基础动力学讲义

MYOKINEMATIC RESTORATION
An Integrated Approach To Treatment of

Patterned Lumbo-Pelvic-Femoral Pathomechanics
Day 1 Day 2
Left Anterior Interior Chain (AIC) Myokinematic Functional
Pattern and Pelvic Joint Dynamics Relationships
Lumbo-Pelvic-Femoral Examination and Assessment

Capsuloligamentous Issues Hruska Adduction Lift Test
Hruska Abduction Lift Test
Femoral Internal and External

Rotators Examination and Assessment (Lab)
Hruska Adduction Lift Test
Myokinematic Influences on the Pelvis Hruska Abduction Lift Test
and Femur
Repositioning Through Integrated
Isolation Demonstration
(Demonstration )
Examination Tests and Assessment
Adduction Drop Test
Extension Drop Test Treatment Considerations &
Straight Leg Raise Myokinematic Hierarchy
Femoral-Acetabular (FA) Rotation
Non-Pathological Left AIC
Trunk Rotation
Pathological Left AIC
Examination Tests and Assessment
(Lab) Left AIC Myokinematic Hierarchy
(Lab)
Left AIC Related Pathomechanics

(Appendix)
Piriformis Syndrome
Ilio-Sacral Joint Dysfunction
Low Back Strain
Myokinematic Restoration Inhibition
Programs
POSTURAL RESTORATION INSTITUTE®
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Date of last revision: January 3, 2017
Copyright 2000-2017 Postural Restoration Institute® ii

Table Of Contents
SECTION ONE
Polyarticular Chains........................................................................................................................................vi
Myokinematics .................................................................................................................................................1
Pattern vs. Position ..........................................................................................................................................3
Joint Dynamics .................................................................................................................................................9
Femoral Rotators .............................................................................................................................................15
Coloring Anatomy of Sacrum, Pelvis & Femur ............................................................................................20
Desirable “Real Estate & Positions ..............................................................................................................27
Myokinematic Influences on the Pelvis & Femur .........................................................................................32
Myokinematic Restoration Assessment Tests ...............................................................................................33
Myokinematic Functional Relationships .......................................................................................................41
Treatment Considerations Algorithm ............................................................................................................48
Myokinematic Hierarchy ................................................................................................................................49
SECTION TWO: APPENDIX

Myokinematic Restoration Repositioning Techniques .................................................................................2
Protonics® Neuromuscular System ...............................................................................................................4
Left AF IR Positioning Program ....................................................................................................................6
Left AF IR Recommendations & Desirable Position of Activity .................................................................11
PRI Right AIC Alternating Reciprocal Gait Recommendations .................................................................15
Myokinematic Restoration Non-Manual Techniques ...................................................................................16
Myokinematic Restoration Inhibition Techniques .......................................................................................44
Integration and Alternating Reciprocal Non-Manual Techniques .............................................................62
Lower Quadrant Myokinematic Restoration Problem Solving ...................................................................68
Positional Influences of a Left AIC on Femoral Stabilizers and Gait .........................................................76
Capsuloligamentous Issues Related to Pelvic Asymmetry & Malaligned Muscle of Left AIC Pattern ...77
Additional Assessment Tests ...........................................................................................................................79
Refining Your Ability to Execute An Accurate HAdLT by Michael Cantrell .............................................81
Avoiding the Initial Pitfalls in the Management of the Patient with FA Instability
by Jennifer Poulin and James Anderson ........................................................................................................87
Kinetic and Kinematic Issues Related to Pelvic-Femoral Dysfunction .......................................................90
Left AIC Related Pathomechanics .................................................................................................................91
References ........................................................................................................................................................101
Medically Informed Consent (Example) ........................................................................................................112
PRI Evaluation Form ......................................................................................................................................113
Copyright 2000-2017 Postural Restoration Institute® iii

COMPOSITE OF COURSES
Myokinematic Restoration – An Integrated Approach to Treatment of
Chain Position Facilitate Inhibit
Anterior Interior Chain (AIC) Hamstrings, Ischiocondylar Adductor, Tensor Fascia Latae, Adductor Magnus,
Gluteus Maximus, Anterior Gluteus Psoas, Psoas Major, Piriformis, Vastus
Medius/Minimus, Posterior Gluteus Lateralis
Medius/Minimus, Internal
Obliques/Transversus Abdominis
Pelvis Restoration – An Integrated Approach to Treatment of Patterned Pubo-Sacral

Pathomechanics
Anterior Interior Chain (AIC) Pelvic Inlet: Pelvic Inlet:
Proximal Iliacus, Sartorius, Rectus Thoracic Diaphragm, Internal and External
Femoris, Internal Obliques/Transversus Obliques, Paravertebrals
Abdominis
Pelvic Outlet:
Pelvic Outlet: Adductor Magnus, Hamstrings
Proximal Obturator, Iliococcygeus,
Puborectalis, Pubococcygeus, Gluteus
Maximus, Piriformis, Coccygeus
Postural Respiration – An Integrated Approach to Treatment of

Patterned Thoraco-Abdominal Pathomechanics
Anterior Interior Chain (AIC) Thoracic Diaphragm Psoas Major
Brachial Chain (BC) Lower Trapezius, Middle Trapezius, Adductors (Pec Major), Scapulothoracic
Triceps, Triangularis Sterni, Serratus IR (Pec Minor), Latissimus Dorsi
Anterior
Posterior Exterior Chain (PEC) Internal Obliques/Transversus Abdominis, Paravertebrals, Quadratus Lumborum
External Obliques
Cervical Revolution – An Integrated Approach to Treatment of Patterned Cervical

Pathomechanics
Temporomandibular Cervical Chain Levator Scapulae, Cervical Colli, Internal Capitis, Temporalis, Upper Trapezius,
(TMCC) Obliques/Transversus Abdominis, Sternocleidomastoid
External Obliques, Lateral Pterygoids,
Posterior Capitis
www.posturalrestoration.com
Copyright 2000-2017 Postural Restoration Institute® iv

COMPOSITE OF COURSES
As related to Left AIC, Right BC, Right TMCC Pattern
Myokinematic Restoration – An Integrated Approach to Treatment of

Left Anterior Interior Chain (AIC) L AF Hamstrings, L AF Ischiocondylar L Tensor Fascia Latae, R FA Adductor
Adductor, R AF Gluteus Maximus, L FA Magnus, L Psoas Major, L FA Piriformis,
Anterior Gluteus Medius/Minimus, R FA R AF Piriformis, R Vastus Lateralis
Posterior Gluteus Medius/Minimus, L
Internal Obliques/Transversus Abdominis
Pelvis Restoration – An Integrated Approach to Treatment of Patterned Pubo-Sacral

Pathomechanics
Left Anterior Interior Chain (AIC) Pelvic Inlet: Pelvic Inlet:
L Proximal Iliacus, R Sartorius, R Rectus R Thoracic Diaphragm, R Internal and
Femoris, L Internal Obliques/Transversus External Obliques, L Paravertebrals
Abdominis
Pelvic Outlet:
Pelvic Outlet: R Adductor Magnus, R Hamstrings, L
L Proximal Obturator, L Iliococcygeus, L Piriformis, L Coccygeus, L Gluteus
Puborectalis, L Pubococcygeus, R Gluteus Maximus
Maximus, R Piriformis, R Coccygeus
Postural Respiration – An Integrated Approach to Treatment of

Patterned Thoraco-Abdominal Pathomechanics
Left Anterior Interior Chain (L AIC) L Thoracic Hemi-Diaphragm L Psoas Major
Right Brachial Chain (R BC) R Lower Trapezius, R Triceps, L L HG Adductors (Pec Major), R
Triangularis Sterni, B Serratus Anterior, B Scapulothoracic IR (Pec Minor), R
Middle Trapezius Latissimus Dorsi
Posterior Exterior Chain (PEC) L Internal Obliques/Transversus B Paravertebrals, R Quadratus Lumborum

Abdominis, R External Obliques
Cervical Revolution – An Integrated Approach to Treatment of Patterned Cervical

Pathomechanics
Right Temporomandibular Cervical B Levator Scapulae, B Cervical Colli, R L Posterior Capitis, R Anterior Capitis, R
Chain (R TMCC) External Obliques, L Lateral Pterygoids, L Anterior Temporalis, R Upper Trapezius,
Anterior Temporalis, R Posterior Capitis, L R Sternocleidomastoid
Internal Obliques/Transversus Abdominis
Copyright 2000-2017 Postural Restoration Institute® v

BRACHIAL CHAIN (BC)
There are two brachial polyarticular muscular chains lying over the anterior pleural and
cervical area. These chains influence cervical rotation, shoulder dynamics and apical
inspirational expansion. They are composed of muscle that attaches to the costal
cartilages and bone of ribs 4 through 7 and xiphoid to the posterior, inferior occipital
bone, anterior, inferior mandible and coracoid process of scapula. These two tracks of
muscles, one on the left side of the sternum and one on the right, are anterior to the
medial and upper mediastinum and upper thoracic cavity and are composed of the
triangular sterni, sternocleidomastoid, scalene, pectoralis minor, intercostals and
muscles of the pharynx and anterior neck. They provide the support and anchor for
cervical-cranial orientation and rotation and rib position. The right brachial chain
muscle is opposed by the right posterior back muscles (PEC), lower trap, serratus
anterior, and external rib rotators, in addition to the left internal abdominal obliques.
The brachial chain muscle on the left is opposed by the left posterior back muscles
(PEC), lower trap, serratus anterior, external rib rotators, and right internal abdominal
obliques.
ANTERIOR INTERIOR CHAIN (AIC)

There are two anterior interior polyarticular muscular chains in the body that have a
significant influence on respiration, rotation of the trunk, ribcage, spine and lower
extremities. They are composed of muscles that attach to the costal cartilage and
bone of rib 7 through twelve to the lateral patella, head of the fibula and lateral
condyle of the tibia. These two tracts of muscles, one on the left side of the interior
thoraco-abdominal-pelvic cavity and one on the right, are composed of the
diaphragm and the psoas muscle. With the iliacus, tensor fasciae latae, biceps
femoris and vastus lateralis muscles this chain provides the support and anchor for
abdominal counter force, trunk rotation and flexion movement.
Copyright 2000-2017 Postural Restoration Institute® vi

THE LEFT ANTERIOR INTERIOR CHAIN PATTERN
By Ron Hruska, MPA, PT
Individuals experiencing symptoms at the knee, hip, groin, sacral-iliac joint, back, top of shoulder, between the
shoulder blades, neck, face, or TMJ, will demonstrate inability to fully adduct, extend or flex their legs, on one or
both sides of their body. They usually have difficulty in rotating their trunk to one or both directions and are not
able to fully expand one or both sides of their apical chest wall upon deep inhalation. Cervical rotation,
mandibular patterns of movement, shoulder flexion, horizontal abduction and internal rotation limitations, on one
or both sides will also compliment the above findings. Postural asymmetry will be very noticeable, with one
shoulder lower than the other, and continual shift of their body directed to one side through their hips.
The pattern that is most often prevalent involves the left anterior interior chain, the right brachial chain and the
right posterior back muscles (PEC) of the body. The left pelvis is anteriorly tipped and forwardly rotated. This
directional, rotational influence on the low back and spine to the right, mandates compulsive compensatory
movement in one or more areas of the trunk, upper extremities and cervical-cranial-mandibular muscle. The
greatest impact is on rib alignment and position, therefore influencing breathing patterns and ability. It is very
possible that respiratory dysfunctions, associated for example with asthma or daily, occupational, repetitive, work
positions, can also influence pelvic balance and lead to a compensatory pattern of an anteriorly tipped and
forwardly rotated pelvis on the left.
Other common, objective findings secondary to compensatory physical attempts to remain balanced over this
unlevel pelvis include elevated anterior ribs on the left, lowered, depressed shoulder and chest on the right,
posterior rib hump on the right, overdeveloped lower right back muscle, curvature of the spine and asymmetry of
the head and face.
This particular pattern of neuromuscular imbalance is enhanced and generated usually at early ages of
development in the pre-adolescent and adolescent years. Since the fibers from our diaphragm that attach to the
front of the low spine and our diaphragm in general is stronger on the right, we all have a tendency to shift and
rotate our spine to the right sooner and more often than to the left. The liver also assists this directional pull on
the spine and pelvis because it keeps the right larger diaphragm better positioned for respiratory activity. We do
not have a liver on the left side. The left diaphragm leaflet is much smaller and does not have the advantage to
pull the ribs up and out upon inhalation, so there is a tendency to relax the left abdominal wall. Consequently,
these abdominal muscles on the left become weak.
This pattern complements our right dominance of extremity use, our daily shifting of weight to the right and
overcompensating patterns of activity above and below our pelvic floor. Airflow for example, will generally
move more easily into the left chest wall than into the right because of the rotational influence of the ribs, as
previously described. Lack of underlying structural support exists on the right that does not exist on the left due to
pericardium position. Rotation of the upper trunk to the left will generate less activity on the neck when in this
pattern because of this dynamic, respiratory, structural phenomena. However, rotation of the upper trunk to the
right limits air movement into the left chest wall. This created torque on soft tissue, secondary to movement on
an imbalanced foundational structure, usually results in chronic muscle overuse, inflammation and pain, such as
one would see in someone diagnosed with fibromyalgia or scoliosis.
Copyright 2000-2017 Postural Restoration Institute® vii

Basic Concepts of the Postural Restoration Institute®
by Ron Hruska, MPA, PT
The human body is not symmetrical. The neurological, respiratory, circulatory, muscular and vision
systems are not the same on the left side of the body as they are on the right, and vice versa. They have
different responsibilities, function, position and demands on them. This system asymmetry is a good
thing and an amazing design. The human body is balanced through the integration of system
imbalances. The torso, for example, is balanced with a liver on the right and a heart on the left.
Extremity dominance is balanced through reciprocal function; i.e. left arm moves with right leg and vice
versa.
Postural Restoration Institute® (PRI) credentialed professionals recognize these imbalances and typical
patterns associated with system disuse or weakness that develops because of dominant overuse. This
dominant overuse of one side of the body can develop from other system unilateral overuse. For
example, if the left smaller diaphragm is not held accountable for respiration as the right is, the body can
bec e i ed. The igh dia h ag i a a i a be e i i f e i a i , beca e f he i e
structural support of the right larger diaphragm leaflet. Therefore, the left abdominals are always
important to use during reciprocal function, such as walking, to keep the torso balanced.
Keeping the right chest opened during breathing is also challenging since there is no heart muscle inside
the right side of the chest. Standing mainly on the right lower extremity to offset the weight of the left
upper torso, assists in moving the pelvis forward on the left and the shoulder complex down on the right.
This asymmetry compliments the special functions of the two sides of the brain. Although the two sides
(hemispheres) of the brain share responsibilities for some functions, each hemisphere has its own
ecia ie . Each he i he e c he i e ide f he b d . The ef b ai ha e
responsibilities for speech and language and thus the right upper extremity becomes a dominant
extremity in communication, growth and development. PRI credentialed professionals recognize when
this normal pattern is not balanced sufficiently with left extremity neurologic and muscular activity.
When these normal imbalances are not regulated by reciprocal function during walking, breathing or
turning, a strong pattern emerges creating structural weaknesses, instabilities, and musculo-skeletal pain
syndromes. Balancing muscle activity around the sacrum (pelvis), the sternum (thorax) and the
sphenoid (middle of the head) through a PRI approach best positions multiple systems of the human
body for appropriate integrated asymmetrical function. PRI credentialed professionals incorporate
reciprocal f c i ed ce eadi g i h he ef e i a d igh a , a d e i a f ci
maximize airflow in and out of the right lung.
Vision, occupational demands, in-uterine position, etc. can all influence asymmetrical tendencies and
patterns. Humpback whales bottom-feed on their right side, lemurs tend to be lefties when it comes to
grabbing their grub, toads use their right forepaw more than their left, chimpanzees hold a branch up
with the left hand and pick the fruit with their right hand, and humans usually balance their center of
gravity over their right leg for functional ease and postural security. PRI credentialed professionals
recognize the more common integrated patterns of human stance, extremity use, respiratory function,
vestibular imbalance, mandibular orientation and foot dynamics; and balance these patterns, as much as
possible, through specific exercise programs that integrate correct respiration with left side or right side
inhibitory or facilitory function.
Copyright 2000-2017 Postural Restoration Institute® viii

Neutral
by Ron Hruska, MPA, PT
State of Disengagement
If e a i he dic i a i fi d defi i i ha a e, a ig ed i h
i g a ide i a a , di e, c e ; be gi g ei he i d ide. If a ea
chemist or pulmonologist it means neither acidic nor alkalinic. If you are a physicist it means having a
net electric charge of zero. If you are a painter it means, of or indicating a color that lacks hue or
achromatic. If you are a neutral politician you are on neither side and possess moderate views. If you
are an engineer, neutral means the machine is in a position in which a set of gears is disengaged.
If you are a PRI clinician, neutral means the human body posture is in a position in which a set of
muscles are disengaging so that a new strategic process of using these same polyarticular muscles can be
established. Those set of muscles are outlined in the summary section of the composite of PRI courses
as related to the Left AIC, Right BC and Right TMCC patterns. Once these muscles and corresponding
predictable faulty movement patterns are placed in a neutral or disengaged state, resumption of activity
can take place from a different start point or position. It is from this point reeducation of the
neuromuscular system, to build more efficient strategies and patterns of movement, can take place.
Transitional Zone
The ability to move from one end of a range of motion through a transitional zone, or mid-zone, to the
other end of the range of motion, and vice e a, c i e i g h gh i a d f
neutrality. It is important that the human experiences this mid-range position or can get into this
transitional zone of neutrality when the body attempts to shift, sway or swing using effortless
momentum.
Dynamic Movement and Balance

M i i a ic i e ii a d e ai i e a ic a a ic ii . U i e ed
ba a ce e e eg i c ide ed be e f a a ic e e , he ea , i e ed ba a ce i
considered to be more of a dynamic movement. Neutrality is dynamic because reciprocal motion
involves dynamic movement and balance across the full spectrum of the available range of motion.
Getting a patient or client neutral when they are moving through dynamic movement patterns across the
full range of motion involves balancing the dynamic transitions between one end of the range of motion
and the other end.
People can develop tendencies or patterns built from sensory processing that promote more motion in
one direction and minimize motion in the other direction. These patterns include motion in all three
planes and include what happens on both the right and left sides of the body. The ability to decrease this
tri-planar bias of the body, which then allows a person to move into and through the mid-zone between
both ends of the movement spectrum, in each of the three planes, is required for neutrality to occur.
Moving into mid-stance or pronation on one lower extremity, as the other lower extremity is swinging
forward for weight of the body to be transitioned to the swinging leg at heel strike, is a good example of
decreased tri-planar balance on the mid-stance or pronated lower extremity. Human locomotion requires
uninterrupted alternating lower extremity exchange of weight support. Unbiased dynamic reciprocal
eigh di ib i a hee a d e a eed cc , f he h a a h gh a e a ,
transitional zone at the pelvis and at each midfoot, during mid-stance.
Copyright 2000-2017 Postural Restoration Institute® ix

Left AIC, Right BC and Right TMCC Inhibition
If tri-planar chains of muscle are overactive, as prime contributors to tri-planar pelvis, thorax, and
cranial positional bias, then muscle inhibition of this chain must occur in order to allow for movement
into a zone of neutrality. Balancing respiration and establishing left thoracic ZOA and left cranial
flexion becomes important for attaining neutrality. Inhibiting the left AIC, right BC and right TMCC
patterned overactive muscle, allows the patient or client to reciprocally move out of a patterned position
and toward the other end of the range of motion, of the right AIC, left BC and left TMCC pattern. The
ability to inhibit the left AIC, right BC and right TMCC pattern is an essential ingredient for alternating
reciprocal activity and neutrality that is needed from the thorax and pelvis, for activity like walking,
running, cross country skiing, skating, etc.
Unbiased Position
If at the time of re-examination, your patient is not neutral, further PRI intervention will not allow the
patie b d e e e c ei i i ic h h . Efficie e e de e d he b d
ability to reciprocally produce action marked by the regular recurrence from a start position that is in an
unbiased position.
This unpolarized or unbiased position is not usually taken into consideration when exercise programs are
designed or when evaluation occurs. In fact, the hypothetical neutral spinal position is rarely achieved,
achievable, nor maintained in activities of daily living. Our spines will never be optimally and
completely aligned at rest or during activity. However, we can achieve neutral zones where the body
functions most optimally.
Summary
Placing the sacrum, sternum and sphenoid in a desirable neutral position, from which movement begins
and ends, is not as challenging as it may seem, if one understands polyarticular triplanar organization
a d a cia ed a e f e i a i . The e a e a hi hica a ache ha e ea e a
i e e he de ad. B hese neutral spine principles do not take into consideration the
normal aberrations, asymmetries, and malalignments of the neuromuscular, cortical, reflexive, visceral
a d e ia e . The e a - e a a e a ei f ce c e atory
lateralization development. Once asymmetrical system integration is understood, optimal subconscious
competent function can occur without homo-lateral (ipsilateral) compensation, or hemi-lateral
symptomology.
PRI has outlined this asymmetrical system-integration and offered corresponding tests to determine if
he a ie i habi a ad i g e g he i g hei i e de i ab e e a ii .
These tests take into consideration: 1) the joints neutral position where minimal resistance is given by
he e iga e c e; 2) he c a i i f e ce C1 a d C2 a d he e i a e ; 3)
the diaphragm and rib interplay influence on sternal and spinal orientation; 4) the pelvic floor septal-
sagittal influence on the frontal plane; and 5) the visual-vestibular influence, in maintaining a center of
mass, on the head-on-body and body-on-head igh i g eac i ife e ba i .
Copyright 2000-2017 Postural Restoration Institute® x

