Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

Lumbo Pelvic Hip Complex Dysfunction (LPHCD):

Predictive Model of Lumbo Pelvic Hip Complex Dysfunction

By Brent Brookbush MS, PES, CES, CSCS, ACSM H/FS

In this article we will discuss a predictive model of Lumbo Pelvic Hip Complex Dysfunction (LPHCD) as it relates to movement impairment, injury prevention, movement preparation, performance enhancement and rehabilitation. Specifically, this article will relate these concepts to the selection of exercise and corrective techniques.

For an introduction to Postural Dysfunction and Movement Impairment please refer to this article:
Introduction to Postural Dysfunction and Movement Impairment

What’s in a name?:

“Lumbo Pelvic Hip Complex Dysfunction” (LPHCD) is a purposely chosen title for the impairment discussed in this article.  Although I would prefer to use the term “Core Dysfunction,” the term core has been defined in a variety of ways by various, well-respected practitioners.  Although the core is commonly defined, as “the hip, SI joint, pelvis, lumbar spine, and all the structures that cross those joints,” the term core is also used to describe the muscles of the trunk alone and/or the muscles of the abdomen.  To mitigate any potential confusion this body segment will be referred to by its constituent parts, as above.

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Lumbo Pelvic Hip Complex Dysfunction (LPHCD) — 70 Comments

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  5. Dear Mr. Brent Brookbush.

    Hello sir, and thank you for your time.

    I just wanted to make sure that you still use the Brent@b2cfitness.com email? I did send you an email; however, i see you have quite a few websites and I don’t know which one to use.

    • Also sir, As I went through your collection of youtube videos, I did have one possible suggestion that may make it a bit easier for users. Your videos are already great, but I think it may help if they were a further organized on youtube.
      It seems at least 2 of your programs for upper and lower dysfunction follow the
      1. Inhibition of Overractive tissues
      2. Isolation of underractive tissues
      3. Reactive Integration

      I sure hope I dont sound haughty, but I was trying to be helpful. Organizing your videos further into entire section headlines, like putting ALL 4-5 of the LPH featured playlists into one headline. I see you have grouped all types of videos together. FOr instance, all your Lumbar-Pelvic Hip dysfunction videos are together, however, it was hard as a user to identify the entire LPH program. It may make it easier for people to follow if you had one general headline or playlist for all the LPH – so that people without the basic kinesiology knowledge can easier identify and follow your overall program. I realized it could be hard for a person without a good background to go through the featured playlists, and select which exercises apply to which condition.

      -Lumbar- Pelvic Hip Dysfunction.
      —Intro Video into LPH complex
      A. LPH static releasse techniques playlist
      1. First video in this category as you have then grouped together already
      2. Second video
      3. etc
      B. Static Stretching Techniques for LPH, if upper body, static for Upper. Etc
      1. First video
      2. Second video
      C. Isolation Exercises for LPH
      1.
      2.
      D. Reactive Integration for LPH.

      • Hey Jason,
        Organization is a constant challenge when you start dealing with a large volume of information. Believe it or not, I have already solved the issue you are speaking of:
        Youtube Video Playlists are organized by Modality, where as the blog – under the heading “Postural Dysfunction & Movement Impairment” – http://brentbrookbush.com/category/postrualdysfunctionandmovementimpairment/ – organizes by impairment and gives sample routines that link back to the videos.
        All modalities progress from one to another… as you move through a program I think you will find it easier to go from the “Static Release” videos to the “Active Release” series and find the appropriate muscle that you are trying to progress. Otherwise we would have 3 or 4 very large playlists.
        Sincerely,
        B2

    • That’s the correct e-mail, and the only site I have is “www.b2cfitness.com” – there are several different pages with various modes of education, but you can always find all of them by starting with the homepage.
      Hope that helps,
      B2

      • Hi Brent,
        Thank you for a great resource. I was reviewing some of the information with my partner (a spine surgeon and pain specialist) and he had a few questions regarding the way you asses anterior pelvic rotation. He pulled many references to review this and am happy to share the list. Your comments back??

        Anterior pelvic tilt and low back pain.

        The are no PubMed referenced studies regarding the reliability of the “Pants” method of determining anterior pelvic tilt is reproducible.

        Normative values for pelvic tilt have not been published.

        There is significant variation in pelvic symmetry in patients without symptoms.

        It is unlikely the “Pants” method would be reproducible on geometric grounds, given that the distance between the ASIS and PSIS is not measured.

        Calculating anterior pelvic tilt by measuring distance from ASIS and PSIS to floor and from ASIS to PSIS is reliable, but there is variability due to thickness of soft tissues overlying ASIS and PSIS.

        There is only a moderate correlation between pelvic tilt measured clinically and radiologically. Both measures are reliable.

        There is only weak evidence that pelvic tilt is associated with low back pain. If anything, low back pain is associated with posterior pelvic rotation.

        The clinical relevance of small differences in pelvic tilt has not been determined.

        Any statistically significant differences are small and largely within the range of measurement error.

        There is considerable overlap of values in populations with and without low back pain.

        There are only isolated case reports that suggest correcting anterior pelvic rotation improves low back pain.

        There is evidence that pain is associated with protective changes in posture.

        There are no PubMed referenced trials of correcting pelvic rotation in the management of low back pain.

