Submitted by: Jeremy Nelson MPT

Mobility of the hip is primary. If you’re looking for a place to start with your assessment of a patient or client, we recommend starting with the hip joint. For the mobility of the hip joint will support the stability of the lumbar spine and the stability required in the knee for critical tasks of weight shifting. With increased stability of the core, the COG can be more easily controlled as the BOS imposes demands and requires static control or dynamic control of the COG. A mobile hip also assists in positioning the COG and assists the knee to lock down, increasing its stability as it prepares to accept the body weight shift.

So when a critical task is assessed, the anatomic segment and its relative posture and movement is investigated to see if indeed the body has the capacity to complete the critical task. As critical tasks, as the name implies, are essential. The body will seek to complete the action through compensatory movements in other adjacent segments.

Mobility of the body segment position pair is examined by testing the PROM to assess the soft tissue and joint integrity and length. Within the workflow of Structured Motion this examination supports upcoming decisions. If the length is inadequate in an antagonist muscle that restricts the required body position posture or motion, then the antagonist will be treated. It is important to consider the reciprocal nature of the neuromuscular system. This may further enhance the next phase of stability, as the antagonist is improved so too is the neurologic balance providing increased capacity of the agonist to produce the required stability.

The stability assessment is not only the brute force capacity of the muscle, but the nervous system current state to employ that force in a coordinated manner over time throughout the ROM. Again, returning to the critical task as the guiding force. Given the adequate mobility of the hip, do the muscles perform in a way to produce the required body position and movement to support the task? Or is a deviation observed? These deviations are at the segment level, and will cause a reaction in other segment movement as the brain seeks to complete the task to support the COG BOS position to attain the specific performance skill.

The stability assessment provides the evidence for the selection of the available therapeutic exercises. Each exercise should be an intensification of the critical task found within the functional movement. The stability assessment will identify if there is a need for group of muscles to be coordinated towards a tri-planar motion, and to what degree each muscle is acting in a concentric, eccentric or isometric manner. Again if the goal is to improve function, then those component parts of the function need to be trained in a way that reproduces the needed force production.

Returning to the hip. A hip that has adequate flexibility and strength will be able to support all of the functional movements available. Without it, attempts to improve posture, movement and balance in other areas of the body will be frustrated, and will likely return to its original state