Welcome!
Thank you for taking this course and exploring and studying the influence of position on specific
patterned muscular movement and action. I am so excited for you to learn how orientation of femoral
rotators relate to stabilization and de-stabilization of the ilio-sacral joint, the hip or the knee. If this is
your first PRI course, you will be introduced to the world of human asymmetrical capsulo-ligamentous
c e, a e ed a ic a c e chai , i i a c ce a e a ed d i e e ai
and osseous orientation, and algorithmic relationships of functional testing.
These concepts will be useful to anybody and everybody who has an interest in tri-planar movement of
the human body and how homo-lateral (ipsilateral) muscle movement can affect and influence hemi-
lateral function.
Treatment considerations and the recommended PRI non-manual techniques, as related to the balanced,
a e ica a e ed h a , i a he begi e PRI c e a e dee i edia e fi d
success at reducing or inhibiting patterned position driven muscle. If you have taken one of our other
courses, you will recognize the strong correlation and integration of three polyarticular chains composed
f c e ha ca bec e e e e i e e i g a e c a eai f he fa i ie
of muscle. If you have taken this course before, you will hopefully enjoy this presentation even more
because of the familiarity with the flow of material, and the unique demonstration and participation by
e fe c e a e dee .
The PRI faculty recognize how important it is to establish a working vocabulary and clinical approach,
ea i h PRI f a i g a d d . Thi c e a e di i fa h f i g hei
e. I i ia i f he d ef e igh i e a a e he e i g he a e di . Thi
lateralized terminology is carried out under subtitles of facilitatory and inhibitory non-manual
techniques, also summarized in this appendix.
O ce agai , ha f a i g ad a age f hi i , a d if hi i fi c e
welcome to PRI! If you are a former PRI student, thank you for continuing on this path of integration!
Hopefully, your clients, patients and future students will be as grateful as I am.
- Ron Hruska, MPA, PT

Director, Postural Restoration Institute
Copyright 2000-2017 Postural Restoration Institute® xi

Myokinematic Restoration EBP Course Overview
Development of human asymmetrical systems is well documented. [1-5] The Postural Restoration
Institute (PRI) was established to explore and explain the science of postural adaptations, asymmetrical
patterns and the influence of polyarticular chains of muscles. Patterns of the human body have been
e ai ed f a ea , ch a he C C e a Pa e de c ibed b Zi , M e e
S e I ai e S d e de c ibed b Sah a , a d he a e ica a ic ar muscle
chai a e de c ibed b H a. [6-8] Pelvic asymmetry is common among symptomatic and
asymptomatic persons. [9-10] This pelvic mal-alignment could either be a result of unilateral anterior or
posterior rotation of an innominate bone. [11] Furthermore, pelvic asymmetry has been thought to alter
body mechanics, affect the length of muscles that originate on the pelvis, and result in increased strain
on bony and soft tissues possibly producing asymmetrical adaptations. [11] Pelvic innominate
asymmetry can lead to diagnoses such as hip impingement, patella-femoral pain, and low back pain
among others. [10-16] This advanced lecture and lab course explores the biomechanics of contralateral
and ipsilateral myokinematic lumbo-pelvic-femoral dysfunction, as a result of the left Anterior Interior
Chain (AIC) polyarticular muscle chain described by Hruska. Treatment emphasizes the restoration of
pelvic-femoral alignment and recruitment of specific rotational muscles to reduce synergistic predictable
patterns of pathomechanic asymmetry. [8, 12-16] Too often, clinicians look at femoral-acetabular (FA)
positioning and strengthening without considering the acetabular-femoral (AF) pelvic position.
Emphasis will be placed on restoration, recruitment and retraining activities using internal and external
rotators of the femur, pelvis and lower trunk. Guidance will be provided on how to inhibit overactive
musculature. This will enable the course participant to restore normal resting muscle position.
Participants will be able to immediately apply PRI clinical assessment and management skills when
treating diagnoses of the lumbo-pelvic-femoral complex.
References:
1. Zaidi, ZF. Body asymmetries: Incidence, etiology and clinical implications. Australian Journal of Basic and
Applied Sciences, 2011; 5(9): 2157-2191.
2. Arun, CP. The importance of being asymmetric: the physiology of digesta propulsion on Earth and in space.
Ann NY Acad Sci, 2004; 1027: 74-84.
3. Wolpert, L. Development of the asymmetric human. European Review, 2005; 13(2): 97-103.
4. Vallortigara, G and Rogers, LJ. Survival with an asymmetrical brain: Advantages and disadvantages of
cerebral lateralization. Behavioral and Brain Sciences, 2005; 28: 575-633.
5. Lee, H. et al. The association between asymmetric hip mobility and neck pain in young adults. Journal of
Manipulative and Physiological Therapeutics, 2013; 23: 364-368.
6. Zink, JG and Lawson, WB. An osteopathic structural examination and functional interpretation of the soma.
Osteopathic Annals, 1979; 7(12): 433-440.
7. Sahrmann, S. Diagnosis and treatment of movement impairment syndromes. St. Louis: Mosby, 2002.
8. Boyle, KL. Clinical application of the right sidelying respiratory left adductor pull back exercise. The
International Journal of Sports Physical Therapy, 2013; 8(3): 349-358.
9. Krawiec, CJ et al. Static innominate asymmetry and leg length discrepancy in asympotomatic collegiate
athletes. Manual Therapy, 2003; 8(4): 207-213.
10. Levangie, PK. The association between static pelvic asymmetry and low back pain. Spine, 1999; 24: 1234-
1242.
11. Chibulka, MT et al. Changes in innominate tilt after manipulation of the sacroiliac joint in patients with low
back pain. Physical Therapy, 1988; 68: 1359-1363.
12. Hruska, R. Pelvic stability influences lower-extremity kinematics. Biomechanics, 1998 (June); 23-29.
Copyright 2000-2017 Postural Restoration Institute® xii

13. Te e , HR e a . I f e ce f ha i g a d abd i a c e ac i a i a i i e Obe e i
people with lumbopelvic pain. Physiotherapy Canada, 2013; 65(1): 4-11.
14. Boyle, KL. Managing a female patient with left low back pain and sacroiliac joint pain with therapeutic
exercise: A case report. Physiotherapy Canada, 2010; 63(2): 154-163.
15. Boyle, KL and Demske, JR. Management of a female with chronic sciatica and low back pain: A case report.
Physiotherapy Theory and Practice, 2009; 25(1): 44-54.
16. Spence, H. Case study report: postural restoration: an effective physical therapy approach to patient treatment.
Techniques in Regional Anesthesia and Pain Management, 2008; 12: 102-104.
Copyright 2000-2017 Postural Restoration Institute® xiii

Myokinematic Restoration An Integrated Approach To Treatment of Patterned Lumbo-Pelvic-Femoral Pathomechanics
MYOKINEMATICS
Defined: The study of motion, or lack of motion, produced by specific muscle force.
In other words, it is the study of muscle as it relates to movement.
1) When using a myokinematic focus, rehabilitative goals will include symmetrical muscle
flexibility, strength and length and how they affect motion.
2) Asymmetries in muscle strength and endurance must be balanced between agonists and
antagonists.
3) The study of myokinematic dysfunction is the study of motion adaptation patterns.
4) Never confuse movement with action Earnest Hemingway
Copyright 2000-2017 Postural Restoration Institute® 1

Anterior view of an
anterior and forward
positioned left innominate
with accompanying right
sacral torsion.
Posterior view of an
anterior and forward
positioned left innominate
with accompanying right
sacral torsion.
Note:
Raised left ischium
Right SI distraction
Rotation of sacrum, L5 and
L4 to the right
O a a
Closure of left obturator
foramen

Pattern vs. position
Describes an individual that is neuro-

R AIC Pattern mechanically oriented in a position of left
AF IR and has most of their body weight
distributed through their left lower
extremity.
Describes an individual that is neuro-
L AIC Pattern mechanically oriented in a position of right
AF IR and has most of their body weight
distributed through their right lower
extremity.
Describes the lower extremity that most of
“Stance” the body weight is distributed on or shifted
to (i.e. standing on left leg = left stance)
Describes either active or passive non-
“Position” movement orientation of proximal segment
to distal segment (i.e. left lower extremity
is in AF IR = left AF IR).
PRI Stance Myokinematic Patterns

Relating to Acetabular Femoral Positions
Left Stance in Left AF IR position = Right AIC Pattern
Right Stance in Right AF IR position = Left AIC Pattern
Left Stance in Right AF ER position = Right AIC Pattern
Right Stance in Left AF ER position = Left AIC Pattern

Left Anterior interior chain (AIC) Pattern
Illustration by Elizabeth Noble for the Postural Restoration Institute®.

BIOMECHANICAL Influences of the

FEMORAL ACETABULAR JOINT (FA)
Normal Anterior Pelvic Position

SOFT TISSUE Influences oN the

FEMORAL ACETABULAR JOINT (FA)
ANTERIOR PELVIC POSITION POSTERIOR PELVIC POSITION
Vastus Lateralis Rectus Femoris Semitendinosus

Biceps Femoris
Ligamentum Ligamentum
Iliofemorale Iliofemorale
Ligamentum Ligamentum
Pubefemorale Pubefemorale
Os Pubis Os Pubis
Femur Femur

PELVIC INFLUENCE ON LUMBAR SPINE ORIENTATION (LORDOSIS)
< 30° ~ 30° > 30°

Illustration by Kristina Swantek for the Postural Restoration Institute ®
Reprinted from The Malalignment Syndrome: Implications for Medicine and Sport. Wolf Schamberger.
Page 17 and 11. Copyright 2002, with permission from Elsevier.

LUMBO PELVIC (LP) JOINT DYNAMICS

A. Capsulo-Ligamentous Structures
1) Anterior Ligaments of Pelvis: The ventral S.I. ligaments are the weakest and are supported
anteriorly by the integrity of the pubic symphysis. (Netter 335)
a. Iliolumbar (blends with the quadratus lumborum)

Superior
Anterior
Inferior
Vertical
Posterior band
b. Sacrospinous (from the lateral aspect of sacrum and coccyx to the spine of the ischium)
2) Posterior Ligaments of Pelvis:
a. Posterior Sacroiliac Ligaments (2 Parts) (Netter 335, 334)

Interosseous Strongest of the posterior ligamentous structures.
It restricts sacral nutation and posterior innominate rotation.
Long dorsal Extends superiorly from the lateral aspect of the sacrotuberous ligament.
It restricts counternutation and anterior innominate rotation.
b. Sacrotuberous
Blends with the long head of biceps femoris
From the P.I.I.S., 4th and 5th transverse tubercles of the lateral sacrum and the lateral
coccyx to the inner ischial tuberosity (restricts sacral nutation)
A key function of the sacrotuberous (posterior) and sacrospinous ligament (anterior) is to
limit the amount of upward movement of the inferior sacrum
B. Muscular Structures of Pelvis (Netter 337, 339, 356)
1) Piriformis
a. Proximal attachment - pelvic surface of the 2nd and 4th sacral segments, superior margin of
the greater sciatic notch and sacrotuberous ligament
b. Distal attachment - greater trochanter of the femur
c. Stabilizes sacrum, acts as a sacrum internal rotator, positions innominate via sacrum and
a a ac ,a b a a a ad ac ab

2) Coccygeus (ischiococcygeus)
a. Proximal attachment - ischial spine
b. Distal attachment - inferior end of the sacrum
c. Supports pelvic floor, draws coccyx forward during parturition or defecation
3) Iliococcygeus and pubococcygeus

a. Proximal attachment - tendinous arch of the levator ani
b. Distal attachment - coccyx and the anococcygeal ligament
c. Supports and slightly raises the floor of the pelvis, resists intraabdominal pressure, as in
forced expiration
4) Gluteus maximus
a. Proximal attachment ilium behind posterior gluteal line and sacrotuberous ligament
b. Distal attachment iliotibial band and gluteal tuberosity of femur
c. Extends acetabulum (pelvis) on femur, extends and externally rotates femur on acetabulum,
a d c a a d ac ab , ac a ,
sacrum to femur, and femur to innominate and acetabulum, innominate to sacrum and femur
to sacrum
The sacral surface (of the SI Joint) is composed of hyaline cartilage and the iliac surface is
composed of fibrocartilage.
When the sacrum moves into nutation (increase lordosis) ligamentous tension increases and joint
compression increases.
C. Pubic Symphysis
Ligaments: (Netter 336 - male/female, anterior/inferior/sagittal view)
1) Superior pubic
2) Arcuate inferior
3) Interpubic (includes fibrocartilage disc)
The decussating tendinous fibers of the rectus abdominus and the external oblique
muscles also strengthen the pubic symphysis anteriorly.

D. L ga e M c e
Ligament Agonistic Muscle Corresponding Joint
Iliolumbar Quadratus Lumborum, Iliacus L4, L5, S1
Sacrospinous Lower Gluteus Maximus, Piriformis SI
Posterior Sacroiliac Hamstrings, Upper Gluteus Maximus Pube and SI
Sacrotuberous Biceps Femoris SI
Pubic Ligaments Rectus Abdominis, External Oblique, Pube

Pyramidalis, Adductor Magnus

FEMORAL ACETABULAR (FA) JOINT DYNAMICS

A. Capsulo-Ligamentous Structures
1) Iliofemoral
The fibrous capsule is reinforced anteriorly by the strong Y-shaped iliofemoral ligaments (of
Bigelow). It attaches to the interior inferior iliac spine, the proximal acetabular rim, and the
intertrochanteric line distally. The iliofemoral ligament prevents hyperextension of the femoral-
acetabular (FA) joint during standing by forcing (twisting) the femoral head into the acetabulum.
Anterior View
Iliofemoral
Ligament
Posterior View
Iliofemoral
Ligament
Illustration by Kristina Swantek for the Postural Restoration Institute®

2) Pubofemoral
The fibrous capsule reinforces inferiorly and anteriorly by the pubofemoral ligament. It arises
from the obturator crest of the pubic bone and passes laterally/inferiorly to merge with the
femoral-acetabular (FA) capsule. It also blends with the medial portion of the iliofemoral
ligament. It tightens during extension and abduction of the FA joint. Key function is checking
over-abduction of the hip.
Anterior View
Pubofemoral
Ligament
3) Ischiofemoral
The fibrous capsule is reinforced posteriorly by the ischiofemoral ligament. It arises from the
ischial part of acetabular rim and spirals superiorly/laterally to the neck of the femur just medial
the base of the greater trochanter. It tends to hold the femoral head medially into the acetabulum,
preventing hyperextension of the femoral-acetabular (FA) joint.
Posterior View
Ischiofemoral
Ligament

Other important capsuloligamentous issues:
Hip in anatomical position (prone)
1) ER is accompanied by anterior glide of the femoral head.

Rotation is limited by tension in the anterior capsule and the pubofemoral ligament.
2) IR is accompanied by a posterior glide of the femoral head.

Rotation is limited by tension in the posterior capsule and the ischiofemoral ligament.
Hip at 90 (seated)
1) Most ligamentous structures loosen.
2) ER is accompanied by a superior glide of the femoral head.

Rotation is limited by the superior capsule and the iliofemoral ligament.
3) IR is accompanied by an inferior glide of the femoral head.

Rotation is limited by tension in the inferior capsule and superior ischiofemoral ligament.
B. Muscular Structures (FA)
Possible R.O.M. of the Femoral-Acetabular (FA) Joint

Flexion 100
Extension 20
Abduction 45
Adduction 30
IR 40
ER 60
ROM values referenced from: Kapandji IA. The physiology of the joints. Lower limb: Churchill Livingstone; 1970. p. 256.
C. L ga e M c e
Ligament Agonistic Muscle Corresponding Joint
Iliofemoral Anterior Gluteus Medius, TFL, FA

Pectineus, Vastus Lateralis
Pubofemoral Ischiocondylar Adductor,

Pectineus, Adductor Brevis FA
Ischiofemoral Gluteus Maximus, Quadratus

Femoris, Obturator AF

Femoral Rotators
EXTERNAL ROTATORS INTERNAL ROTATORS
ILIACUS (LESSER TROCHANTER), PSOAS (LESSER GLUTEUS MEDIUS (ANTERIOR FIBER GREATER
TROCHANTER) TROCHANTER)
GLUTEUS MAXIMUS (ILIOTIBIAL FASCIA, GLUTEAL GLUTEUS MINIMUS (ANTERIOR GREATER
TUBEROSITY) TROCHANTER)
PIRIFORMIS (GREATER TROCHANTER) TENSOR FASCIA LATAE (ILIOTIBIAL TRACT, GERDY S
TUBERCLE)
SUPERIOR GEMELLUS, OBTURATOR INTERNUS,
INFERIOR GEMELLUS, OBTURATOR EXTERNUS, ADDUCTOR MAGNUS (ISCHIOCONDYLAR-MEDIAL
QUADRATUS FEMORIS CONDYLE)
SEMIMEMBRANOSUS (MEDIAL TIBIAL CONDYLE)
SARTORIUS (GRACILIS AND SEMITENDINOSUS
SEMITENDINOSUS (MEDIAL TIBIAL CONDYLE)
TENDON)
PECTINEUS (PECTINEAL LINE) after 90o of hip flexion it
becomes an internal rotator
ADDUCTOR LONGUS (LINEA ASPERA)
*RECTUS FEMORIS more active as an external rotator

with anterior pelvic rotation
*BICEP FEMORIS LONG HEAD/FIBULAR HEAD
FEMORAL STABILIZERS
ADDUCTOR MAGNUS (LINEA ASPERA) BICEP FEMORIS SHORT HEAD

( ) Attachment site
EXTERNAL ROTATORS INTERNAL ROTATORS
HIP EXTENSORS
ADDUCTOR MAGNUS SEMIMEMBRANOSUS
*BICEP FEMORIS LONG HEAD/FIBULAR HEAD *SEMITENDINOSUS
GLUTEUS MAXIMUS
KNEE FLEXORS
GRACILIS BICEP FEMORIS SHORT HEAD
BICEPS FEMORIS LONG HEAD *SEMITENDINOSUS
POPLITEUS
HIP FLEXORS
ILIACUS/PSOAS TENSOR FASCIA LATAE
SARTORIUS
*RECTUS FEMORIS more active as an external
rotator with anterior pelvic rotation
KNEE EXTENSORS
VASTUS LATERALIS with valgus
GASTROC/SOLEUS with supination
*RECTUS FEMORIS more active as an external
rotator with anterior pelvic rotation
* Two Joint Muscle

