Passive Hip Stabilization Case Study

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Passive Hip Stabilization
As I mentioned in the last case study, I look at the position of the lower extremities when correcting full body alignment . The legs and feet should be directly underneath the pelvis. The knees and the feet should be pointing up towards the ceiling. Most of the time, I see one of these abnormal postures instead.

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Tight hip rotator muscles pull on the leg so it falls to the outside, sometimes evenly and sometimes not. The primary function of the psoas muscle is to flex the hip, but it is an accessory muscle, also, for hip external rotation. When the legs fall out into external rotation while the patient is in supine, you can be sure
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By using an upper body wedge of the appropriate size, tension in the upper body, head, neck, and eyes, that is more often than not, contributing to lingering pain in the lower back and legs, can be relaxed. The body is “eased” into positions of more length on a smaller wedge as the tissue releases tension in response to gentle movement.

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When you consider the water balloon illustration, it makes sense tension and pressure from above would provoke lower back pain. As I have educated my patients regarding the effects of the upper body, head, neck, and eyes on their lower back and how positioning can be used to manage and treat their symptoms, the response has been overwhelmingly
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. . and almost everything else, for that matter! Elevating the eyes, head, neck and upper body alleviates the pressure seemingly translated into the lower back and legs from the elevated areas of tension. Even for my patients who are complaining of severe lower back pain, positioning the upper body on a wedge of variable sizes from as small as 5° to a larger wedge of 30° or more will finally provide them with relief from their symptoms. Sometimes one, two, or three pillows are, also, needed under the knees. It is not uncommon, however, for the lower back to be very comfortable, or even pain free, without any support under the knees when the upper body is correctly positioned. This is surely one explanation for the popularity of recliners.
It is worth repeating that this modified supine position is not to be used habitually as a solution for lower back and leg symptoms! This position serves as the BEGINNING POSITION for the exercise program when it is done in supine. As the movement from the exercises lengthens the soft tissues, the wedge is to be gradually reduced. The goal is to eventually tolerate supine positioning without any compensation whatsoever. (The case examples on p. 127-158 will show you how positioning and the other exercises were used to alleviate lower back pain.)

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