The Bill Hartman Podcast for The 16% Season 6 Number 9 Podcast
When you see somebody that has a lot of internal rotation and a limitation in external rotation, you have a very significant anterior orientation situation. So the only way under those circumstances, especially with a narrow ISA, a narrow ISA should be biased towards external rotation with limitation and internal rotation. But what we should see is with a retroverted acetabulum, that would bias me towards external rotation and limit me towards internal rotation. But if I continue to anteriorly orient the pelvis forward, what it does is it untwists the ligamentous structure of the hip. Now I have this really freed up internal rotation situation because of the anterior orientation. The muscular structure above the trochanter though gives me the limitation in external rotation. The first order of business under every circumstance is I got to bring this pelvis back. I got to bring the thorax back at the same time. And what that will do is it'll give me a position where I can start to recapture the relative motions between the bones. Because what you have right now is you have a pelvis that's probably oriented like that and then forward. The thing you got to be careful of when you're trying to reorient somebody that is a narrow ISA archetype is that if I promote too much muscle activity in that posterior lower area, I'm not gonna see a change. So you gotta be really, really careful with the positions that you're gonna start with. Chances are this person also has limited early ER in all hip motions. So like the hip flexion would be limited, the straight leg raise would be limited, things like that. And so you have to make sure that you're not moving them into a position where they will immediately try to utilize a compensatory strategy because this person will use lumbar flexion as the external rotation. So you ask somebody to posteriorly orient their pelvis during an activity in the hopes of recapturing the orientation. What's going to happen is you're going to get that lumbar flexion as a substitution, and then you won't see the changes in the hips like you want. So you're probably going to have to go with something that would be more unilateral, or you're going to use some form of a rolling activity with a limited amount of hip flexion.
anterior pelvic orientationnarrow ISAhip internal/external rotationlumbar flexion substitutionunilateral training strategies