Myokinematic Restoration An Integrated Approach To Patterned Lumbo-Pelvic-Femoral Pathomechanics
Femoral Rotators
External Rotators
MUSCLE PROXIMAL ATTACHMENT DISTAL ATTACHMENT INNERV-
ATION
Sides of T12-L5 vertebrae and discs L1-L4
PSOAS MAJOR between them; transverse processes of Lesser trochanter of femur
all lumbar vertebrae
Sides of T12-L1 vertebrae and Pectineal line, iliopectineal eminence via L1, L2
PSOAS MINOR
intervertebral disc iliopectineal arch
Iliac crest, iliac fossa, ala of sacrum, Tendon of psoas major, lesser trochanter, and L1-L4
ILIACUS
and anterior sacroiliac ligaments distal femur
Ilium posterior to posterior gluteal line, Most fibers end in iliotibial tract that inserts into L5, S1, S2
GLUTEUS MAXIMUS dorsal surface of sacrum and coccyx, lateral condyle of tibia; some fibers insert on
and sacrotuberous ligament gluteal tuberosity of femur
Anterior surface of sacrum and L5, S1, S2
PIRIFORMIS Superior border of greater trochanter of femur
sacrotuberous ligament
Medial surface of greater trochanter (trochanteric L5, S1-S3
SUPERIOR GEMELLUS Ischial spine
fossa) of femur
Medial surface of greater trochanter (trochanteric L4, L5, S1,
INFERIOR GEMELLUS Ischial tuberosity
fossa) of femur S2
Pelvic surfaces of ilium and ischium; Medial surface of greater trochanter (trochanteric L5, S1-S3
OBTURATOR INTERNUS
Obturator membrane fossa) of femur
Margins of obturator foramen and L3, L4
OBTURATOR EXTERNUS Trochanteric fossa of femur
obturator membrane, arcuate tendon
Quadrate tubercle on intertrochanteric crest of L4, L5, S1,
QUADRATUS FEMORIS Lateral border of ischial tuberosity
femur and area inferior to it S2
Anterior superior iliac spine and S2-S4
SARTORIUS Superior part of medial surface of tibia
anterior part of iliac crest
Pectineal line of femur, just inferior to lesser L2-L4
PECTINEUS Superior ramus of pubis
trochanter
ADDUCTOR LONGUS Body of pubis inferior to pubic crest Middle third of linea aspera of femur L2-L4
Anterior inferior iliac spine and ilium Base of patella and by patellar ligament to tibial L2-L4
RECTUS FEMORIS
superior to acetabulum tuberosity
BICEP FEMORIS Long Head Ischial tuberosity L5, S1-S3
Lateral side of head of fibula; tendon is split at
Linea aspera and lateral supracondylar L5, S1, S2
BICEP FEMORIS Short Head this site by fibular collateral ligament of knee
line of femur
INTERNAL ROTATORS
MUSCLE PROXIMAL ATTACHMENT DISTAL ATTACHMENT INNERVATION
External surface of ilium between L4, L5, S1
GLUTEUS MEDIUS Lateral surface of greater trochanter of femur
anterior and posterior gluteal lines
External surface of ilium between Anterior surface of greater trochanter of L4, L5, S1
GLUTEUS MINIMUS
anterior and inferior gluteal lines femur
Anterior superior iliac spine and Iliotibial tract that attaches to lateral condyle L4, L5, S1
TENSOR FASCIA LATAE
anterior part of iliac crest of tibia
Adductor part: inferior ramus of Adductor part: gluteal tuberosity, linea L2-L5, S1
ADDUCTOR MAGNUS pubis, ramus of ischium aspera, medial supracondylar line
Ischiocondylar Portion
Hamstrings part: ischial tuberosity Hamstrings part: adductor tubercle of femur
SEMITENDINOSUS Medial surface of superior part of tibia L4-5, S1-2
Posterior part of medial condyle of tibia; L4, L5, S1, S2
Ischial tuberosity
SEMIMEMBRANOSUS reflected attachment forms oblique popliteal
ligament (to lateral femoral condyle)
FEMORAL STABILIZERS
MUSCLE PROXIMAL ATTACHMENT DISTAL ATTACHMENT INNERVATION
Adductor part: inferior ramus of Adductor part: gluteal tuberosity, linea aspera, L2-L5, S1
ADDUCTOR MAGNUS pubis, ramus of ischium medial supracondylar line
(Middle Fibers)
Hamstrings part: ischial tuberosity Hamstrings part: adductor tubercle of femur
BICEP FEMORIS Short Linea aspera and lateral Lateral side of head of fibula; tendon is split at L5, S1, S2
Head supracondylar line of femur this site by fibular collateral ligament of knee

Positional and Compensatory Influences of the Left AIC

Pattern on Muscle of the Lumbo-Pelvic-Femoral Region
Patients with a Left AIC pattern who are positioned in a state of right AF IR and left AF ER present with
the following myokinematic relationships:
The Left Side
The left innominate is positioned in a state of AF flexion, abduction, and external rotation with
compensatory femoral (FA) activity. All efforts to restore correct AF position and rehabilitate FA
activity on the left side should include extension, adduction and internal rotation.
Left AIC Positional Influences on Left Lumbo-Pelvic-Femoral Muscle Length and Strength
Flexors
Iliacus / Psoas (ER) short and strong secondary to flexion (positional) and external rotation
(compensatory). Overactive as a flexor and external rotator secondary to position (compromised
sagittal opposition from hamstrings, glute max and obliques).
Rectus Femoris (ER) short and strong secondary to flexion (positional) and external rotation
(compensatory).
TFL (IR) short and strong secondary to flexion (positional) and overactive as an internal rotator
secondary to compromised agonistic anterior glute med and IC adductor magnus.
Pectineus (IR >90° hip flexion) long and weak secondary to external rotation (compensatory).
Extensors
Biceps femoris (ER) long and weak secondary to flexion (positional).
Semi-ten and Semi-mem (IR) longer and weaker secondary to flexion (positional) and external
rotation (compensatory).
Glute Max (ER) extension fibers long, weak and out of position for optimal extension because of
flexion (positional) - i.e. anterior pelvic rotation. External rotator fibers are short and strong with
optimal leverage secondary to external rotation (compensatory).
Abductors
Posterior Glute Med (ER) short and strong secondary to abduction and external rotation
(compensatory).
Anterior Glute Med (IR) long and weak secondary to abduction and external rotation
(compensatory).

Adductors
Adductor Magnus and Longus (ER) long and weak secondary to abduction (compensatory) in
frontal plane, but short and strong in transverse plane.
Ischiocondylar Adductor Magnus (IR) longer and weaker secondary to abduction and external
rotation (compensatory).
Additional Rotators
Piriformis (ER) short and strong secondary to external rotation (compensatory).
Obturator Internus (ER) short, straight and weak secondary to flexion, i.e. anterior forward rotation
(positional) and external rotation (compensatory).
Vastus Lateralis (IR) long and weak secondary to external rotation (compensatory) with increased
postural demand on lateral soft tissue secondary to compromised position of hamstrings, glute max
and obliques.
The Right Side
The right innominate is positioned in a state of AF extension, adduction and internal rotation with
positional femoral activity. All efforts to restore correct AF position and rehabilitate AF and FA
activities on the right side should include flexion, abduction and external rotation.
Left AIC Positional Influences on Right Lumbo-Pelvic-Femoral Muscle Length and Strength
Flexors
Iliacus / Psoas (ER) long and weak secondary to extension and internal rotation (positional).
Rectus Femoris (ER) long and weak secondary to extension and internal rotation (positional).
TFL (IR) short or normal length secondary to extension and internal rotation (positional).
Pectineus (IR >90 hip flexion) short and strong secondary to internal rotation (positional).
Extensors
Biceps femoris (ER) long secondary to internal rotation (positional) and strong secondary to
extension (positional).
Semi-ten and Semi-mem (IR) short and strong secondary to extension and internal rotation
(positional).
Glute Max (ER) External rotator fibers are long, weak and out of position for optimal external
rotation secondary to internal rotation (positional). Extension fibers short and strong with optimal
leverage secondary to extension (positional).

Abductors
Posterior Glute Med (ER) long and weak secondary to adduction and internal rotation
(positional).
Anterior Glute Med (IR) long secondary to adduction (positional) but short and strong secondary
to internal rotation (positional).
Adductors
Adductor Magnus and Longus (ER) short and strong secondary to adduction (positional) in frontal
plane, but long and weak in transverse plane.
Ischiocondylar Adductor Magnus (IR) shorter and stronger secondary to adduction and internal
rotation (positional).
Additional Rotators
Piriformis (ER) long and weak secondary to internal rotation (positional).
Obturator Internus (ER) long, angled and weak secondary to extension, i.e. relative posterior
tilt/backward rotation (positional) and internal rotation (positional).
Vastus Lateralis (IR) short and strong secondary to internal rotation (positional) with increased
demand as an abductor and internal rotator (compensatory).

sacrum
R L L R
Pelvic Surface Dorsal Surface
1 Piriformis
2 Iliacus
3 Gluteus maximus

hip bone
Lateral surface
Left Right
1 Gluteus medius
2 Gluteus minimus
3 Gluteus maximus
4 Piriformis
5 Adductor magnus
6 Obturator externus / internus

Left Hip Bone

Medial surface
1 Iliacus
2

LEFT HIP BONE

From above
1 Iliacus

LEFT HIP BONE

Ischial Tuberosity, from behind and below
From behind
1 Adductor magnus
1 Adductor magnus
From below
2

FEMUR
From the front and medial side
4
2
From the front From the medial side
3
3
Left
1 Piriformis
2 Gluteus minimus
3 Iliacus
5 Gluteus medius
Right
From the medial side From the front

FEMUR
From behind, from lateral side and from above
From behind
1
1 7
2
Left
3 From the lateral side

7
2
4
1
3 4
4
1 Gluteus medius
3 Iliacus
4 Adductor magnus
From above 5 Gluteus maximus
6 Piriformis
7 Gluteus minimus
Right
From the lateral side
From behind
6
From above

DESIRABLE REAL ESTATE FOR REPOSITIONING
1) Hamstrings (sagittal)
Illustration by Elizabeth Noble for the Postural Restoration Institute ®.

2) Ischiocondylar Adductor (frontal)
Illustration by Elizabeth Noble for the Postural Restoration Institute ®.

3) Gluteus Maximus (transverse)
Illustration by Kristina Swantek for the Postural Restoration Institute®.

DESIRABLE REAL ESTATE FOR ACETABULAR (HOLE)

CONTROL
1) Gluteus Maximus (pulls femur into acetabulum)
1st Piton
2) Obturator (pulls acetabulum onto femur)
3) *Gluteus medius / minimus (pulls acetabulum onto femur) 2nd Piton

4) *Iliacus (pulls femur into acetabulum)
5) Adductors
Last Piton
6) Gravity
*These two muscles secure the acetabulum via attachment at lesser and greater trochanters with
a b a a d c a ac ac .
DESIRABLE POSITIONS: Left AF IR & Right AF ER

Working to achieve L AF IR / R AF ER and maximizing opportunities to develop motor control in this
position reduces further developmental, compensatory L AIC patterning. Strategies on how to acquire
this desirable pattern and restore a balance between the L AIC (R AF IR / L AF ER) and R AIC (L AF
IR / R AF ER) are offered by the Postural Restoration Institute.
Left AF ER / Right AF IR Left AF IR / Right AF ER
Figure 10: Clockwise rotation of the acetabulum on the Figure 11: Anticlockwise rotation of the acetabulum on the
femur results in the acetabulum internally rotating on the femur results in the acetabulum internally rotating on the
fixed right femur causing right acetabulum femoral internal fixed left femur causing left acetabulum femoral internal
a AF IR a d c c a ac ab a left AF IR and concomitant right acetabulum
a a AF ER ac ab a a a right AF ER ac ab nally
rotating on the fixed left femur. (J. Masek, 2014) rotating on the fixed right femur. (J. Masek, 2014)
Figures from: Masek, J. Femoroacetabular impingement mechanisms, diagnosis, and treatment options using postural
restoration®: part 1. Sportex. March 2015. Used with permission. https://co-kinetic.com/profile/18

Top 3 Anti-Gravitational External Rotators
1) Gluteus Maximus
2) Biceps Femoris
3) Obturators
Top 3 Anti-Gravitational Internal Rotators
1) Adductor Magnus (Ischiocondylar Adductor)
2) Anterior Gluteus Medius / Gluteus Minimus
3) Semimembranosus and Semitendinosus
Top 3 Most Powerful Positioned External Rotators

1) Gluteus Maximus (FA) (AF)
2) Obturator (FA) (AF)
3) Psoas (FA) (AF)
Top 3 Most Powerful Positioned Internal Rotators
1) TFL (FA)
2) Anterior Gluteus Medius (AF) (FA)
3) Adductor Magnus (Ischiocondylar Adductor) (AF)

MYOKINEMATIC INFLUENCES ON THE PELVIS & FEMUR

A. Important Considerations
1) Which pelvic and femoral rotators are inactive? Active? Long? Short?
2) A femoral rotator is also a pelvic mover or a pelvic stabilizer.
3) One third of hip flexion movement is the consequence of pelvic posterior rotation or back
extension. This rotation always occurs within the first 8 degrees of hip flexion movement
(Bohannon 1985). Therefore, it is important to have working AF extensors and external rotators.
4) The most likely beginning of pathomyokinematics at the pelvis occurs with a long, inactive bicep
femoris (long head) on the left; a long, inactive, ischiochondylar adductor on the left; and a long,
weak, inferior, gluteus maximus on the right.
5) The most important movement of the hip is internal/external rotation, which activates receptors
of the posterior & anterior capsule. Abduction and adduction is also important because they
activate receptors of the inferior & superior portions of the capsule. Less than 3% of the capsular
receptors are found to be excited by flexion and extension of the hip in a cat that has similar
afferent responses and thresholds as a human. (Rossi A & Grigg P. Characteristics of hip joint
mechanoreceptors in a cat. Journal of Neurophysiology June 1982. Vol 47(6):1029-1042)
6) FA adduction and internal rotation lengthen obturator internus
7) Internal rotation of the FA joint lifts levator ani and pelvic floor and stabilizes the low back
B. Pelvic Musculature
Upper Half Lower Half
1) Piriformis 1) *Gluteus maximus
2) *Gluteus maximus 2) Obturator
3) Gluteus medius / minimus 3) Levator ani
4) Iliacus 4) Coccygeus
5) Psoas 5) Pubococcygeus
6) Tensor fascia latae 6) Adductors

*The gluteus maximus muscle influences both upper and lower pelvic floor functional activity
because of its attachment to sacrum.

MYOKINEMATIC RESTORATION TESTS

A. Adduction Drop Test
B. Extension Drop Test
C. Straight Leg Raise
D. Trunk Rotation
E. Femoral Acetabular (FA) Range of Motion
F. Femoral Acetabular (FA) Neuromuscular Control
G. Hruska Adduction Lift Test
H. Hruska Abduction Lift Test

ASSESSMENT TEST DESCRIPTIONS
A. Adduction drop TEST (ADT)

The patient lies on his or her side with the lower leg and hip flexed (90 degrees). Stand behind the
patient and passively flex, abduct and extend the hip to neutral while maintaining 90 degrees of knee
flexion. Passively stabilize the pelvis from falling backward and allowing femoral internal rotation to
occur. Make sure the top innominate is positioned directly over the bottom innominate so the frontal
plane starting position does not give any false positives (top innominate too cephaled) or false
negatives (top innominate too caudal).
A positive test is indicated by a restriction from the anterior-inferior acetabular labral rim, transverse
ligament, and piriformis muscle or impact of the posterior inferior femoral neck on posterior inferior
rim of acetabulum that does not allow the femur to adduct; possibly secondary to an anteriorly
rotated, forward hemipelvis. Usually seen on the left in a Left AIC oriented patient.
*Positive Negative
* Reflective of an osseous restriction from the acetabular labral rim.
Illustrations by Elizabeth Noble for the Postural Restoration Institute®.

B. EXTENSION DROP TEST (EDT)

The patient is positioned in supine with both thighs on the table. Both hips and knees are flexed to
the chest. Passively lower one leg over the edge of the table while helping the patient hold the
untested knee close enough to the chest to maintain the low back against the table. Do not allow hip
abduction to occur past zero degrees on the tested extremity while passively dropping the FA joint
into extension.
A positive test is indicated when the tested lower extremity (usually the left) is restricted in hip
extension because of the forward orientation of the tested side compared to the other. If both femurs
do not approach the edge of the mat or table the patient is tested on, the innominates are rotated
forward bilaterally and the psoa c a ac . P ac a ac a
ac a a a . T lengthens the TFL and VL, which could lead to
hyperactivity restricting hip extension.
There is also a rotary component to this issue, especially seen with limitation in hip extension on one
side. Since the forward, anteriorly rotated pelvis accompanies sacral rotation to the contralateral side
(right rotation on a right oblique axis or left rotation on a left oblique axis) the iliofemoral ligament
will also limit extension when the femur is externally rotated by the therapist, through testing with
a a .
The femur in this case will not approach the patient support surface without femoral internal rotation
a d a ( . c c ) a a ad ad d
superior anterior condyloid labral rim of acetabulum.
Positive Negative

C. STRAIGHT LEG RAISE (SLR)
The patient li a a d d. Pa a a
while securing full knee extension. Stop moving the leg at the point where the opposite leg begins to
move toward the ceiling passively or when the leg has reached a point where the tension at the back of
the hip and leg is noted and limits comfortable movement.
A positive test is indicated by limited or unlimited/excessive passive hip flexion of one extremity or
both extremities. Less than 75-80° is considered limited. Greater than 100° is considered
unlimited/excessive.
Positive (limited) Positive (unlimited/excessive)
Negative

D. Trunk Rotation
The patient is positioned supine with knees maximally flexed and together, and feet flat on the table.
Pa a a a d, ab
the other hand (placing it on the anterior lower ribs and sternum). A yardstick may be used to
measure the distance from the mat to the upper-most point of the superior knee, while maintaining
the opposite posterior thorax contact with the mat. Repeat the test in the other direction.
A positive test is indicated when the legs do not rotate in one direction as compared to the other. For
example, the legs are restricted in rotation to the left (ie. the legs do not rotate to the left as they do to
the right as measured through the use of an upright ruler). This means that trunk rotation is limited
more to the right secondary to probable left hip anterior rotation and sacral-lumbar orientation of the
spine to the right. Therefore, postural restoration should be initiated at the left lower extremity to
address left mechanical instability and maintain proper restored pelvi-femoral neuromechanics.
Right Trunk Rotation (limited) Left Trunk Rotation

E. Femoral Acetabular (FA) RANGE OF MOTION

The patient is seated on the edge of a treatment table with knees bent at a 90°. This test is performed
in the seated position (versus prone) to allow the hip ligamentous structure to be in a resting state.
U a , a a passive hip (FA) rotation on both the left and right side.
Most common goniometric findings of a Left AIC oriented patient in the seated position usually
reflect both osteokinematic and myokinematic (muscle position) influences. Therefore, in a non-
pathologic compensatory pattern of a Left AIC patient, where osteokinematic issues exist in a seated
position, Left FA IR will usually be decreased and Right FA ER will usually be decreased because
of the following reasoning:
*D c a d FA IR a c a d . Pa abd c d
in a Left AIC pattern or L AF ER position when placed in a seated state with legs directly in front of
a ac a .T hit ac ab
upon FA IR.
* Decreased right FA ER may also reflect the seated test position. A Left AIC patterned individual
with a Right AF IR positioned pelvis the right femur will be in an adducted state with the legs
d c a a d a .T impinge a ,
and medial acetabular rim upon FA ER.
Left FA IR (limited) Right FA ER (limited)
Where osseous and capsular restrictions do not exist (following repositioning), a non-pathological
compensatory Left AIC patterned individual should have increased FA IR on the left and increased
FA ER on the right, to near normal values, compared to before repositioning.
If capsular and soft tissue issues exist after repositioning secondary to over-compensatory activity, a
non-pathology compensatory pattern can now become a patho compensatory pattern. See page 39
for treatment rationale.

Before Repositioning After Repositioning

PROM AROM PROM AROM
IR
LEFT
ER
IR
RIGHT
ER
Soft Tissue pathology

(capsuloligamentous laxity and/or associated capsuloligamentous restriction
identifiable after pelvic repositioning)
W a 90 , IR ca b c c d a d d c d b c a
ligament and/or the inferior capsule.
W a 90 , ER ca b c c d a d reduced by either the iliofemoral ligament and/or
the superior capsule.
AF and FA Treatment Rationale for the Left AIC Patho Compensatory

Pattern
L IR ( R ) R IR ( L )
* Posterior superior capsule stretch. * AF ER glute max to re-position lengthened

AF & FA ADD/IR IC adductor for hip right obturator for hole control.
approximation to stabilize pubefemoral * AF & FA ABD posterior glute med to
ligament/inferior capsule. stabilize superior ischialfemoral
AF & FA IR anterior glute med to stabilize ligament/capsule.
iliofemoral ligament/inferior capsule. Inferior capsule or anterior capsule stretch.
L ER ( R ) R ER ( L )
* AF & FA ADD/IR IC adductor for hip * Inferior capsule or anterior capsule stretch.
approximation to stabilize pubefemoral AF ER glute max to position lengthened
ligament/inferior capsule. right obturator for hole control.
* AF & FA IR anterior glute med to stabilize AF & FA ABD posterior glute med to stabilize
iliofemoral ligament/inferior capsule. superior ischialfemoral ligament/capsule.
Posterior superior capsule stretch.

