that reveal she has an abductor origin enthesopathy with no evidence of a muscle pathology. 
 
Nadia is concerned because the adductor pain is limiting her yoga practice significantly and is concerned the hip pain won’t dissipate without further attention.
 

Diagram of the hip joint. Used to evaluate hip pain and mobility issues.

Using OPQRST we have gathered the following details regarding her issue. 
 
O: Pain for several months in her left leg. Client is unaware at what initially caused the issue. 
P: Client is unable to fully abduct her left leg.  Pain in triangle pose and prasarita padottanasana. 
Q: Client reports constant sharp pain throughout the affected area when practicing. She also said the top of her upper inner groin is warm to touch. She says the severity of the pain subsides to dull ache when she is not practicing.  
R: left groin area. 
S: Severe since she can’t practice yoga and load the hip without feeling pain. 
T:  Pain leg for at least 4 months. Client advised she has had right side psoas issues for a long time, possibly years, but this pain has been longer than the duration of the leg pain. 
*Yoga Medicine would love to hear from you on what you would test and how you would treat  Nadia’s evaluation?

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