In part one of this discussion I introduced a common injury that may present in a clinical setting. Injury, weakness (inhibition) or tightness (facilitation) of the adductor group of the thigh. I’d like to now introduce you to a test that may be administered by the clinician or as a take home assessment of recruitment and compensation patterns in hip abduction.
In a side lying position I simply ask the client to raise a straight leg toward to ceiling. In doing so glute med and min should “fire” at approximately the same time, lifting the leg straight laterally, toward the ceiling. In the presence of inhibition of glute med., min., and potential facilitation of the adductor group, there may be a variety of substitution patterns. Normal range of motion should be at least 45 degrees of abduction (toward the ceiling). Try this on yourself and see what you find.
Lie on your side, raise top leg toward the ceiling.
Compensation patterns that may present are as follows:
Tight Adductors = ROM below 45 degrees abduction.
Piriformis Facilitation = External rotation of femur, evident by the toes pointing toward the ceiling.
Tensor Fasciae Lata Facilitation = The hip will come into flexion, draw the thigh anterior (toward the front). Also may be seen that the trunk twist posterior (back) still creating hip flexion.
Quadratus Lumborum Facilitation = In an attempt to raise the leg, the hip will hike toward the shoulder, creating a slight side bend in the low back.
Any of these conditions may create or add to low back and hip pain, and may be a contributing factor in dysfunction of the rest of the kinetic chain. Try this test, and let me know what you find. In future installments we will look at what you find, and discuss treatment options from a clinical standpoint, and what you can do at home in self treatment.