F. Femoral Acetabular (FA) NEUROMUSCULAR CONTROL

W a a d d ab , a FA IR a d FA ER c .I
also important to note which muscle the patient feels with FA IR muscle strength testing (glute med vs
TFL).
LEFT RIGHT
1 2 3 4 5 1 2 3 4 5
FA IR
Glute Med TFL Glute Med TFL
FA ER 1 2 3 4 5 1 2 3 4 5

Myokinematic Functional Relationships
+ L ADT + L EDT
* - L EDT (Iliofemoral / pubefemoral laxity)
Limited R TR
*Non-Limited R TR (Right iliolumbar laxity)
L SLR
Note: Proximal attachment site of hamstring group is more forward and elevated
secondary to anterior rotation of innominate.
* L SLR (Long, neuromuscularly weak, hypotonic, overly stretched
i ac i e ha i gg ha bec e e ed a he somatosensory
cortical level secondary to tactile extinction of LE)
L IR (FA ROM)
Note: Ove ac TFL, FA ER a d c tight posterior capsule
secondary to left AF ER osseous position.
R ER (FA ROM)
Note: Overactive right adductors, r FA IR a d a ad
anterior medial acetabular cotyloid rim upon FA ER secondary to right AF IR osseous
position.
+ R ADT + L ADT
Note: Posterior Exterior Chained or PEC
+ L EDT + L ADT
+ R EDT + R ADT
L AF IR = R AF ER
R AF IR = L AF ER
KEY:
L = Left R = Right B = Bilateral + = Positive Test – = Negative Test
ADT = Adduction Drop Test SLR = Straight Leg Raise AF IR = Acetabular Femoral Internal Rotation
EDT = Extension Drop Test ↑ = Increased AF ER = Acetabular Femoral External Rotation
TR = Trunk Rotation Test ↓ = Decreased FA IR = Femoral Acetabular Internal Rotation
( ) = Patho Compensatory Issues FA ER = Femoral Acetabular External Rotation
FA ROM = Femoral Acetabular Range of Motion

MYOKINEMATIC RESTORATION TESTS
NON PATHO-COMPENSATORY TEST

PRI TESTS RESULTS OF A LEFT AIC PATTERN
Adduction Drop Test Positive Left

(unable to adduct left side)
Positive Left
Extension Drop Test (unable to extend left femur to neutral)
Straight Leg Raise L SLR

Lef SLR (see pg 41)
Trunk Rotation Limited Right Trunk Rotation

(leg rotation to the left)
* L FA IR ROM
Femoral Acetabular (FA) R.O.M. (compared to right)
* R FA ER ROM
(compared to left)
FA Neuromuscular Control Positive Left TFL
Hruska Adduction Lift Test < Level 2 Right Hruska Adduction Lift
Test (patient lying on their left side)
Hruska Abduction Lift Test < Level 2 Right Hruska Abduction Lift
Test (patient lying on their left side)
D c a d FA IR a c a d . Pa abd c d
in a Left AIC pattern or L AF ER position when placed in a seated state with legs directly in front of
a ac a .T hit ac ab
upon FA IR.
Decreased right FA ER may also reflect the seated test position. A Left AIC patterned individual
with a Right AF IR positioned pelvis the right femur will be in an adducted state with the legs
d c a a d a .T impinge a ,
and medial acetabular rim upon FA ER.
G. Hruska Adduction Lift Test

This test is used as a Myokinematic measurement with each grade reflecting muscle position,
strength, and neuromuscular abili . T a d , c ac d a
shoulder. (Patient is lying on their left side with righ a ac d a d
R Hruska Adduction Lift Test.)
Position
1) Patient sidelying back rounded
2) Uppermost lower extremity resting on therapists shoulder (neutral hip, extended knee)
3) Lower leg in flexed position
4) Maintain pelvis in a neutral position (do not allow upper pelvis to rotate forward or
backward)
Mechanics
1) Step 1: ask patient to raise ankle of flexed lower leg to upper knee
2) Step 2: have patient raise flexed lower knee while keeping ankle to the knee
3) Step 3: patient will then raise lower hip while maintaining the above positions
4) Discontinue test at the step patient is unable to perform
Grading Criteria
LEVEL 0
Inability to raise lower ankle off mat or table
Obturator weakness of flexed extremity
LEVEL 1
Ability to raise lower ankle to upper knee
Inability reflects either weakness of FA external

rotators or AF stability of active extremity

LEVEL 2
Ability to raise lower knee and ankle
Inability reflects instability of AF and weakness of

adductor magnus and obturators or an anterior tilted
and forwardly rotated pelvis with accompanying FA
IR weakness secondary to long position of
ischiochondylar adductor and short position of
gluteus minimus, medius and TFL)
LEVEL 3
Ability to maintain above position while lifting
lower hip off table slightly
Inability reflects weakness of FA stabilizers on

extended extremity including the short head of the
biceps femoris and adductor magnus and possibly
bilateral AF stabilizers including muscles of the
pelvic diaphragm and lower gluteus maximus
LEVEL 4
Ability to raise hip completely off mat or table to

a d a d a d
Inability reflects lack of core lumbopelvic femoral

strength and more than likely the internal obliques on
side of the flexed leg and external obliques on side of
the extended leg
LEVEL 5
Ability to raise hip above level of the patients

shoulder and equal to examiners shoulder
I ab c a a d
proprioceptive skills to shift hips

H. Hruska Abduction Lift Test

This test is used as a Myokinematic measurement with each grade reflecting muscle position, strength,
kinesthetic awareness, and neuromuscular ability. The test is named for the leg, which is placed on the wall.
(Patient is lying on their left side with right foot placed on the wall R Hruska Abduction Lift Test.)
Position
1) Patient sidelying with upper leg extended and aligned with hip and shoulder.
2) Adjust position of knees to wall, so that top knee is above the level of the ipsilateral
shoulder.
3) Lower leg is flexed with lower toes positioned on the wall directly under the top foot and
ac d 4 6 b .
4) Top palm should be placed flat on surface in front of chest and upper hand under head.
Mechanics (Discontinue test at the step the patient is unable to perform)

1) Step 1: ask patient to press bottom toes into wall to stabilize pelvis
2) Step 2: instruct patient to press bottom hip into the surface to engage lower abs and lower
adductors
3) Step 3: ask patient to turn and raise bottom knee up or inwardly using lower ischiocondylar
adductor and anterior gluteus medius, without moving top hip backwards.
4) Step 4: turn top heel up or top toes down without lowering bottom knee or moving top hip
forward.
5) Step 5: attempt to raise top leg off wall while trunk and hips are stabilized in previous
positions.
Grading Criteria
LEVEL 0
Inability to position top leg in alignment with top

shoulder and hip and with top knee above top
shoulder without experiencing top hip impingement,
sacral iliac pain or low back pain.
Malaligned pelvis and poor integration of adductors,

abductors and FA rotators in frontal plane.
LEVEL 1
Ability to push bottom hip into surface.
Inability reflects weakness in bottom internal

oblique and transversus abdominis or bottom
quadratus lumborum or top external obliques.

LEVEL 2
Ab a b nee without
moving top pelvis backwards.
Inability reflects poor strength or kinesthetic

awareness of ischiocondylar adductor or anterior
gluteus medius; or lax iliofemoral pubofemoral
ligament.
LEVEL 3
Ability to rotate top extremity inward (FA IR)

without moving top pelvis forward.
Inability reflects poor strength or kinesthetic

awareness of ipsilateral gluteus minimus and anterior
gluteus medius, or impingement of medial femoral
head on anterior medial cotyloid labral rim
secondary to forward, anteriorly rotated contralateral
pelvis.
LEVEL 4
Ability to raise top leg completely off the wall and

hold without using lateral trunk muscle.
Inability reflects poor integration between

contralateral hip adductors, and ipsilateral hip
abductor (gluteus medius).
LEVEL 5
Ability to move correctly abducted top lower

extremity into extension without extending low back
or flexing knee or rotating leg externally (FA ER).
Inability reflects inability to extend leg with gluteus

maximus during concomitant abduction and FA
ab a d d b add c (IR ) a d
anterior gluteus medius and TFL.

Influence of an anterior & forward positioned

ef a e eg e g
In a non patho-compensatory Left AIC pattern, you will more than likely see decreased left leg
length, compared to the right.
If you see increased left leg length, compared to the right, this is usually associated with a patho-
compensatory Left AIC pattern.
References:
1) Cooperstein R, Lew M. The relationship between pelvic torsion and anatomical leg length inequality: a
review of the literature. Journal of Chiropractic Medicine. 2009;8:107-118.
2) Cummings G, Scholz JP, Barnes K. The effect of imposed leg length difference on pelvic bone symmetry.
Spine. 1993;18(3):368-373.
3) Juhl JH, Ippolito Cremin TM, Russell G. Prevalence of frontal plane pelvic postural asymmetry part 1.
JAOA. 2004;104(10):411-421.
4) Karski T, Karski J. The biomechanical aetiology of the so-called idiopathic scoliosis. The role of gait and
a di g a ea e he igh leg i he de el e f he def i . Surgical Science. 2014;5:33-38.
5) Klein KK, Buckley JC. Asymmetries of growth in the pelvis and legs of growing children. ACTJ.
1968;22(2):53-55.
6) Nourbakhsh MR, Arab AM. Relationship between mechanical factors and incidence of low back pain.
JOSPT. 2002;32(9):447-460
7) Rothbart BA. Relationship of functional leg-length discrepancy to abnormal pronation. Journal of the
American Podiatric Medical Association. 2006;96(6):499-504.

Treatment considerations
Can They Adduct?

(Are they Neutral?)
NO YES
Reposition
Can they Adduct? HAdLT 3/5

YES
HAbLT 3/5
NO
YES NO
Consider Need for

Inhibition Standing Unsupported NWB or Standing
Left Posterior Capsule PRI Non-Manual Supported PRI Non-
Right Adductor Techniques Manual Techniques
Left TFL
HAdLT > 4/5 HAdLT 3/5

Can they Adduct? HAbLT > 4/5 HAbLT 3/5
NO YES NO
YES NO
Reassessment Alternating Standing

Reciprocal PRI Unsupported
Needed
Non-Manual Integration PRI Non- Reassessment
Techniques Manual Techniques Needed

Myokinematic Restoration An Integrated Approach To Patterned Lumbo-Pelvic-Femoral Pathomechanics
Myokinematic Hierarchy of Lumbo-Pelvic-Femoral

Control For the Left AIC Patient
(+ Left Adduction Drop Test, + Left Extension Drop Test)
1) Bicep Femoris (ER/EXT) repositions (left side on a L AIC patient)
2) Gluteus Maximus (ER) obturator (right side on a L AIC patient) Right

HOLE
Obturator
3) Adductor Magnus (ER) obturator (right side on a L AIC patient) Control
4) Anterior Gluteus Medius (IR) (left side on a L AIC patient)
5) Ischiocondylar Adductor (IR) (left side on a L AIC patient)
6) Semimembranosus / Semitendinosus (IR) (left side on a L AIC patient)
Left AIC (Non Pathological) - Who ARE THEY?

1) Right SI Strain
2) Hip Bursitis
3) Tibial Stress Fractures or Shin Splints
4) Hip Impingement Syndrome
5) Pubalgia
6) Hamstring Pulls
7) Anterior Knee Pain or PFP

Left AIC (Non Pathological) Treatment Hierarchy Examples

1) Bicep Femoris (ER/EXT)
a. 90-90 Hip Lift (pg 16)
b. 90-90 Hip Lift with Medial Hamstring (pg 17)
c. 90-90 Supported Hip Lift with Hemibridge (pg 2)
a b c
2) Gluteus Maximus (ER)

a. Supine Hooklying Resisted Right Glute Max with Right AF ER (pg 31)
b. Left Sidelying Right Glute Max (pg 32)
c. Standing Supported Right Knee Flexion with Left Hip Approximation (pg 36)
d. All Four Right Glute Max (pg 38)
a b c d
3) Adductor Magnus (ER)

a. Left Sidelying Supported Right Glute Max with Right Hip Extension and Right FA ER (pg
34)
b. Left Sidelying Supported Right Glute Max with Hip Extension and FA Abduction (pg 35)
c. Standing Wall Supported Left Knee Flexion with Resisted Right Glute Max (pg 38)
a b c

4) Anterior Gluteus Medius (IR)

a. Right Sidelying Supported Left Glute Med (pg 39)
b. Left Sidelying Knee Toward Knee with Balloon (pg 40)
c. Step Around (pg 42)
d. Standing Resisted Trunk Around with Left AF IR and Right Trunk Rotation (pg 43)
a b c d
5) Ischiocondylar Adductor (IR)

a. Right Sidelying Respiratory Resisted Left Adductor Pull Back (pg 26)
b. Left Sidelying Foot Toward Foot (pg 28)
c. Seated Left Adductor Pull Back (pg 29)
d. Single Leg Left Hip Approximation (pg 30)
a b c d
6) Semimembranosus / Semitendinosus (IR)

a. Standing Left AF IR Lunge in High Guard (pg 19)
b. Standing Supported Right Knee Flexion with Weighted Left Proximal Hamstring (pg 21)
c. Standing Left Lift with Right Trunk Rotation (pg 22)
d. Retro Stairs with Resisted Glute Max (pg 23)
a b c d

Myokinematic Hierarchy of Ipsilateral FA Instability

For the Left AIC Patient Secondary to Pubofemoral /
Iliofemoral Laxity
(+ Left Adduction Drop Test, — Left Extension Drop Test)
1) Bicep femoris (ER/EXT) - repositions
2) Ischiocondylar adductor (IR)
3) Anterior gluteus medius (IR)
4) Gluteus maximus (ER) obturator N d HOLE Ob a F a n

Control on Both Sides (Begin with
Left Side)
5) Adductor magnus (ER) obturator
6) Semimembranosus / semitendinosus (IR)
Left AIC (Pathological) - Who ARE THEY?

1) Left SI Strain
2) Hip Impingement Syndrome
3) Snapping Hip Syndrome
4) Pelvic Floor Pain
5) Vulvodynia
6) Dyspareunia

Left AIC (Pathological) Treatment Hierarchy Examples

1) Bicep Femoris (ER/EXT)
a. 90-90 Hip Lift with Hip Shift (pg 2)
b. 90-90 Supported Hip Lift with Hemibridge (pg 2)
c. 90-90 Supported Hip Shift with Hemibridge and Balloon (pg 2)
a b c
2) Ischiocondylar Adductor (IR)

a. Sidelying Respiratory Scissor Slides (pg 25)
b. Right Sidelying Respiratory Left Adductor Pull Back (pg 26)
c. Left Sidelying Knee to Knee (pg 27)
d. Standing Supported Right Glute Max with Left Hip Approximation and Left FA IR (pg 30)
a b c d
3) Anterior Gluteus Medius (IR)

a. Right Sidelying Supported Left Glute Med (pg 39)
b. Right Sidelying Supported Hemi 90-90 with Left FA IR (pg 39)
c. Left Sidelying Left Flexed FA Adduction with Right Extended FA Abduction and Left
Abdominal Co-Activation (pg 41)
d. Standing Supported Left AF IR with Right FA Abduction (pg 43)
a b c d

4) Gluteus Maximus (ER)

a. 90-90 Resisted Right Glute Max with Right FA ER (pg 31)
b. Left Sidelying Knee Toward Knee (pg 33)
c. Retro Stairs (pg 35)
d. Standing Supported Right Knee Flexion with Left Hip Extension (pg 37)
a b c d
5) Adductor Magnus (ER)

a. Left Sidelying Knee Toward Knee (pg 33)
b. Left Sidelying Supported Right Glute Max with Hip Extension and FA Abduction (pg
35)
c. Standing Wall Supported Left Knee Flexion with Resisted Right Glute Max (pg 38)
a b c
6) Semimembranosus / Semitendinosus (IR)

a. Supine Hooklying Supported Resisted Right Glute Max with Left Glute Med (pg 42)
b. Standing Supported Right Glute Max with Resisted Left Hamstring (pg 20)
c. Standing Supported Right Glute Max with Left Hip Approximation and Left FA IR (pg 30)
d. Standing Supported Right Knee Flexion with Weighted Left Hamstring and Right Trunk
Rotation (pg 24)
a b c d

PRI Standing Unsupported Integration Non-Manual

Technique Examples
a. Standing Left AF IR with Resisted Left Arm Pull Down and Right FA Abduction (pg 62)
b. Right Lateral Walking (pg 63)
c. Left Stance Reciprocal Step Through (pg 64)
a b c
PRI Alternating Reciprocal Non-Manual Technique Examples

a. Heel Stair Descents (pg 65)
b. Retro Walking (pg 66)
c. Decline Retro Walking (pg 67)
a b c

Myokinematic Restoration Inhibition Programs

(The inhibition programs below are highly recommended for Myokinematic Restoration programs)
1) Left Tensor Fascia Latae (TFL) Inhibition

a. 90-90 Hip Lift (pg 44)
b. Supine Hooklying Synchronized Resisted Glute Max (pg 46)
c. Right Sidelying Left Anterior Glute Med with TFL Inhibition (pg 47)
d. Prone FA Abduction Alternating Reciprocal Hamstring Curls (pg 47)
a b c d
Consider using these recommended inhibition techniques if the patient:

* Activates their TFL before or after repositioning with FA IR
* Is engaging their TFL with any PRI non-manual technique progression
2) Right Adductor Inhibition

a. Supine Hooklying Adductor Magnus Inhibition (pg 48)
b. Supine Right Adductor Magnus Stretch (pg 48)
c. Left Sidelying Right Extended FA Abduction and Left Abdominal Co-Activation (pg 49)
d. Standing Left Knee Flexion in Right FA Abducted Position (pg 49)
a b c d

* Is unable to find and feel left adductor
* Has decreased right FA ER
* Over activates right adductor when attempting to adduct the left femur during level 2 of the
HAdLT

3) Left Posterior Capsule Inhibition

a. All Four Right Glute Maximus (pg 52)
b. Standing Posterior Capsule Stretch (pg 52)
c. Standing Wall Supported Ischial Femoral Ligamentous Stretch (pg 53)
d. Standing Supported Respiratory Left AF IR (pg 54)
e. Sidelying Obturator Restorative Technique (pg 55)
f. Left Sidelying Left Ischial Femoral Ligamentous Stretch with Left FA Adduction (pg 55)
a b c d
e f

* Has decreased left FA IR
* Has < 1 HAdLT, <1 HAbLT

4) Right Inferior Gluteus Maximus Inhibition

a. All Four Inferior Glute Max, Adductor Magnus and Quadratus Femoris Stretch
(pg 56)
b. Modified All Four Inferior Glute Max, Adductor Magnus and Quadratus Femoris Stretch
(pg 56)
a b

* Has decreased right FA ER
* Has < 1 HAdLT
5) Plantar Flexor Inhibition

a. Squatting Bar Reach (pg 57)
b. Standing Gastrocnemius and Soleus Stretch (pg 57)
c. All Four Belly Lift Walk (pg 58)
d. Long Seated Hamstring Stretch (pg 59)
e. Supine Supported Straight Leg Raise Alternating Crossovers (pg 60)
f. Seated Resisted Serratus Punch with Left Hamstrings (pg 61)
a b c
d e f

* Has decreased bilateral FA ER
* Over activates their plantar flexors with PRI non-manual techniques
* Has a positive Thomas test after repositioning
* Has an early heel rise during gait
* Has decreased dorsiflexion ROM

Notes:

Appendix – Myokinematic Restoration
Appendix
Myokinematic Restoration Repositioning Techniques ................................................................2
Protonics® Neuromuscular System .............................................................................................4
Left AF IR Positioning Program ..................................................................................................6
Left AF IR Recommendations & Desirable Position of Activity ................................................11
PRI Right AIC Alternating Reciprocal Gait Recommendations .................................................15
Myokinematic Restoration Non-Manual Techniques
Left Hamstring ...................................................................................................................... 16
Left Ischiocondylar Adductor ............................................................................................... 25
Right Gluteus Maximus ........................................................................................................ 31
Left Gluteus Medius ............................................................................................................. 39
Myokinematic Restoration Inhibition Techniques

Left Hip Flexor ..................................................................................................................... 44
Left Tensor Fascia Latae (TFL) ............................................................................................ 46
Right Adductor ..................................................................................................................... 48
Right Quadratus Lumborum and Left Psoas ......................................................................... 50
Left Posterior Capsule........................................................................................................... 52
Right Inferior Gluteus Maximus ........................................................................................... 56
Plantar Flexor ........................................................................................................................ 57
Integration and Alternating Reciprocal Non-Manual Techniques ...................................................62
Lower Quadrant Myokinematic Restoration Problem Solving....................................................68

Positional Influences of a Left AIC on Femoral Stabilizers and Gait..........................................76
Capsuloligamentous Issues Related to Positional Asymmetry &
Malaligned Muscle of Left AIC Pattern ......................................................................................77
Additional Assessment Tests .......................................................................................................79
Refining Your Ability to Execute An Accurate HAdLT by Michael Cantrell ............................81
Avoiding the Initial Pitfalls in the Management of the Patient with
FA Instability by Jennifer Poulin and James Anderson ..............................................................87
Kinetic and Kinematic Issues Related to Pelvic-Femoral Dysfunction .......................................90
Left AIC Related Pathomechanics
Piriformis Syndrome ............................................................................................................. 91
Sacro-Iliac Strain .................................................................................................................. 94
Hip Bursitis ........................................................................................................................... 95
Osteitis Pubis (Pubalgia) ....................................................................................................... 96
Tibial Stress Fractures........................................................................................................... 97
Hamstring Strains ................................................................................................................. 98
References ....................................................................................................................................101
Medically Informed Consent (Example)......................................................................................112
PRI Evaluation Form ...................................................................................................................113
Copyright © 2000-2017 Postural Restoration Institute® 1
Appendix Myokinematic Restoration
MYOKINEMATIC Restoration REPOSITIONING
90-90 Hip Lift With hip shift

1. Lie on your back with your feet flat on a wall and your knees and hips bent at a
90-degree angle.
2. Place a 4-6 inch ball between your knees.
3. Inhale through your nose and exhale through your mouth, performing a pelvic tilt
so that your tailbone is raised slightly off the mat. Keep your back flat on the mat.
4. As you maintain a hip lift, shift your left hip down and your right hip up so that
your right knee is slightly above the left.
5. Slowly take your bent right leg on and off the wall so that your right thigh comes
toward your chest. You should feel the muscles behind your left thigh and left inner thigh engage.
6. Perform 3 sets of 10 repetitions, 1-2 times a day.
90-90 Supported Hip Lift with hemibridge

90-degree angle.
2. Inhale through your nose and as you exhale through your mouth, perform a
pelvic tilt so that your tailbone is raised slightly off the mat. Keep your low
back flat on the mat. Do not press your feet flat into the wall instead dig down
with your heels.
3. Maintain the pelvic tilt with your left leg on the wall and straighten your right
leg.
4. Slowly take your straight right leg on and off the wall as you breathe in through
your nose and out through your mouth. You should feel the muscles behind
your left thigh engage.
5. Perform 3 sets of 10 repetitions.
90-90 Supported Hip Shift With Hemibridge and balloon

90-degree angle.
3. Place your right arm above your head and a balloon in your left hand.
4. Inhale through your nose and as you exhale through your mouth, perform a
pelvic tilt so that your tailbone is raised slightly off the mat. Keep your low
back flat on the mat. Do not press your feet flat into the wall instead dig down
with your heels.
5. Shift your left knee down so that it is below the level of your right without
moving your feet and press your left knee into the ball. You should feel your left inner thigh engage.
6. With your left knee shifted down, take your right foot off the wall. You should feel the back of your left
thigh engage. Maintain this position for the remainder of the exercise.
7. Now inhale through your nose and slowly blow out into the balloon.
8. Pause three seconds with your tongue on the roof of your mouth to prevent airflow out of the balloon.
9. Without pinching the neck of the balloon and keeping your tongue on the roof of your mouth, inhale again
through your nose.
10. Slowly blow out as you stabilize the balloon with your hand.
11. Do not strain your neck or cheeks as you blow.
12. After the fourth breath in, pinch the balloon neck and remove it from your mouth. Let the air out of the
balloon.
13. Relax and repeat the sequence 4 more times.