        Absence of evidence of effect is not evidence of absence of effect, but why has this not been studied?

        • I would love a list of references and we would be happy to add them to our list of upcoming research reviews, so that more students had access to research and learned how to apply finding to practice.
          Try not to think of the “pants” method as a new prognostic indicator of an anterior pelvic tilt, but as a teaching cue to help new students do static and dynamic postural assessments. I do not use the pants method myself, but I find it to be a very powerful tool in helping students to start visualizing pelvic alignment. Remember, that this is an educational site and I am trying to create a resource for students both experienced… and brand new to the world of human movement science. In time, “the pants method” should be replaced by more reliable methods.
          Thank you so much for the time and effort you put into this post, and for reviewing it with a surgeon… I love and am a huge proponent of the integration of practices.
          Sincerely,
          B2
          If you would like to e-mail me with the list or share my information with your friend I can be reached by e-mail at Brent@BrookbushInstitute.com

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  19. This is a great article. Everything makes sense. Im having a better understanding of this due to your videos, workshops, & articles. Thank you.

    Sincerely,
    Bernadette

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  23. Brent,

    Love all the info on the website, keep it coming. It has been great resource for me. I would like to start some dialogue on the hip internal/external rotation. It is my understand that the gluteus medius is the primary internal rotator. So while its synergists in that respect, TFL/adductors/gluteus minimus, can be tight, what about the theory that the gluteus medius is commonly weak when internally rotating? This theory would also require the ‘deep six lateral rotator group’ to have some tightness.

    Any feedback would be awesome.

    Thank,

    Matt

    • Hey Matt,
      The Gluteus Minimus , not the Gluteus Medius is the primary internal rotator. The gluteus medius may be divided into anterior and posterior halves, with the anterior half contributing to internal rotation and the posterior half contributing to external rotation. It is generally believed that the fibers that externally rotate the hip become weak. As I mentioned in the graphs in this article, the TFL, gluteus minimus and adductors are short, while the gluteus medius, gluteus maximus and the deep rotators of the hip are long. It could be that the deep rotators of the hip are long and over-active much like the biceps femoris. In the case we would release these rotators, but not stretch them.
      Hope that clarifies some of the kines questions… thanks again for your inquiry,
      B2

  24. Hey Brent,

    Yes it does. At the unfortunate expense of your valuable time, I have a follow up question if you don’t mind. So in theory, the common man with anterior pelvic tilt etc. is likely to have interiorly rotated femurs because of the adductors/tfl/glut min. Where my experience differs is: if one feels and holds contact with the head of the femur and subsequently has the client perform internal/external hip rotations,it seems to me that 99% of the time the head of the femur can easily externally rotate while internal rotation is severely limited. Therefore I interpret this as limited internal rotation with excessive external rotation. What variables am I not considering or is my fundamental understanding of the concept skewed?

    Thanks again for the feedback Brent.

    Matt H.

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  31. Read your article again. I like read and re-read your articles. It seems that every time I read it, I get a better grasp on it. Meaning having a better undertanding without thinking. It’s still challenging, but you are an excellent writer and teacher!
    Bernadette

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  39. Hi, studying for my NASM for a 6 months.. Had my own bootcamp already. However, I find the NASM test hard to digest especially Chapter 6 and 7
    Thank you for anything you could do to help me? I am looking over all your videos underactive overactive strengthening stretching progression regression flexible continumm synergistic dom. recpirical inhibition and more?? Thank you in advance..
    studied the 100 nasm pretest and got 80% and studied 495 test questions…

    • Sounds like you are on the right track Megan J,
      I would say is your next step is to start an NASM routine of your own, and try to integrate some of the ideas in your bootcamp. Application will help all of this stick.
      B2

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  53. Brent what do you think is usually the general problem when it come to a twisted pelvis? Im having a very difficult time fixing this problem. My right side of my pelvis is anteriorlly rotated and left side rotated back. My left glute medius and max feel smaller but are actually stronger and my left lower back feels veey small and tight conpared to my right. I really wish i lived closer :/

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  55. Hi DR. Brookbush, i just have a little comment to make, i was following your logic with the muscle imbalance and specialy, about the piriformis, which is an external hip rotator, and specialy when you stated that ”This leads to the biceps femoris, adductor magnus and piriformis becoming over-active and adopting the rather peculiar combination of attributes of “long and overactive” in LPHCD” and ”Due to the propensity toward over-activity and adaptive lengthening (in most cases), the long head of the biceps femoris, adductor magnus and piriformis are generally released and not stretched”
    And then when i go down to see the treatment that should be done, you’ve mentioned piriformis in the group of muscle that should be activated or integrated, contradicting the logic that have been followed upward.

    Waiting your swift response and thank you in advance

    • Nice catch Mohammed,
      I need to come up with a better way to graph the muscular activity and length of each dysfunction. Once, you add “long/over-active” as a possible behavior you end up with an extra category that is not as easily related to the visible signs and correlating joint actions.
      The piriformis should be released, generally not stretched (unless knees bow out), and may benefit from the exercises used during “gluteus medius activation” for strength and conditioning.
      B2

  56. So if i understood u right, the piriformis belongs to the overactive muscles that just need to be released like the adductor magnus,biceps femoris and sartorius and not under the category of the muscles that need activation as it is now.. thank u for ur response

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