Mike Cantrell from PRI and the Cantrell Center talks postural and movement asymmetries in sports, with specific examples from soccer, running, and baseball, and how these asymmetries can lead to some of the common injuries we see such as sports hernia, femoral acetabular impingement (FAI), and shoulder impingement. Some great case studies from Mike that will help to explain the mechanics behind these injuries plus rehab solutions.
R adductor concentrically working all the time holding the athlete in R stance.
Pelvis, sacrum, and lower lumbar spine orient to R -- torso will orient to L -- R obliques then concentrically shorten.
R Add and Obliques are both attached to pubic ramus (constant tug -- of -- war)
L Add and Obliques are eccentrically elongating (inhibited)
Adduction Lift Test -- must inhibit R adductor and abdominal wall to get R hip abduction (also need R glute med to activate). This athlete just uses his TFL.
This athlete abducts his R leg by moving his pubic symphysis away from R leg -- activates L abdominal wall/inhibits R abdominal wall and adductor. No pain!
Abduction lift test (see video below)
Level 3 Adduction lift test -- marry up the L abdominal wall and R adductor through the pelvic floor
Femoral Acetabular Impingement
Different types of impingement L vs R
R hip -- R acetabulum rotated around R femoral head so sitting deep in the socket (AF IR). Sets the stage for impingement of anterior structures if unable to get out of the position.
Usually see limited ER ROM in sitting -- femoral head can't translate anterior or superior
L hip -- pelvis rotated to the right wrapped around R femoral head, so to keep the foot pointing straight ahead the L hip will position itself in relative external rotation (FA ER)
Femoral head is always seated forward bumping into labrum
Have to teach pt. to rotate pelvis over L femoral head and find an anterior glute med and adductor on the L to screw the hip into the socket the right way
Position of scapula is crucial -- glenoid alignment and ability of rotator cuff to work effectively
Achieve stability through extension -- need to build stability without the extended pattern
R scapula medially rotated (inferior angle moving away from rib cage), L opposite -- compensation is increased R ER and L IR ROM.
That position results in inhibited subscapularis on the R, increases humeral superior migration. Also complain of R upper trap pain -- trying its best to retract the scapula since the middle and lower trap are not functioning (remember scap. is medially rotated)
End up with inefficient coupling of upper trap and middle delt -- end up impinging R shoulder
Must close down L ribs with exhale, then inhale into R chest wall to stabilize R scapula on the rib cage.
Traditionally heavy emphasis on scapular thoracic stability, i.e. pinch your shoulder blades
Need thoracic scapular stability -- find zone of apposition on the L, turn on L lower trap to turn the spine to the R (functioning in a thoracic scapular manner). Also turn on R lower trap in a scapular thoracic manner to turn trunk R (remember trunk is normally rotated L is L AIC, R BC pattern)
BIO
Mike Cantrell MPT, PRC
Mike graduated from the University of Georgia in 1981 with a Bachelor's degree in Dietetics. After a period in the U.S. Army, he completed his Master's degree in Physical Therapy from Emory University School of Medicine in Atlanta. Mike's orthopedic skills continued to advance as he began practicing at the University of Georgia as the sole physical therapist for a population of 30,000 students. In 1992, he and his wife Tassie opened their private practice where Postural Restoration techniques are carried out with patients presenting a variety of diagnoses and often traveling from surrounding states. The Cantrell Center became a Postural Restoration Certified Center in 2006. Mike's passion and reputation for successful clinical outcomes and his background in nutrition, sports medicine and Postural Restoration has led to consultation and speaking opportunities within his local community and across the country. He has published a number of articles for the Postural Restoration Institute and has been a featured speaker at PRC national conferences for several years. Mike was a member of the 2006 class to earn the designation of Postural Restoration Certified (PRC) as a result of advanced training, extraordinary interest and devotion to the science of postural adaptations, asymmetrical patterns, and the influence of polyarticular chains of muscles on the human body as defined by the Postural Restoration Institute®.
For more on Mike Cantrell and the Cantrell Center, check out the link HERE