Right Sidelying Respiratory Left Adductor Pull Back

1. Lie on your right side with your feet on a wall with your
hips and knees at a 90-degree angle, ankles and knees
together and your back rounded. Place a pillow under your
head and keep your back and neck relaxed.
2. Place an appropriate size bolster between your feet and a
towel between your knees. Your left knee should be lower
than your left hip and ankle.
3. Push your right foot into wall.
4. Begin by inhaling slowly through your nose as you pull
back your left leg.
5. Exhale through your mouth as you squeeze your left knee down into the towel for 3 seconds.
6. Inhale again as you pull back your left leg further. You should begin to feel your left inner thigh engage.
7. Exhale and squeeze your left knee down.
8. Continue the sequence until you have completed 4-5 breaths in and out. Attempt to pull back your left leg
further each time you inhale.
9. Relax your knees back to the starting position and repeat the sequence 4 more times.
Left Sidelying Resisted Right Glute Max

1. Lie on your left side with your hips and knees bent at a 60-90-degree angle.
2. Place your ankles on top of a 3-5 inch bolster and place your feet firmly on a
wall.
3. Place tubing around both thighs slightly above your knees.
4. Shift your right hip forward until you feel a slight stretch or pull in your left
outside hip.
5. Keeping your feet on the wall, raise your right knee keeping it shifted
forward. You should feel your right outside hip (buttock) engage.
6. Hold this position while you take 4-5 deep breaths, in through your nose and
out through your mouth.
7. Relax and repeat 4 more times.

Protonics® Curls with Medial Hamstring

I designed and patented the Protonics® neuromuscular system in 1995 to provide programmable
resistance to the left hamstring for pelvic-femoral repositioning. Research, using Protonics®,
confirmed significant improvement in function and reduction of pain in subjects with
patellofemoral (femoral-patellar) pain.
– Ron Hruska
Repositioning
It is suggested that these activities be performed in the order as listed below. Place the system on the
LEFT leg and set the system to a ___. Perform 15 repetitions of each. Repeat 3-4 times a day.
Prone Hamstring Curl

Lie on your stomach with a pillow under your lower ribs, a
towel under your left lower thigh to keep the hip in neutral
alignment and a bolster between your thighs. Turn your left
thigh inward and pull your heel toward your buttocks. Lower
the leg slowly until your knee is fully extended (straight).
Repeat.
Supine Hamstring Curl

Lie on your back with your left leg over the edge of a bed or
table and your right leg bent up and resting. Place a small towel
under your left lower thigh and a bolster between your left thigh
and right foot. Turn your left thigh inward. Maintain this
position as you straighten the left knee and then bend it back
again moving the heel toward the floor and underneath the
buttocks if possible. Repeat.
Seated Hamstring Curl

Sit with your legs over the edge of a mat or chair and a ball
between your knees. Keep your knees at the level of the hip or
slightly higher by placing a small towel under your left thigh.
Allow your back to round slightly as you turn your left thigh
inward and pull your heel toward your buttocks. Slowly
straighten your leg. Repeat

Standing Hamstring Curl

Stand on your right leg with your back slightly rounded. Rotate
or turn your left leg inward. Raise your left heel toward your
buttocks keeping your thighs in line with each other and your
shoulders directly above your hips. Lower your leg slowly until
your knee is fully straight. Repeat.
Block Side Stepping

Place Protonics on left leg with setting at ___. Stand sideways with your left foot next to a 4 / 6 / 8 inch
block. Perform 5 standing hamstring curls with left leg. Keep your left thigh neutral as you pull your leg
back and place your left foot on the outer edge and top of the block. Step up, lift right foot and place it
next to other foot. Slowly lower right foot to the floor. Step down with your left leg. Always keep left
foot behind the right. Repeat ___ times.
Step Over
Place Protonics on left leg with setting at ___. Stand facing a 4 / 6 / 8 inch block. Pull back left leg at the
knee as you place your left foot on the top of the block. Step up and lift right foot to top of block. Then
slowly lower right foot to floor. Step down with your left leg. Step back up to the top of the block, going
backwards, with left leg. Lift right foot to the top of the block. Lower right foot behind block. Step
down with left leg. Repeat ___ times.
Lateral Step Up
Place Protonics on left leg with setting at ___. Advance sideways up the stairs leading with left leg.
Remember to pull back left leg at the knee before advancing up to the next step. Keep left foot behind the
right. Keep feet parallel to each other or stay neutral at the hip. Try to place both feet flat on respective
steps prior to hip movement. Advance sideways down the stairs with right leg. Perform ___ flights (10
to 12 steps in a flight of stairs), up and down, ___times a day.
Forward Stair Descents / Backward Stair Ascents

Place Protonics system on left leg with setting at ___. Advance up the stairs backward. Remember to pull
back left leg at the knee before advancing up to the next step. Then go down the stairs facing forward.
Keep your feet neutral or parallel with each other. Try to place both feet flat on respective steps prior to
advancing up or down each step. Take your opposite hand to most flexed knee with each step. Perform
___ flights (10 to 12 steps in a flight of stairs) up and down, ___ times a day.
Retraining / Walking
Following two exercise sessions a day, wear the Protonics system at a resistance level of ___ during
activities of daily living for a period of 1 to 2 hours.
The Protonics® system is intended for use during occupational and home environmental
activity for retraining. Therefore, it is not recommended for use during long walks,
recreational running, retraining periods longer than 2 hours, or more than 8 hours of total
retraining during a 24-hour period.

LEFT AF IR POSITIONING PROGRAM

Seated Legs Crossed
When in a seated
position keep your trunk
rounded and your knees
at or above hip level.
For increased comfort,
place a small bolster
underneath your left
thigh and shift your left
knee back.
If you prefer to cross your legs,

attempt to cross your right leg over
your left more so than your left over
your right.
Sleeping Standing
Stand on your left

as you place your
right foot out in
front of you and
shift back onto
your left hip as far
as you can,
comfortably, by
rotating your
pelvis, not your
trunk.
Occasionally stand
on your right leg
If you sleep on your left side, place a
and shift your
pillow under your waist and one to two
pelvis to the left
pillows between your knees.
while displacing
If you sleep on your right side, place a
weight evenly
pillow under your waist and one to two
through both legs.
pillows between your ankles.

Driving
When driving a car, sit with your back

supported so that your trunk remains slightly
rounded.
Shift your left knee behind your right and
turn your left thigh inward.
Working at a Desk When working at a desk we

encourage you to keep your back
supported so that your trunk
remains slightly rounded
When writing with your right
hand, we suggest that you sit with
your trunk slightly side bent to the
left and keep your left shoulder
lower than your right.
When writing with your left hand,
we suggest that you keep your
trunk neutral and upright as you
support your right shoulder and
arm on the writing surface.
Standing FROM CHAIR
When standing up from a

chair, first scoot to the
edge of the chair and shift
your left knee behind your
right.
As you begin to stand start
to turn your trunk towards
the left by reaching with
your right hand towards
your left knee. Your left
arm will be behind you
helping push you up from
the chair.
Continue to stand up
keeping your trunk turned Scoot Shift Turn Stand
towards the left and your
left knee shifted behind
your right.
.

Reaching
While reaching for something we suggest that you first place your right
foot in front of you and shift back onto your left hip.
Keep your right shoulder behind your left and attempt to reach with your
left hand.
Getting On a Bicycle
If you are mounting the right side of the bike we suggest you hike your left leg up above the level
of your right and then begin to swing your left leg over the seat of the bike.
To position yourself in the seat, we suggest that you bring your left foot off the ground first and
position your left foot in or on the left pedal.
As you are placing your foot on the pedal, begin to bring your bottom back on the seat.
If you are mounting the left side of the bike it is recommended that you lift your right knee in
front of you creating a 90-90 position with your trunk and your thigh.
Now bring your right leg over the bar in the middle and plant your right foot down on the ground.
To position yourself in the seat, we suggest that you bring your left foot off the ground first and
position your left foot in or on the left pedal.
As you are placing your foot on the pedal, begin to bring your bottom back on the seat.

Getting Into a Car
When getting in a car on the drivers side, we suggest that you first slightly shift your left knee behind your
right.
Keeping your left foot on the ground, begin to bring your right leg into the car as you keep your trunk slightly
oriented to the left.
Now bring your left leg into the car next to the right.
When driving, we encourage you to keep your left foot planted firmly on the floor board of the car and your
left knee shifted behind your right. It is best if your seat remains in an upright position.
When getting into a car on the passengers side, we suggest that you first slightly shift your left hip back.
Keeping your right foot planted on the ground begin to bring your left foot into the car as you also begin
to orient your trunk to the left.
When riding, we recommend that you keep your left knee shifted behind your right. It is best if your
seat remains in an upright position.

Getting Into Bed
When positioning yourself on the right side of the bed, we suggest that you first sit on the edge of the
bed, and shift your left knee behind your right.
Begin to lie down on your back as you simultaneously swing your legs up to the bed.
Now roll to the left keeping your knees bent.
When positioning yourself on the right side of the bed, we suggest that you first sit on the edge of
the bed and shift your left knee behind your right.
Begin to lie down on your left side as you simultaneously swing your legs up to the bed.
Now roll to the right keeping your knees bent.

Left AF IR RECOMMENDATIONS
1. 90-90 Hip Shift With Medial

Hamstring & Left Adductor 4. Scissor Slides
2. Retro Stairs
3. Dynamic Edge 5. Sidelying Knee to Knee

6. Seated Scissor Slides
7. Sit Stand Hip Shift with Tubing
8. Sit Stand Hip Shift Without Tubing

DESIRABLE SEQUENCE OF ACTIVITY

* Indicates most desirable dynamic state without functional failure
1) L AF IR / L FA IR L AF IR / R FA IR L AF IR / *R FAER
2) R AF ER / R FA IR R AF ER / *L FA IR R AF ER / L FA ER
TERMINOLOGY KEY FOR Technique DESCRIPTIONS

R = Right L = Left B = Bilateral
AF = Acetabular Femoral FA = Femoral Acetabular TR = Trunk Rotation
IR = Internal Rotation ER = External Rotation NR = Neutral Rotation
TF = Tibial Femoral FT = Femoral Tibial TL = Thoracic Lumbar
TT = Talo Tibial EV = Eversion
ADD = Adduction ABD = Abduction = Integration
FLEX = Flexion EXT = Extension
Le e eceding / = P i i n Le e f ll ing / = Ac i n
When n / e i = Ac i n = Next step

3) L AF ER / L FA IR L AF ER / *R FA IR L AF ER / R FA ER
4) R AF IR / R FA IR R AF IR / L FA IR R AF IR / *L FA ER

PRI Right AIC Alternating Reciprocal Gait Recommendations
1. Lead with the left arm and the right leg when moving forward. Remember to move both
the left arm with the right leg and the right arm with the left leg.
2. Hit each heel as you strike the ground and try to push off with your great toes on each
side as your foot leaves the ground.
3. Wear shoes that have good arch support and find and feel your right arch with each step
you take on the right side.
4. Occasionally take a smaller step with the left leg than the right or a larger step with the
right leg than the left. Remember this would include moving the left arm forward more
than the right or the right arm backward more than the left.
5. Walk and weave. Move from the left side of the sidewalk to the right and vice versa.
6. If you feel the need to walk clockwise, remember to focus on feeling the right shoe arch
and take a greater swing with the left arm as the right leg moves forward and your body
weight shifts over the left leg.
7. If you feel the need to walk counter-clockwise, remember to heel strike and push off with
the great toe on the left side. As the right knee comes up, when the left foot is on the
ground, move the left elbow to the right knee slightly more and raise the right knee
slightly higher than you would on the other side.
Trunk
Trunk
Hips
Hips
R L
L R

Appendix – Left Hamstring
Left Hamstring
90-90 Hip Lift
(Left Hamstring – Supine #1)
1. Lie on your back with your feet flat on a wall and your knees and hips bent at a 90-degree angle.
3. Inhale through your nose and exhale through your mouth, performing a pelvic tilt so that your
tailbone is raised slightly off the mat. Keep your back flat on the mat. Do not press your feet into the
wall, instead dig down with your heels. You should feel the muscles on the back of your thighs
engage.
4. Hold this position while you take 4-5 deep breaths, in through your nose and out through your mouth.
90-90 Hip Lift with Hip Shift (B AF EXT / L AF IR FA ADD)

tailbone is raised slightly off the mat. Keep your back flat on the mat.
4. As you maintain a hip lift, shift your left hip down and your right hip up so that your right knee is
slightly above the left.
5. Slowly take your bent right leg on and off the wall so that your right thigh comes toward your chest.
You should feel the muscles behind your left thigh and left inner thigh engage.

90-90 Hip Lift with Medial Hamstring

3. Move your left foot and ankle slightly outward while gently squeezing the ball.
4. Inhale through your nose and as you exhale through your mouth perform a pelvic tilt so that your
tailbone is raised slightly off the mat. Keep your back flat on the mat. Do not press your feet flat into
the wall instead dig down with your heels.
5. Slowly take your bent right leg on and off the wall so that your right thigh comes toward your chest.
You should feel the muscles behind your left thigh, left inner thigh and left outer hip (buttock)
engage.
90-90 Supported Hip Lift with Hemibridge

2. Inhale through your nose and as you exhale through your mouth, perform a pelvic tilt so that your
tailbone is raised slightly off the mat. Keep your low back flat on the mat. Do not press your feet flat
into the wall instead dig down with your heels.
3. Maintain the pelvic tilt with your left leg on the wall and straighten your right leg.
4. Slowly take your straight right leg on and off the wall as you breathe in through your nose and out
through your mouth. You should feel the muscles behind your left thigh engage.

90-90 Supported Hip Shift with Hemibridge and Balloon

5. Shift your left knee down so that it is below the level of your right without moving your feet and
press your left knee into the ball. You should feel your left inner thigh engage.
6. With your left knee shifted down, take your right foot off the wall. You should feel the back of your
left thigh engage. Maintain this position for the remainder of the exercise.
9. Without pinching the neck of the balloon and keeping your tongue on the roof of your mouth, inhale
again through your nose.
12. After the fourth breath in, pinch the balloon neck and remove it from your mouth. Let the air out of
the balloon.

Standing Left AF IR Lunge in High Guard

(Left Hamstring – Standing #2)
1. Place your right knee on a 6-10 inch block and your left leg in front of the block with your knee and
hip bent and foot flat.
2. Raise both arms slightly below shoulder height with your elbows bent at a 90-degree angle and keep
your forearms together.
3. Bring your right heel to the floor as you lift your knee off the block.
4. Attempting to keep your right heel down (as much as possible), shift your body weight forward onto
your left leg as you bring your right knee toward the block.
5. Keeping your back rounded, rotate your trunk to the left by moving your left arm away from your
right. You should feel the muscles on the front of your left thigh and left outer hip (buttock) engage.
Option:
1. Perform steps 1-5.
2. Bring your left arm back to your right.
3. Slowly shift back as your right knee moves away from the block.
4. Continue lunging forward and back until you have performed 10 repetitions.

Standing Supported Right Glute Max with Resisted Left Hamstring

(R FA IR / L AF IR EXT)
1. Anchor tubing around a stable structure, and place the other end around your left ankle.
2. Round your back and place both hands on a firm surface.
3. Turn your right foot in at a 45-degree angle, and shift your body weight onto your right leg.
Maintaining contact with your right arch, slightly bend your right knee.
4. Hike your left leg up as if you were pulling your left foot out of mud. You should feel your left inner
thigh engage.
5. Slightly pull back your left leg without using your back. You should feel the muscles on the back of
your left thigh and right outside hip (buttock) engage.
6. Hold the above position as you inhale slowly through your nose, and gently push your left hand down
into the surface.
7. Maintain the position of your left hand and exhale through your mouth as you gently press your right
hand down into the surface.
8. Continue this process for 4 more breaths always pressing down with your left on inhalation and down
with the right on exhalation.
9. Relax and repeat the entire sequence 4 more times.
R = Exhalation
L = Inhalation

Standing Supported Right Knee Flexion with Weighted Left Proximal Hamstring
1. Stand against a desk or counter, and place your right foot on a 2-inch block and a
3-5 lb. ankle weight around your left ankle.
2. Place your hands on the surface in front of you and round your back.
3. Maintaining contact with your right shoe arch, begin to straighten your right knee as you raise your
left foot off the floor.
4. Keeping your left leg straight, hike your left hip up above the level of your right. Your left foot will
be higher than your right. You should feel your left inner thigh engage.
5. Keeping your left hip hiked, bring your left thigh back and bend your left knee. You should feel the
back of your left thigh engage.
6. Maintaining the above position, squat down by bending your right knee. You should feel the muscles
on the front of your right thigh and right outer hip (buttock) engage.
7. Staying in the right squat position and keeping your left hip hiked and thigh pulled back, straighten
and bend your left knee 10 times. You should feel the muscles on the back of your left thigh engage.

Standing Left Lift with Right Trunk Rotation

1. Sit on a stable surface so your hips are higher than your knees.
2. Straighten your right leg, and bend your left knee at a 90-degree angle. Shift your left hip back.
3. Round your back and reach forward and to the right with both hands.
4. Maintaining the above position, push yourself up off the surface using your left leg by pushing
through your left mid-foot/heel. Stay as steady as possible until you have cleared the surface and keep
your left hip back. You should feel the muscles on the front of your left thigh and left outer hip
(buttock) engage.
Attempt to fill or expand your left upper back with air on each inhalation.
6. Slowly lower yourself back down to the surface.

Retro Stairs with Resisted Glute Max

1. Stand with your heels in front of 6-inch stairs, and place a band above your knees.
2. Advance your right foot on the first step, turn your heel slightly out and firmly place your entire foot
flat on the step.
3. Shift your right hip back as you place weight through your right arch. Your zipper line should be
lined up over your right great toe.
4. Push through your right mid-foot and arch to slowly raise your left foot off of the ground, keeping
your left toes pointed straight or slightly inward.
5. Continue to slowly raise your left foot as you feel the top of your right thigh and right outside hip
(buttock) engage.
6. Advance your left foot to the step behind you keeping your right thigh and outside hip (buttock)
engaged.
7. Place your left toes down first and then make contact with your heel.
8. Shift your left hip back as you place weight through your left mid-foot/heel. You should feel a stretch
in your left outside hip (buttock).
10. Advance your right foot to the step your left foot is on by pushing through your left mid-foot/heel.
You should feel your left outside hip (buttock) engage.
11. Repeat the entire sequence until you have completed 10-12 steps.
12. Relax and perform 1-2 more times.

Standing Supported Right Knee Flexion with Weighted Left Hamstring and Right Trunk
Rotation
1. Place your right foot on a 2-inch block and a 3-5 lb. ankle weight around your left ankle.
2. Place a dowel or stick in your left hand, and round your back as you reach back with your right hand.
5. Keeping your left hip hiked, bring your left thigh back and bend your left knee. You should feel the
muscles on the back of your left thigh engage.
6. Without letting your left hip drop, turn your left lower leg out to the side. You should feel the
muscles on your left outside hip (buttock) engage.
7. Maintaining the above position, squat down by bending your right knee. You should feel the muscles
on the front of your right thigh and right outside hip (buttock) engage.

Appendix Left Ischiocondylar Adductor
Left Ischiocondylar Adductor
Sidelying Respiratory Scissor Slides

(Left Ischiocondylar Adductor – Sidelying #1)
Right Sidelying
1. Lie on your right side with your hips and knees bent at a 90-degree angle, and place a ball between
your knees.
2. Press your right foot slightly into the wall.
3. Inhale through your nose and gently slide your left leg back without letting your trunk rotate back.
4. Exhale through your mouth as you gently push your left knee down into the ball.
5. Inhale again and slide your left leg back further.
6. Exhale and squeeze into the ball again.
7. Repeat this sequence until you have taken a total of 4-5 breaths, in through your nose and out through
your mouth.
Left Sidelying
1. Lie on your left side with your hips and knees bent at a 90-degree angle, and place a ball between
your knees.
2. Press your left foot slightly into the wall.
3. Inhale through your nose, and as you exhale through your mouth gently slide your right leg forward
without letting your trunk rotate forward.
4. As you maintain the above position, inhale through your nose as you gently push your left leg up into
the ball.
5. Exhale again and slide your right leg forward further.
6. Inhale and squeeze your left leg into the ball.
7. Repeat this sequence until you have taken a total of 4-5 breaths, in through your nose and out through
your mouth.

Right Sidelying Respiratory Left Adductor Pull Back

1. Lie on your right side with your feet on a wall with your hips and knees at a 90-degree angle, ankles
and knees together and your back rounded. Place a pillow under your head and keep your back and
neck relaxed.
2. Place an appropriate size bolster between your feet and a towel between your knees. Your left knee
should be lower than your left hip and ankle.
3. Push your right foot into wall.
4. Begin by inhaling slowly through your nose as you pull back your left leg.
6. Inhale again as you pull back your left leg further. You should begin to feel your left inner thigh
engage.
8. Continue the sequence until you have completed 4-5 breaths in and out. Attempt to pull back your
left leg further each time you inhale.
Right Sidelying Respiratory Resisted Left Adductor Pull Back

(R AF NR / FA EXT L AF IR L FA ADD)
1. Lie on your right side with your feet on a wall, hips and knees at a 90-degree angle, ankles and knees
together and your back rounded. Place a pillow under your head and keep back and neck relaxed.
3. Place tubing around your left leg just below your knee for resistance. Have another person hold the
other end to provide resistance.
4. Push your right foot into the wall.
engage.

Left Sidelying Knee To Knee (R AF NR / FA ER L FA IR)

1. Lie on your left side with your hips and knees bent at a 90-degree angle, your feet on the wall, knees
together and back rounded. Place a pillow under your head and keep your back and neck relaxed.
2. Place a small bolster underneath your ankles.
3. Push your bottom foot into the wall.
4. Lif o n o o e high.
5. Then lif o n in o lower thigh to the point of touching your upper thigh. You should feel
your left inner thigh and left outer hip (buttock) engage.
6. Hold your left thigh up to your right thigh while you take 4-5 deep breaths, in through your nose and
(R AF ER / FA ER L FA IR) (R AF IR / FA ER L FA IR)
Shift right knee forward and repeat above. Shift right knee back and repeat above.

Left Sidelying Foot Toward Foot

1. Lie on your left side and place a 2-3 inch bolster under your left abdominal wall. Place a pillow under
your head and keep your back and neck relaxed.
2. Place your right foot on a stool about 13 inches in height and your left foot underneath it.
3. Your shoulder, hip, knee and ankle should all be lined up.
4. Reach your right leg down toward the wall and press your left hip down into the mat. You should
feel your left abdominal wall engage as you pull up away from the towel roll.
5. While keeping your abdominals engaged, turn your left leg in so that your toes are towards the ceiling
and raise your left leg off of the mat. You should feel your left inner thigh engage.
Left Sidelying IO/TA and Left Adductor with Right Glute Max
(R AF ER / FA ER L FA IR FA ADD)
1. Lie on your left side with your left leg straight.
2. Place a 2-3 inch towel under your left side and 1-2 pillows under your head so that your neck is
slightly sidebent to the right.
3. Bend your right leg and cross it over your left leg.
4. Place your right foot slightly ahead of your left knee and drop the inside of your right foot toward the
mat so that you can feel the arch of your foot push into your shoe.
5. Push your left hip down into the mat so that your right hip moves toward the wall. You should feel
your left abdominals engage as you lift up away from the towel roll. With your right hand you can
feel your left abdominals engage. Do not engage your neck.
6. Keeping your right arch in contact with the mat, shift your right knee and hip forward and turn your
right knee out. You should feel your right outside hip (buttock) engage.
7. Keeping your left hip down and right knee turned out, turn your left leg in so that your toes are
towards the ceiling and pick your entire leg up. You should feel your left inner thigh engage.

Left Sidelying Supported Left Flexed FA Adduction with Right Extended FA Abduction (L
AF IR / FA IR R FA IR FA ABD)
1. Lie on your left side with your right leg straight and your left leg bent at a 60-degree angle. Your
right shoulder, hip, knee and ankle will be lined up.
2. Place 2-3 pillows under your head so that your head is slightly sidebent to the right.
3. Place your left foot on a 2-3 inch bolster with your foot pressing into the wall and a small bolster
underneath your left side.
4. Sligh l ai e o lef knee off of he floo b ning o high in o b hing your left foot
into the wall and using it as a pivot point. You should feel your left inner thigh and left outer hip
(buttock) engage.
5. Keep your left knee raised from the floor and turn your right leg in.
6. Attempt to take your right foot off of the wall. You should feel your right outside hip (buttock)
engage.
7. Hold this position while you take 4-5 deep breaths, in through the nose and out through the mouth.
Seated Left Adductor Pull Back

(Left Ischiocondylar Adductor – Seated #3)
1. Sit in a chair with your knees at or above hip level and
round out your back.
2. Place a ball between your knees.
3. Round out your back and roll your pelvis back, feeling
o i bone .
4. Without moving your feet, shift your left knee back or
your right knee forward. You should feel the back of
5. Keeping your left knee shifted back, gently press your
left knee into the ball. You should feel the muscles in
your left inner thigh engage.
6. Hold this position while you take 4-5 breaths, in
through your nose and out through your mouth.

Single Leg Left Hip Approximation

(Left Ischiocondylar Adductor – Standing #4)
1. Place a 3-5 lb. ankle weight around your left
ankle and place your right foot on a 2-4 inch
block with your right knee bent.
2. Shift your weight over to your right leg as you
slowly pull up or hike up your left leg. Your left
foot should now be slightly higher than your right
foot, and your trunk should be sidebent to the
left. Maintain contact with your right shoe arch
and keep your right knee slightly bent.
3. Maintaining the above position, turn your left leg
slightly inward. You should feel your left inner
thigh, left outer hip (buttock) and left abdominals
engage.
4. Hold this position while you take 4-5 deep
breaths, in through your nose and out through
your mouth.
Standing Supported Right Glute Max with Left Hip Approximation and Left FA IR
(Left Ischiocondylar Adductor – Standing #11)
1. Stand against a desk or counter and place your right foot on a 2-inch block.
5. Sidebend to the left and bend your left knee. You should feel your left abdominals and the back of
6. Maintaining this position, slowly bring your left lower leg out to the side and back in 10 times feeling
your left outer hip (buttock) engage. You should also continue to feel your left inner thigh, back of
your left thigh and right outer hip (buttock) muscles engaged.

Appendix – Right Gluteus Maximus
Right Gluteus Maximus
90-90 Resisted Right Glute Max with Right FA ER

(Right Gluteus Maximus – Supine #2)
1. Lie on your back with your feet on a wall and knees and hips bent at a 90-degree angle.
2. Place tubing around your thighs (just below your knees) and a 4-5 inch ball between your ankles.
4. Maintain a pelvic tilt and shift your right knee up (your right knee should be slightly higher than
your left).
5. Squeeze the ball with your ankles and turn your right thigh out. You should feel your right
outside hip (buttock) engage.
6. Hold this position while you take 4-5 deep breaths, in through your nose and out through your
mouth.
Supine Hooklying Resisted Right Glute Max with Right AF ER

(Right Gluteus Maximus – Supine #7)
1. Lie on your back and place your feet on a 2-inch block against the wall.
2. Place a band around your knees and a ball between your ankles.
4. Maintaining a pelvic tilt, shift your left knee down below the level of your right. You should feel
your left inner thigh engage.
5. Keeping your left inner thigh engaged and your right foot flat on the block, turn your right knee
out. You should feel your right outside hip (buttock) engage.
6. Hold this position while you take 4-5 breaths, in through your nose and out through your mouth.

Left Sidelying Right Glute Max (L AF IR / R FA ER)

(Right Gluteus Maximus – Sidelying #4)
1. Lie on your left side with your feet on the wall and your hips and knees bent at a 90-degree angle.
Keep your back rounded.
2. Place a small towel roll under your ankles and left abdominals.
3. Press your left hip down into the table so that your right hip moves toward the wall. You should
feel your left abdominals engage as you lift up away from the towel roll.
4. Shift your right hip forward until you feel a slight stretch or pull in your left outside hip (buttock).
5. Turn your right knee out keeping your left knee on the mat. Use the wall as a fulcrum or pivot
point for leg rotation.
6. Turn your knee as high as you can without moving your right hip back. You should feel your
right outside hip (buttock) engage.
mouth.

Left Sidelying Knee Toward Knee

1. Lie on your left side with your hips and knees at a 90-degree angle, your feet on the wall, knees
2. Place a small bolster under your ankles and under your left side.
3. Press your left hip down into the table so that your right hip moves toward the wall. You should
feel your left abdominals engage as you lift up away from the towel roll.
4. Push your bottom foot into the wall and shift your right knee forward so that it is ahead of your
left.
5. Keeping your right knee shifted forward and your left hip down, lift up or turn out your upper
thigh. You should feel your right outside hip (buttock) engage.
6. Then lift up or turn in your lower thigh high enough that is clears the mat but not to the point of
touching your right knee. You should feel your left inner thigh and left outer hip (buttock)
engage.
7. Hold this position as you take 4-5 deep breaths, in through your nose and out through your
mouth.

Left Sidelying Left Adductor with Resisted Right Glute Max (L AF IR / R FA ER)
1. Lie on your left side with your feet on the wall, hips and knees at a 90-degree angle. Place a 4-6
inch bolster under your ankles. Place a pillow under your head and keep your back and neck
relaxed.
2. Place tubing around both thighs.
3. Press your feet into the wall and shift your right knee forward ahead of your left knee.
4. Keep your right knee shifted forward and slowly raise your right leg by turning your thigh
outward. You should feel the outside of your right hip (buttock) engage.
5. Note: If you now do not feel the muscles of your left inner thigh, raise your left knee slightly off
the mat.
mouth.
Left Sidelying Supported Right Glute Max with Right Hip Extension and Right FA ER
(R AF NR / FA ER)
1. Lie on your left side with your left hip and knee bent at a 90-degree angle resting in front of you.
Place a pillow(s) under your right lower leg.
2. Reach your right hand forward towards your left knee so that your right hip moves forward over
your left hip.
3. Keep your right knee bent at a 90-degree angle and press your right foot/arch into the wall.
4. Keeping your right foot/arch on the wall, rotate your right thigh out by lifting your right knee
towards the ceiling. You should feel your right outside hip (buttock) engage.
5. Hold this position while you take 4-5 deep breaths, in through the nose and out through the
mouth.

Left Sidelying Supported Right Glute Max with Hip Extension and FA Abduction
(R AF NR / FA EXT ER)
1. Lie on your left side with your left hip and knee bent at a 90-degree angle.
2. Keep your right hip neutral (aligned with your body) and place your right lower leg on several
pillows or an appropriate size bolster. Your right knee will also be at a 90-degree angle.
3. Press your left foot into the wall and press your right knee into the wall.
4. Maintain the above position and rotate your right thigh out towards the ceiling. Lift your right
thigh up towards the ceiling. You should feel your right outside hip (buttock) engage. Your right
ankle should not move off the bolster.
5. Hold position as you take 4-5 deep breaths, in through your nose and out through your mouth.
Retro Stairs (R AF IR / AF NR)

(Right Gluteus Maximus – Standing #1)
1. Stand with your heels placed in front of 6-inch stairs and point your toes forward.
2. Advance your right foot on the first step keeping your feet neutral or parallel with
each other.
3. Shift your hip back and to the right as you place weight through your right mid-
foot/heel. Your zipper line should be lined up over your right great toe.
4. Keep your back rounded.
5. Begin lifting your left leg to the step keeping your weight shifted over to the right.
You should be using your right leg to advance yourself to the next step by pushing
slowly through your right mid-foot/heel.
6. Continue to advance up the stairs until you have completed 1 flight always leading
with your right foot. You should feel your right outer hip (buttock) engage.
7. Relax and perform 1-2 more flights (10-12 steps).

Standing Supported Right Knee Flexion with Left Hip Approximation

1. Stand against a desk or counter, and place your right foot on a 2-inch block.
3. Maintaining contact with your right arch, begin to straighten your right knee as you raise your left
foot off the floor.
4. Keeping your left leg straight, hike your left hip up above the level of your right as you sidebend
your trunk to the left. Your left foot will be higher than your right. You should feel your left
inner thigh engage.
5. Keeping your left hip hiked, slowly begin to lower your left foot toward the floor by bending your
right knee.
6. Continue lowering your left foot until it is about an inch from the floor. You should continue to
feel your left inner thigh, along with the muscles on the front of your right thigh and right outer
hip (buttock) engage.
mouth.

Standing Supported Right Knee Flexion with Left Hip Extension

1. Stand against a desk or counter, and place your right foot on a 2-inch block.
3. Maintaining contact with your right shoe arch, begin to straighten your right knee as you raise
your left foot off the floor.
4. Keeping your left leg straight, hike your left hip up above the level of your right. Your left foot
will be higher than your right. You should feel your left inner thigh engage.
5. Keeping your left hip hiked, bring your left thigh back and bend your left knee. You should feel
the muscles on the back of your left thigh engage.
6. Maintaining the above position, squat down by bending your right knee. You should feel the
muscles on the front of your right thigh and right outer hip (buttock) engage.
mouth.
Option:
1. Perform steps 1-6.
2. Straighten your right knee as you keep your left hip hiked and knee bent.
3. Continue to squat up and down on your right leg 10 times.

Standing Wall Supported Left Knee Flexion with Resisted Right Glute Max
(L AF IR / R FA ER)
1. Stand with your feet shoulder width apart and tubing
around your knees.
2. Place your right foot flat on the wall behind you.
3. Shift your right knee down and sidebend your trunk to the
left.
4. Maintaining the above position, press your right foot/arch
into the wall and rotate your right knee out against the
resistance of the band. You should feel the muscles on the
outside of your right hip (buttock) engage.
5. Keeping your right knee turned out, begin to squat down
by bending your left knee. Place your right hand on the
wall for stability. You should feel the muscles on the front
of your left thigh and left outer hip (buttock) engage.
6. Hold this position while you take 4-5 deep breaths, in
All Four Right Glute Max

(Right Gluteus Maximus – All Four #1)
1. Place a 1-2 inch folded towel under your left knee.
2. Position yourself on your hands and knees with your back rounded and your right side against the
wall.
3. Step forward with your right arm and right knee as you sidebend to the left. Keep your weight
forward and to the left. Your nose should be over your left index finger. You should feel your
left abdominals.
4. Maintaining this position, gently press your right knee into the wall. You should feel your right
outer hip (buttock) engage.
5. Hold this position for 4 to 5 breaths, in through your nose and out through your mouth.

Appendix – Left Gluteus Medius
Left Gluteus Medius
Right Sidelying Supported Left Glute Med (L AF IR / FA IR)

(Left Gluteus Medius – Sidelying #1)
1. Lie on your right side with your feet on a wall, hips and knees at a 90-degree angle and your back
rounded.
2. Place your lower arm or a pillow under your head and upper hand on the floor in front of you to help
stabilize your trunk.
5. Slide or shift your left hip back as far as you can without arching your back.
6. Press your left knee down into the ball. You should feel your left inner thigh engage.
7. Rotate your left thigh “in by lifting your left lower leg towards the ceiling. You should feel your left
8. Hold this position for 4-5 deep breaths, inhaling through your nose and exhaling through your mouth.
Right Sidelying Supported Hemi 90-90 with Left FA IR

1. Lie on your right side with your right hip and knee bent at a 90-degree angle and your right foot
placed on the wall.
2. Keep your left hip neutral and place your left knee on a bolster so that it is below the level of your left
hip.
3. Place your right arm or a pillow under your head and keep your back and neck relaxed.
4. Press your right foot into the wall.
5. Press your left knee down into the bolster feeling your left inner thigh engage.
6. With your right foot pushing into the wall and your left knee down, slowly raise your left lower leg
up towards the ceiling. You should feel the muscle on your left outer hip (buttock) engage.
7. Slowly lower and raise your left lower leg 10 times while keeping your left outer hip (buttock) muscle
engaged.

Left Sidelying Knee Toward Knee with Balloon

1. Lie on your left side with your hips and knees at a 90-degree angle, your feet on the wall, knees
Place a balloon in your right hand.
2. Place a small bolster under your ankles and under your left side.
3. Press your left hip down into the table so that your right hip moves toward the wall. You should feel
your left abdominals engage as you lift up away from the towel roll.
4. Push your bottom foot into the wall and shift your right knee forward so that it is ahead of your left.
5. Turn your right knee out or up, feeling your right outside hip (buttock) engage.
6. Turn your left knee up using your left inner thigh, left outer hip (buttock), and left abdominal wall
without touching your knees together. Don t use or tighten your neck, keep it relaxed.
7. Inhale through your nose and slowly blow out into the balloon.
10. Slowly blow out again as you stabilize the balloon with your hand.
12. After the fourth breath in, pinch the balloon neck, remove it from your mouth and let the air out.

Left Sidelying Left Flexed FA Adduction with Right Extended FA Abduction and Left
Abdominal Co-Activation (L AF IR / FA IR R FA ABD)
1. Lie on your left side and place a 2-3 inch bolster under your left abdominal wall and 1-2 pillows
under your head so that your neck is slightly sidebent to the right.
2. Place a crate or a stool that is about 13 inches in height under your right ankle and bend your left
knee. Your right ankle, hip and shoulder will be lined up.
3. Inhale through your nose and as you exhale through your mouth, reach down toward the wall with
your right leg.
4. Push your left hip down firmly into the mat and try to arch your left abdominal wall. You should feel
your left abdominal wall engage as you lift up away from the towel roll.
5. With your left abdominal wall engaged and your right leg reaching down, push the outside border of
your left foot down into the mat and “turn your left knee up. You should feel your left inner thigh
and left outer hip (buttock) engage.
6. With your left inner thigh engaged, attempt to pick your right foot off of the stool with your foot
turned out to the side. You should feel your right outer hip (buttock) engage.

Supine Hooklying Supported Resisted Right Glute Max with Left Glute Med
(R AF IR / FA ADD L FA FLEX FA IR)
(Left Gluteus Medius – Supine #6)
1. Lie on your back with your feet on a 2-inch block and your knees bent.
2. Place a ball between your knees and a band around your ankles.
4. Shift your left knee down towards you so that your left knee is slightly below your right, and press
your left knee into the ball. You should feel your left inner thigh engage.
5. Now lift your left foot off of the block. You should feel the back of your right leg and outside hip
(buttock) engage.
6. With your left foot off of the block, turn your left lower leg out to the side. You should feel your left
outer hip (buttock) engage.
Step Around (L AF NR / TR AF IR FA FLEX AF IR)

(Left Gluteus Medius – Standing #17)
1. Place your left foot on top of a 2 to 4-inch block. Step up and lift your right foot to the same position.
2. Slowly lower your right foot to floor in front of you with your toes pointed inward, forming a “T
with your right and left feet. Lower your left foot a step in front of your right foot.
3. Continue “stepping around with your right foot, forming a “T and following with your left foot,
placing it a step in front of the right. You should feel the muscles on your left outer hip (buttock).
4. Repeat in the same manner until you have reached the start position.
5. Relax and repeat this sequence 4 more times.

Standing Resisted Trunk Around with Left AF IR and Right Trunk Rotation
(L AF IR / R TR FA FLEX)
1. Stand with tubing in your left hand, facing
away from the door.
2. Shift your left hip back, and slightly bend both
knees. You should feel your left outer hip
(buttock) engage.
3. Keeping your left hip back and weight through
your left mid-foot/heel, begin to orient your
trunk to the right by reaching across the
midline of your body with your left hand. You
should feel your left abdominal wall engage.
4. Keeping your trunk turned to the right, raise
your right foot off of the ground. You should
feel the muscles on the front of your left thigh,
left outer hip (buttock) and left abdominals
engage.
5. Balance in this position while you take 4-5
deep breaths, in through your nose and out through your mouth.
Standing Supported Left AF IR with Right FA Abduction

1. Stand against a desk or counter, and place your left foot on a 1-2 inch block. Keep your weight
through your left mid-foot/heel.
3. Shift your left hip back, bend your left knee and pull your left knee in slightly. You should feel your
left outer hip (buttock) and left inner thigh engage.
4. Sidebend your trunk to the left so that your left shoulder is slightly below your right shoulder. You
should feel your left outer abdominals engage.
5. Maintaining the above position, turn your right ankle out to the side, finding contact with your right
shoe arch.
6. Pick your right foot up and lift it out to the side. Squat slightly, keeping your right foot lower than
your left. You should feel the muscles on the front of your left thigh, left outer hip (buttock), left
inner thigh and right outer hip (buttock) engage. If you are unable to feel your right outer hip
(buttock) engage, then rest your right shoe arch on the floor.
*To increase awareness of the left hip and leg support, remove your right hand from the support (picture 4).

Appendix Myokinematic Restoration Inhibition
Left Hip Flexor Inhibition

90-90 Hip Lift
(Left Hip Flexor Inhibition – Supine #2)
1. Lie on your back with your feet flat on a wall and your
knees and hips bent at a 90-degree angle.
3. Inhale through your nose and exhale through your
mouth, performing a pelvic tilt so that your tailbone is
raised slightly off the mat. Keep your back flat on the
mat. Do not press your feet into the wall, instead dig
down with your heels. You should feel the muscles on
the back of your thighs engage.
90-90 Supported Hip Shift with Hemibridge and Balloon

(Left Hip Flexor Inhibition – Supine #14)
5. Shift your left knee down so that it is below the level of your right without moving your feet and
press your left knee into the ball. You should feel your left inner thigh engage.
6. With your left knee shifted down, take your right foot off the wall. You should feel the back of your
left thigh engage. Maintain this position for the remainder of the exercise.
the balloon.

Paraspinal Release with Left Hamstrings

(Left Hip Flexor Inhibition – Long Seated #1)
1. Place both of your palms on a 3-4 inch block and place your feet directly in front of you.
2. Pull your shoulder blades down and together.
3. Dig both of your heels into the floor and push down with your arms lifting your hips off the floor.
You should feel the muscles on the back of your thighs and shoulder blades engage.
4. Once your hips are in the air, round your back by tucking your bottom up.
5. Continue to dig both of your heels into the floor as you move your hips slightly forward or away from
the block.
6. Keeping your hips forward and your shoulders pulled together, pick your right foot off the floor. You
should feel the back of your left thigh engage.

Left Tensor Fascia Latae (TFL) Inhibition
Supine Hooklying Synchronized Resisted Glute Max

(Left TFL Inhibition – Supine #4)
1. Lie on your back with your feet placed on a 2-inch block.
2. Place a band around your knees.
3. Start with your knees together and place your arms at your side with your elbows bent at a 90-degree
angle.
4. Inhale through your nose as you turn your knees and hands out to the side keeping your elbows at
your side.
5. Exhale through your mouth as you bring your knees and hands back together slowly. At the end of
exhalation, perform a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back
flat on the mat.
6. Continue the sequence of inhalation while bringing your hands and knees out and exhalation bringing
your hands and knees in.
7. Perform a pelvic tilt at the end of each exhalation.
8. Concentrate on filling your chest more with each inhalation using your diaphragm not your neck.
9. Relax and repeat this sequence 4 more times.
INHALATION
EXHALATION

Right Sidelying Left Anterior Glute Med with TFL Inhibition

(Left TFL Inhibition – Sidelying #3)
1. Lie on your right side with hips and knees bent at a 90-degree angle, supported by a firm surface.
2. Place yourself in a position where you feel a firm post, leg of a table, etc. behind your thighs.
3. Slightly raise your left knee up, maintaining a space between your knees.
4. Push the back of your left thigh into the surface. You should feel the back of your left thigh engage.
5. Push your right knee down into the floor by turning your thigh out. You should feel your right outside
6. As you maintain the above position, turn your left knee inward by raising your left lower leg up. You
should feel the outside of your left hip (buttock) engage.
Prone FA Abduction Alternating Reciprocal Hamstring Curls

(Left TFL Inhibition – Prone #3)
1. Lie on your stomach with pillows placed underneath your abdomen and a small rolled towel under
both thighs.
2. Place a band around your ankles and above your knees.
3. Place 3-5 lb. ankle weights around both ankles, and bend your knees to a 90-degree angle.
4. Move your knees out to the side against the resistance of the band.
5. Pull your left ankle back and towards the outside of your left hip as you reciprocally move your right
leg down towards the mat. You should feel the muscles on the back of your left thigh and left outside
7. Slowly lower your left leg as you reciprocally pull your right ankle back and towards your right
outside hip. You should feel the muscles on the back of your right thigh and right outside hip
(buttock) engage.

Right Adductor Inhibition
Supine Hooklying Adductor Magnus Inhibition

(Right Adductor Inhibition - Supine #1)
1. Lie on your back with your feet on a 2-inch block.
2. Place a bolster or an appropriate size pillow on your right side.
tailbone is raised slightly off the mat. Keep your back flat on the mat. You should feel the muscles on
4. Maintaining a pelvic tilt, let your right knee lower to the side until it reaches the bolster or pillows.
You should feel a stretch across your right inner thigh.
6. Let your left knee drop down to meet your right.
7. Keeping both legs together, slowly bring them upright as one unit.
Supine Adductor Magnus

(Right Adductor Inhibition - Supine #4)
2. Cross your right leg in front of your left so that your right ankle is resting on the front of your left
thigh.
3. Place both hands behind your left thigh and interlink your fingers.
4. Gently pull your left thigh towards you. You should feel a stretch in your right inner thigh and the
outside of your right hip (buttock).

Left Sidelying Right Extended FA Abduction and Left Abdominal Co-Activation

(Right Adductor Inhibition - Sidelying #5)
1. Lie on your left side and place a 2-3 inch bolster under your left abdominal wall and 1-2 pillows
under your head so that your neck is slightly sidebent to the right.
2. Place a crate or a stool that is about 13 inches in height under your right ankle and bend your left
knee. Your right ankle hip and shoulder will be lined up.
3. Inhale through your nose and as you exhale through your mouth reach your right leg down toward the
wall and press your left hip down into the mat. You should feel your left abdominal wall engage as
you pull up away from the towel roll.
4. Attempt to pick your right foot off of the stool with your foot/ankle turned out to the side. You
should feel your right outer hip (buttock) engage.
Standing Left Knee Flexion in Right FA Abducted Position

(Right Adductor Inhibition - Standing #7)
1. Stand with your feet shoulder width apart
and back rounded.
2. Shift your left hip back and bend your left
knee keeping your weight through your
left mid-foot/heel. Turn your left knee in
slightly. You should feel the muscles on
your left outer hip (buttock), left inner
thigh and the front of your left thigh
engage.
3. Sidebend your trunk to the left so your left
shoulder is slightly below your right. You
should feel your left abdominals engage.
4. Raise your right foot off the floor and turn
your right ankle out to the side, finding
contact with your right shoe arch.
5. Begin to move your right foot away from
your left, and place your right arch down
to the floor.
6. Reach forward with your left hand and back with your right as you begin to squat down by bending
your left knee. You should feel the muscles on the front of your left thigh, left outer hip (buttock),
left inner thigh and left abdominals engage. You will also feel a stretch in your right inner thigh.

Right Quadratus Lumborum and Left Psoas Inhibition
Supine Psoas and Rectus Femoris Stretch

(Right QL and Left Psoas Inhibition - Supine #1)
1. Lie on your back on an elevated surface with your right knee bent to your chest (hands grasped
behind your thigh) and left knee bent with your foot resting on the table.
2. Keeping a firm grip on your right thigh, lower your left leg over the elevated surface.
3. Press your left thigh into the table and bring your left heel back towards you by bending your knee.
You should feel a stretch on the front of your left thigh and hip.
Standing Supported Passive Left Hip Approximation

(Right QL and Left Psoas Inhibition - Standing #4)
1. Stand against a desk or counter, and place your left foot on a 2-inch block.
3. Keeping your back rounded, attempt to place an equal amount of weight through both legs as you
shift your left hip back and sidebend your trunk to the left. You should feel the muscles on the front
of your left thigh and left outer hip (buttock) engage.

Seated Supported Left AF IR with Right Psoas and Iliacus and Right FA ER
(Right QL and Left Psoas Inhibition - Seated #2)
1. Sit in a chair and place your feet flat on the floor. Your knees should be at or above the level of your
hips (you may need to place a block under your feet).
2. R d back a d ll el i back feeli g i b e.
3. Begin by shifting your left knee back so that it is behind your right. You should feel your left inner
thigh engage.
4. Slightly orient and sidebend your trunk to the left. You should feel your left abdominal wall engage.
5. Pick your right foot slightly off the floor and turn your right ankle inward (your thigh will turn
outward). You should feel the muscles on the front of your right hip engage.
6. With your left hand, reach towards your right knee, orienting your trunk to the right as you gently
press your left hand into your right knee.

Left Posterior Capsule Inhibition
All Four Right Glute Max

(Left Posterior Capsule Inhibition – All Four #1)
1. Place a 1-2 inch folded towel under your left knee.
2. Position yourself on your hands and knees with your back rounded and your right side
against the wall.
3. Step forward with your right arm and right knee as you sidebend to the left. Keep your
weight forward and to the left. Your nose should be over your left index finger. You should
feel your left abdominals.
4. Maintaining this position, gently press your right knee into the wall. You should feel your
right outer hip (buttock) engage.
5. Hold this position for 4 to 5 breaths, in through your nose and out through your mouth.
Standing Posterior Capsule Stretch

(Left Posterior Capsule Inhibition – Standing #1)
1. Place your left foot behind you on a 2 to 6-inch block or
step.
2. Keeping both feet flat, slowly shift your left hip back. Keep
your weight through your left mid-foot/heel.
3. Rotate your trunk to the left by reaching for your left knee
with your right hand. You should feel a stretch on the
outside of your left hip (buttock). Pull your left knee in
slightly and feel your left inner thigh engage.

Standing Wall Supported Ischial Femoral Ligamentous Stretch

1. Stand with your heels 7 to 10-inches away from a wall.
2. Place an appropriate size bolster between the upper most part of your thighs. The bolster should be
big enough that you are unable to touch your knees when attempting to bring them together.
3. Bring your arms out in front of you as you round out your back, performing a pelvic tilt so your lower
back is flat on the wall.
4. Keeping your lower back flat on the wall, shift your left hip back so that your left knee is behind your
right knee. You should feel the muscles on your left outer hip (buttock), left inner thigh and the top of
both thighs engage.
5. Inhale through your nose and as you exhale through your mouth, reach forward with both hands.
6. Inhale again and attempt to expand your upper back with air.
7. Exhale and reach further. You should feel a stretch on the outside of your left hip (buttock) and
through your upper back.
8. Repeat the breathing sequence until you have taken 4-5 breaths, in through your nose and out through
your mouth.
9. Slowly stand up and continue to squeeze the bolster as you push through your heels, keeping your
lower back flat on the wall.

Standing Supported Respiratory Left AF IR

1. Stand facing a table, desk or a counter top.
2. Place a 2-inch block underneath your left foot.
3. Place your right foot on the ground ahead of your left.
4. Round out your back and place forearms on the surface.
5. Shift your left hip back so that your pant zipper is towards your left big toe. You should feel a stretch
in your left outer hip (buttock). The majority of your weight should be on your left leg, through your
left mid-foot/heel.
6. Keeping your left hip back, inhale through your nose as you slightly squat by bending both knees.
7. Exhale through your mouth as you push through your left mid-foot/heel and straighten both knees.
You should feel the muscles on the front of your left thigh and left outer hip (buttock) engage.
8. Repeat this breathing sequence for a total of 4-5 deep breaths, in through your nose and out through
your mouth, slightly squatting with each inhalation and returning to the starting position on
exhalation.
Inhale Exhale

Sidelying Obturator Restorative Technique

(Left Posterior Capsule Inhibition - Sidelying #1)
1. Lie on your right side with your feet on a wall, ankles and knees together and your back rounded.
2. Place a pillow under your head and relax your neck and back.
3. Place an appropriate size bolster between your feet and between your thighs as close to the pubic
bone as possible. Your left hip and ankle should be lined up as well as your right hip and right ankle.
If not, adjust the size of the bolster(s).
4. Inhale slowly through your nose.
5. Exhale through your mouth as the therapist applies angled, downward pressure on your left knee
using both hands. Pause 4-5 seconds after exhaling. Note: You may experience significant discomfort
between your thighs when pressure is placed on your knee. This should decrease as the technique
continues.
6. Inhale again as you actively shift your left hip back.
7. Exhale as the therapist presses down again.
8. Continue this sequence until you have taken 4-5 deep breaths, in through your nose and out through
your mouth.
Position Exhalation Inhalation
Left Sidelying Left Ischial Femoral Ligamentous Stretch with Left FA Adduction
(Left Posterior Capsule Inhibition - Sidelying #10)
1. Lie on your left side with your right leg straight and your left
leg bent at a 60-degree angle.
2. Place a small bolster underneath your left knee and your left
abdominal wall.
3. Place your left foot flat on the wall and your right foot on the
wall. Turn your right foot/ankle out so that your right arch is
resting on the wall.
4. Keep right ankle, hip, and shoulder lined up.
5. Rotate your right hip forward until you feel a stretch in your
left outer hip (buttock). Your pant zipper will be toward your
left leg.
6. Keeping your right hip forward, lift your left knee off the
bolster. You should feel your left inner thigh engage.
7. Hold this position for 4 to 5 breaths, in through your nose and

Right Inferior Gluteus Maximus Inhibition
All Four Inferior Glute Max, Adductor Magnus and Quadratus

Femoris Stretch
(Right Inferior Gluteus Maximus Inhibition – All Four #1)
1. Position yourself on your hands and knees.
2. Keeping your right knee bent, straighten your left leg and turn your right ankle
in towards your left knee.
3. Continue to reach with your left leg as you keep your back rounded. You
should feel a stretch on the outside of your right hip (buttock).
Modified All Four Inferior Glute Max, Adductor Magnus and Quadratus Femoris Stretch
(Right Inferior Gluteus Maximus Inhibition – All Four #3)
1. Position yourself on your hands and knees.
2. Bend your right knee and cross your leg in front of your left thigh so that your right ankle is in front
of your left knee.
3. Lower yourself onto your forearms and straighten your left leg.
4. Keeping your back rounded, continue to reach back with your left leg until you feel a stretch on the
outside of your right hip (buttock).
*INCORRECT*
Do not roll your trunk to the
right or let your upper body
come all the way down.

Plantar Flexor Inhibition
S Bar Reach
(Plantar Flexor Inhibition – Standing #2)
1. Position yourself behind a door frame, and place the bar on the outside of the frame as pictured
above.
2. Keep your feet shoulder width apart and pointing straight ahead.
3. Round out your back as you tuck your bottom under you.
4. Keep your weight through your heels and hold onto the bar as you slowly squat down keeping your
back rounded. Squat as much as you can without letting your heels come off the floor.
5. Hold this position for 4-5 deep breaths in through your nose and out through your mouth. Attempt to
fill or expand your upper back chest wall with air on each inhalation.
6. On the final exhale, slowly stand up by pushing through your heels and keeping your back rounded.
Standing Gastrocnemius and Soleus Stretch

(Plantar Flexor Inhibition – Standing #4)
Gastrocnemius Stretch
1. Stand against a high counter or table top with your right leg in front of
you and your left leg behind you.
2. Straighten your left leg and slightly bend your right.
3. Keeping your left leg straight and your left heel on the floor, bend your
right knee until you feel a stretch on the back of your left calf muscle.
4. Hold this position while you take 4-5 deep breaths, in through your nose
and out through your mouth.
Soleus Stretch
1. Stand against a high counter or table top with your right leg in front of
you and your left leg behind you.
2. Slightly bend both your knees.
3. Keeping your left heel on the floor, bend both your knees further until
you feel a stretch on the upper part of your left calf muscle.
4. Hold this position while you take 4-5 deep breaths, in through your nose
and out through your mouth.

All Four Belly Lift Walk

(Plantar Flexor Inhibition – All Four #1)
1. Position yourself on your hands and knees with your back rounded.
2. Raise both knees off the ground simultaneously so they are straight and your back is round.
3. Sh e a d igh e abd mi al m cle a be d k ee a d alk fee cl e
your hands, taking small steps. Your hands should not move.
4. Maintain a contraction of your abdominal muscles in this short position with your back maximally
rounded.
5. Once you have gone as far as you can, hold the position while you take 4-5 deep breaths, in through
your nose and out through your mouth.

Long Seated Hamstring Stretch

(Plantar Flexor Inhibition – Long Seated #1)
1. Sit against the wall with hand weights placed under your hands and a bolster placed under your
ankles.
2. Pull your shoulder blades down and together.
3. As you keep your shoulder blades together, straighten your elbows and lift your bottom off the floor.
4. Keeping your bottom raised, bring your upper body forward.
5. Roll your legs forward and then back again towards the wall. You should feel a stretch on the back of
your thighs.

Supine Supported Straight Leg Raise Alternating Crossovers

(Plantar Flexor Inhibition – Supine #3)
1. Lie on your back with your knees bent and feet flat on a mat or the ground.
2. Inhale through your nose and exhale through your mouth, performing a pelvic tilt so that your tail
bone is raised slightly off the mat. Keep your back flat on the mat.
3. Maintaining the pelvic tilt, straighten out your right leg.
4. Raise your left arm straight up to the ceiling.
5. Inhale through your nose, keeping your ribcage down, then exhale through your mouth as you reach
towards your right leg with your left arm. You should feel the muscles on the back of your left thigh
and your abdominals engage.
6. Maintain this position and inhale again, filling your right chest wall.
7. Exhale and reach further towards your right foot with your left arm. Hold this position as you inhale
again.
8. Repeat breathing sequence once more then relax and repeat 2 more times.
9. Repeat on the other side switching to your left leg and right arm.

Seated Resisted Serratus Punch with Left Hamstrings

(Plantar Flexor Inhibition – Seated #1)
1. Sit in a chair with your feet flat and your knees at hip level.
2. Anchor a piece of tubing in a door slightly above the level of your head and position yourself so the
tubing is behind you.
3. Place the other end of the tubing in your right hand.
4. Dig your left heel into the floor. You should feel the muscles on the back of your left thigh engage.
5. Inhale through your nose and exhale through your mouth as you reach forward and down with your
right hand.
6. Hold this position and inhale again, filling the back of your right chest wall with air. Exhale and
reach forward further. You should feel the muscle underneath your right shoulder blade engage.
7. Continue this sequence for 3 breaths in and out, maintaining position as you inhale and reaching as
you exhale.

Appendix – Integration
Integration
Standing Left AF IR with Resisted Left Arm Pull Down and Right FA Abduction
(Integration – Standing #13)
1. Anchor a piece of tubing in the top of a door and hold onto the other end with your left hand.
2. Place a 2-inch block under your left foot.
3. Shift your left hip back and slightly bend your left knee. Keep your weight through your left mid-
foot/heel. You should feel the front of your left thigh and your left outer hip (buttock) engage.
4. Reach down towards the ground with your left hand as you sidebend your trunk to the left. You
should feel the muscles on your left abdominal wall engage.
5. Maintaining the above position, slightly bring your right foot out to the side as you turn your right
ankle out so that your right arch is toward the floor. You should feel the muscles on the outside of
your right hip (buttock) engage.
6. Hold this position while you take 4-5 breaths, in through your nose and out through your mouth.
*If you are unable to feel your right outer hip (buttock) on step #5, place your right arch down onto
the floor and maintain the left squat position, feeling your left outer hip (buttock), front of your left
thigh and left inner thigh engage. With your right arch resting on the floor, you should also feel a
stretch in your right inner thigh.

Right Lateral Walking

1. Shift your left hip back, slightly bend your left knee and sidebend your trunk to the left. You should
feel your left outer hip (buttock) and left abdominals engage.
2. Maintain this position as you lift your right foot off the ground and move it out away from the
midline of your body.
3. Place your right foot on the ground and pull your left knee in slightly. You should feel your left inner
thigh engage.
4. Pause and breathe.
5. Shift your body weight onto your right leg, and maintain contact with your right shoe arch as you lift
your left foot off of the ground. Slowly bring your left foot towards the midline of your body,
keeping your trunk sidebent to the left.
6. Continue this lateral sequence until you have taken 10 steps.

Left Stance Reciprocal Step Through

Option A
1. Stand as in picture #1 with your left foot on a 2-4 inch block. Be sure to look straight ahead during
this activity.
2. Shift your left hip back and pull your left knee in slightly. You should feel the muscles on your left
inner thigh and left outer hip (buttock) engage.
3. Sidebend your trunk to the left, feeling your left abdominal wall engage.
4. Keeping your left outer hip (buttock) muscle engaged, slowly bring your left arm and right leg back
as your right arm comes forward. Tap the ground with your right foot.
5. Pause, then slowly bring your right leg and left arm forward as your right arm goes back. Tap the
ground with your right foot.
6. Continue this sequence 10 times, keeping your left outer hip (buttock) muscle engaged.
Option B
1. Stand as in picture #3 with your left foot on a 2-4 inch block. Be sure to look straight ahead during
this activity.
2. Shift your left hip back, and pull your left knee in slightly. You should feel the muscles on your left
inner thigh and left outer hip (buttock) engage.
3. Sidebend your trunk to the left, feeling your left abdominal wall engage.
4. Keeping your left outer hip (buttock) muscle engaged, slowly bring your left arm and right leg
forward as your right arm goes back. Tap the ground with your right foot.
5. Pause, then slowly bring your right leg and left arm back as you bring your right arm forward. Tap
the ground with your right foot.
6. Continue this sequence 10 times keeping your left outer hip (buttock) muscle engaged.
1 2 3

Alternating Reciprocal Non-Manual Techniques
Heel Stair Descents

1. Stand at the top of the stairs and face backwards. Shift your left hip back.
2. Round your back and begin to bend your left knee as you bring your right leg behind you. Sidebend
your trunk to the left as you feel your left outer abdominals engage.
3. Continue to bend your left knee as you lower your right leg to the step below, leading with your right
heel, not your toes. Hold this position for 3-5 seconds. You should feel the muscles on the front of
your left thigh, left outer hip (buttock) and left abdominals engage.
4. Place your right heel down first and then your toes.
5. Lower your left leg down to the level of your right (or go back to the top step). Shift your right hip
back.
6. Round your back, and begin to bend your right knee as you bring your left leg behind you. Sidebend
your trunk to the right as you feel your right outer abdominals engage.
7. Continue to bend your right knee as you lower your left leg to the step below, leading with your left
heel, not your toes. Hold this position for 3-5 seconds. You should feel the muscles on the front of
your right thigh, right outer hip (buttock) and right abdominals.
8. Place your left heel down first and then your toes.
9. Alternate each leg until you have reached the bottom of the steps.
10. Relax and repeat 1-2 more times.

Retro Walking
(L AF IR / R FA EXT R FA IR AF IR / L FA EXT FA IR)
1. Stand with your feet shoulder width apart and place tubing around your ankles. This activity can also
be performed without a resistance band/tubing.
2. Round out your back.
3. Place your right foot forward and left arm forward, while your right arm is behind you.
4. Shift your left hip back and bend your left knee, keeping your weight through your left mid-foot/heel.
Sidebend your trunk to the left. You should feel your left outer hip (buttock) and left abdominals
engage.
5. Keeping your back rounded and left hip back, slowly bring your right leg out to the side and back
(making a half circle) with your right toes pointed straight ahead, as your right arm moves forward
and left arm back. Hold this position 3 seconds before placing your right foot on the floor. You
should feel your left outer hip (buttock), front of your left thigh and right outer hip (buttock) engage.
6. Place your right foot on the ground.
7. Shift your right hip back and bend your right knee, keeping your weight through your right mid-
foot/heel. Sidebend your trunk to the right. You should feel your right outer hip (buttock) and right
abdominals engage.
8. Keeping your back rounded and right hip back, bring your left leg out to the side and back (making a
half circle) with your left toes pointed straight ahead, as your left arm moves forward and right arm
back. Hold this position 3 seconds before placing your left foot on the floor. You should feel your
right outer hip (buttock), front of your right thigh and left outer hip (buttock) engage.
9. Repeat 4-6 steps backwards with each leg while inhaling through your nose and exhaling through
your mouth.

Decline Retro Walking

*Pictures reflect the end position of each phase of movement

Starting Position
Stand with your right foot in front of you and your left foot
behind you with your feet shoulder width apart. The
weight of your body should be on your right foot.
Bring your right arm behind you, and reach across the
midline of your body with your left arm. In this position
take a deep breath in.
1. As you exhale, begin to shift your body weight to your left as you
bring your right foot behind you, and reach across the midline of
your body with your right arm. Keep your back rounded as you
try to balance on your left leg.
Picture #1 should reflect the end position of this
movement. Once in this position take a breath in.
ON
Starting Position
1
2. Exhale and shift your weight to your right leg as you bring your left leg behind
you and your left arm reaching towards your right toes. Lower your body closer
to the ground when shifting to the right leg by bending your right knee further
than before. Keep your back rounded as you try to balance on your right leg.
Picture #2 should reflect the end position of this movement. Once in
this position take another breath in.
3. Exhale and shift your weight to the left leg as you bring your right leg behind you
and your right arm reaching towards your left toes. Lower yourself even further
to the ground than in step #2 by bending your left knee closer to the ground.
Keep your back rounded as you balance on your left leg.
Picture #3 should reflect the end position of this movement. Once in
this position take another breath in. ON ON
2 3
4. Continue the sequence above until your left hand is touching

your right toes with your weight on your right foot and your
back rounded.
In the final phase of movement, exhale as you shift to
your left, and bring your right leg behind you. Reach
across the midline of your body with your right hand
until you have touched your left toes. Keep your back
rounded as you try to balance on your left leg. Your
position should reflect picture #5.
ON 5. In this position take a deep breath as you exhale slowly, stand
ON up keeping your back rounded and your body weight on your
left foot.
4 5

LOWER QUADRANT
MYOKINEMATIC RESTORATION PROBLEM SOLVING
1. Inactive left hamstring, anteriorly rotated, forwardly tipped left hemipelvis
2. Limited right apical expansion secondary to inactive left abdominal obliques
3. Restricted left posterior hip capsule acceptance of femoral head
4. Weak left hip: gluteus medius and ischiocondylar adductor (L FA IR)
5. Weak left hip: gluteus medius (L FA IR)
6. Weak right hip: gluteus maximus (R FA ER)
7. Weak concomitant left adductor and right abductor
8. Inactive left abdominal oblique
9. Tight, restrictive, short, strong right adductor
10. Weak right hip: gluteus medius (R FA IR) with concomitant gluteus maximus
11. Restrictive right rectus femoris
12. Restrictive right psoas Limiting right hip extension after reposition
13. Restrictive right pectineus
14. Inability to shift hips to the left secondary to restricted left posterior capsule and tight left gluteus
maximus
15. Inability to rotate lumbar spine to the left secondary to weak right psoas and iliacus
(1) 90-90 Supported Hip Lift with Hemibridge (Left Hamstring – Supine #6)
1. Lie on your back with your feet flat on a wall and your knees and hips
bent at a 90-degree angle.
2. Inhale through your nose and as you exhale through your mouth,
perform a pelvic tilt so that your tailbone is raised slightly off the mat.
Keep your low back flat on the mat. Do not press your feet flat into the
wall instead dig down with your heels.
3. Maintain the pelvic tilt with your left leg on the wall and straighten
your right leg.
4. Slowly take your straight right leg on and off the wall as you breathe in
through your nose and out through your mouth. You should feel the
muscles behind your left thigh engage.
(2) 90-90 Hip Lift with Balloon (Left Hamstring – Supine #8)
1. Lie on your back with your feet flat on a wall and your knees
and hips bent at a 90-degree angle.
3. Place your right arm above your head and a balloon in your
left hand.
4. Inhale through your nose and exhale through your mouth,
performing a pelvic tilt so that your tailbone is raised slightly
off the mat. Keep your back flat on the mat. Do not press your
feet flat into the wall instead dig down with your heels. You
should feel the muscles on the back of your thighs engage.
5. Inhale through your nose and slowly blow out into the balloon.

7. Without pinching the neck of the balloon and keeping your tongue on the roof of your mouth, take
another breath in through your nose.
8. Slowly blow out again as you stabilize the balloon with your hand.
the balloon.
(3) Right Sidelying Respiratory Resisted Left Adductor Pull Back

1. Lie on your right side with your feet on a wall, hips and knees at a 90-degree angle, ankles and knees
together and your back rounded. Place a pillow under your head and keep back and neck relaxed.
3. Place tubing around your left leg just below your knee for resistance. Have another person hold the
other end to provide resistance.
engage.
(4) Left Sidelying Knee to Knee

1. Lie on your left side with your toes on the wall, knees together and back rounded.
2. Place a bolster underneath your ankles.
3. Push your bottom toes into the wall.
4. Lift up or turn out your upper thigh.
5. Then lift up or turn in your lower thigh. You should feel your left inner thigh engage.
6. Hold legs together while you take 4-5 deep breaths in through your nose and out through your mouth.

(5) Right Sidelying Supported Left Glute Med

1. Lie on your right side with your feet on a wall, hips and knees at a 90-degree angle and your back
rounded.
2. Place your lower arm or a pillow under your head and upper hand on the floor in front of you to help
stabilize your trunk.
5. Slide or shift your left hip back as far as you can without arching your back.
6. Press your left knee down into the ball. You should feel your left inner thigh engage.
7. Rotate your left thigh in by lifting your left lower leg towards the ceiling. You should feel your left
8. Hold this position for 4-5 deep breaths, inhaling through your nose and exhaling through your mouth.
(6) Left Sidelying Resisted Right Glute Max

1. Lie on your left side with your hips and knees bent at a 60-90-degree angle.
2. Place your ankles on top of a 3-5 inch bolster and place your feet firmly on a wall.
3. Place tubing around both thighs slightly above your knees.
4. Shift your right hip forward until you feel a slight stretch or pull in your left outside hip.
5. Keeping your feet on the wall, raise your right knee keeping it shifted forward. You should feel your
right outside hip (buttock) engage.

(7) Left Sideyling Supported Left Flexed FA Adduction with Right Extended FA
Abduction (Left Gluteus Medius – Sidelying #25)
1. Lie on your left side with your right leg straight and your left leg bent at a 60-degree angle. Your
right shoulder, hip, knee and ankle will be lined up.
2. Place 2-3 pillows under your head so that your head is slightly sidebent to the right.
3. Place your left foot on a 2-3 inch bolster with your foot pressing into the wall and a small bolster
underneath your left side.
4. Slightly raise your left knee off of the floor by turning your thigh in or by pushing your left foot
into the wall and using it as a pivot point. You should feel your left inner thigh and left outer hip
(buttock) engage.
5. Keep your left knee raised from the floor and turn your right leg in.
6. Attempt to take your right foot off of the wall. You should feel your right outside hip (buttock)
engage.
(8) 90-90 Supported Alternating Crossovers

(Right Quadratus Lumborum and Left Psoas Inhibition – Supine #2)
1. Lie on your back with your knees and hips bent at a 90-degree angle and feet on the wall.
2. Place a 3-4 inch bolster (towel roll) under your tailbone.
tailbone is raised slightly off the mat. Keep your back flat on the mat. Do not press your feet flat into
the wall instead dig down with your heels. You should feel the muscles on the back of your thighs
engage.
4. Place your right hand behind your head and place your left hand across your face touching your right
ear. Your elbow will be pointing straight up in the air.
5. Shift your right hip/knee up so that your right knee is slightly higher than your left.
6. Bring your right knee towards your left elbow.
7. Inhale through your nose and as you exhale through your mouth, rotate your upper body to the right
while keeping your right hip/knee shifted up.
8. Maintaining this position inhale again and exhale as you rotate your upper body back to midline and
replace your right foot on the wall.
9. Switch the position of your hand placement and repeat this exercise bringing your left foot off the
wall.
10. Continue from side to side until you have completed 2-3 sets of 10 on each side. Do not use your back
or neck.

(9) Supine Hooklying Adductor Magnus Inhibition

(Right Adductor Inhibition – Supine #1)
1. Lie on your back with your feet on a 2-inch block.
2. Place a bolster or an appropriate size pillow on your right side.
tailbone is raised slightly off the mat. Keep your back flat on the mat. You should feel the muscles on
4. Maintaining a pelvic tilt, let your right knee lower to the side until it reaches the bolster or pillows.
You should feel a stretch across your right inner thigh.
6. Let your left knee drop down to meet your right.
7. Keeping both legs together, slowly bring them upright as one unit.
(10) Left Sidelying Supported Right Glute Max with Right Hip Extension and Right FA IR
1. Lie on your left side with your left hip and knee bent at a 90-degree angle and rest it in front of you.
Place firm pillows or a bolster under your right lower leg. (Right ankle should be higher than your
right hip).
2. Reach your right hand forward towards your left knee so that your right hip moves forward over your
left hip.
4. While maintaining pressure of your right foot into the wall, rotate your right thigh in by gently
pressing your right knee into the pillows or bolster. You should feel your right outside hip (buttock)
engage.

(11) Supine Psoas and Rectus Femoris Stretch

(Right Quadratus Lumborum and Left Psoas Inhibition – Supine #1)
1. Lie on your back on an elevated surface with your left knee bent to your chest (hands grasped behind
thigh) and right knee bent with your foot resting on the table.
2. Keeping a firm grip on your left thigh, lower your right leg over the elevated surface.
3. Press your right thigh into the table and bring your right heel back towards you by bending your knee.
You should feel a stretch on the front of your right thigh and hip.
(12) Single Leg Stance with Contralateral Glute Max

1. Anchor a piece of tubing in a door or around a stable surface.
2. Stand facing the anchored tubing, and place the other end around your right
foot.
3. Place your left foot on a 2 to 4-inch block.
4. Slightly shift your weight over to your left side as you take your right foot off
the ground. You should feel your left outside hip (buttock) and left inner thigh
engage.
5. Now pull your right leg back towards your left heel keeping your right leg/toes
turned in. You should feel your right outside hip (buttock) engage.

(13) Left Sidelying Supported Right Glute Max with Right Hip Extension and Right FA
ER (Right Gluteus Maximus – Sidelying #16)
1. Lie on your left side with your left hip and knee bent at a 90-degree angle resting in front of you.
Place a pillow(s) under your right lower leg.
2. Reach your right hand forward towards your left knee so that your right hip moves forward over your
left hip.
4. Keeping your right foot/arch on the wall, rotate your right thigh out by lifting your right knee
towards the ceiling. You should feel your right outside hip (buttock) engage.
(14) Retro Stairs

1. Stand with your heels placed in front of 6-inch stairs and point your toes
forward.
2. Advance your left foot on the first step keeping your feet neutral or parallel
with each other.
3. Shift your hip back and to the left as you place your weight through your left
mid-foot/heel. Your zipper line should be lined up over your left great toe.
Keep your left knee pulled in slightly.
4. Keep your back rounded.
5. Begin lifting your right leg to the step keeping your weight shifted over to
the left. You should be using your left leg to advance yourself to the next
step by pushing slowly through your left mid-foot/heel.
6. Continue to advance up the stairs until you have completed 1 flight always
leading with your left foot. You should feel your left outer hip (buttock)
engage.
7. Relax and perform 1-2 more flights (10-12 steps).

(15) Seated Supported Left AF IR with Right Psoas and Iliacus and Right FA ER
(Right Quadratus Lumborum and Left Psoas Inhibition – Seated #2)
1. Sit in a chair and place your feet flat on the floor. Your knees should be at or above the level of your
hips (you may need to place a block under your feet).
2. Round out your back and roll your pelvis back feeling your sit bones.
3. Begin by shifting your left knee back so that it is behind your right. You should feel your left inner
thigh engage.
4. Slightly orient and sidebend your trunk to the left. You should feel your left abdominal wall engage.
5. Pick your right foot slightly off the floor and turn your right ankle inward (your thigh will turn
outward). You should feel the muscles on the front of your right hip engage.
6. With your left hand, reach towards your right knee, orienting your trunk to the right as you gently
press your left hand into your right knee.

Positional Influences of an Anterior & Forward

Positioned Left Innominate with Accompanying
Right Sacral Torsion (LEFT AIC) on Femoral
Stabilizers & Gait
1) Muscle function of the hip is dependent on:
Position in the range
Availability of motion of the proximal and distal segments
2) Adductors may be:

Flexors in the neutral hip joint
Extensors in the flexed hip joint
– Basmajian
3) Lateral rotators (iliopsoas, pectineus, adductor magnus) of the hip joint may become
medial rotators from a position of extreme medial rotation of the femur or extreme
hip flexion. – Kapandji
4) Lateral rotation of femur and tibia at midstance, terminal stance, and preswing (toe
off) is limited in extreme hip flexion.
5) S a c a ce e ca c ea e e -lordo e ef , ea ef
extensors, and dystonic left lower quadrant stabilizers.
6) P b e ac f c ea ed e - d :
Adaptive shortening of iliotibial band and iliopsoas
Increased tonic activity of tensor fascia latae and vastus lateralis at midstance,
terminal stance, preswing, initial swing, and midswing, in addition to
beginning stance and terminal swing phases
Increased vastus lateralis activity throughout all phases of gait
Increased iliopsoas at midswing, terminal swing, initial contact and loading, in
addition to stance and preswing phases
(Note: 1/3 of hip flexion movement results from posterior pelvic rotation. –
Elia 1996)
Overall decrease of gluteal activity
Decreased medial hamstring activity:
- From 18 to 28 percent of the stance phase (initial contact)
- From 40 to 58 percent of swing phase (midswing)
- In the last 20 percent of swing phase (terminal swing)
Increased anterior translation force of the proximal tibia without co-activation
of hamstrings and pelvic control
Overuse of plantar flexors, gastrocnemius, and soleus for hip extension
assistance

Capsuloligamentous Issues Related to Positional

Asymmetry & Malaligned Muscle of Left AIC
Pattern
Joints that are designed specifically for mobility are the synovial joints (hips, knees and elbows).
Mec a ece dec de e b d e e e e a a f c
and movement patterns.
If, over time, encoding is allowed to take place during static and dynamic activity, these
facilitators of proprioception assume that the patterns associated with a forward, anteriorly
rotated pelvis (AIC) are normal. Encoding of this faulty pattern is normalized and
neuromuscular adaptation begins.
When a prolonged increase in muscle length occurs the muscle spindles develop a higher
threshold for detecting changes in length and rate of change. With a left AIC, this occurs at the
left hamstring (because of the anterior tilt of the hemipelvis). In this lengthened position an
increase demand on motor efferent neurons develops in order to produce coordinated, smooth
movements (i.e. control).
The Golgi tendon organs, at the myotendinous junction of the left hamstring, become more
responsive to eccentric muscle action; while on the right it is more concentric. Activation causes
inhibition of synergists and antagonists (quadriceps) on the ipsilateral side and opposite reflex
action on the contralateral side.
The Ruffini endings in the fibrous layer (zona obicularis) of the right FA joint capsule are more
responsive to direction and speed of capsular stretch then on the left. This is because the
sensitivity of position changes, amplitude, and velocity of a joint is greatest where the
intracapsular fluid pressure is high. The Pancinian corpuscle become more active in joints where
stance phase or closed kinetic activity is high by responding rapidly to high velocity changes
(acceleration and deceleration) in joint position. Therefore, the Pancinian corpuscles are more
active in the right peripheral extremity joints (knee a d a e) a d e e ec e ca e
fibrous layers.
This increase in neural input on the right Golgi-Mazzoni corpuscles, found along the inner
surface of the FA capsule, and the respective Golgi ligament endings give the individual a better
sense of positional awareness and control. Therefore, patients with a left AIC often demonstrate
a right lower extremity dominance by increasing their right stance phase time during function
(increased right COG). This altered neuromuscular control (secondary to torsional
pathomechanics of the pelvis and weakness in the left hamstrings and gluteals) leads to muscle
inhibitions, weakness, and compensatory patterns involving other muscles. The CNS receives
this faulty sensory input from both FA joints and alters the neuromuscular function in other
segments of the kinetic chain so that daily activity can continue. In other words, this is an
example of how reflexive patterns of adaptation become a daily occurrence and over time can be
c de ed a b e e rological system (state of homeostasis).

Disturbances in joint position, perception, movement reflexes, and postural balance will be
evident in the clinical, myokinematic exam. Altered proprioception and abnormal
arthrokinematics increase over-compensatory activity of synergistic muscles around the joint to
minimize the stress, dyskinesia, injury, etc. This compensatory overuse of synergistic stabilizers
leads to compression and congruence breakdown of the joint, as well as malfunction of the
proximal stabilizers.
For one to establish normal FA, myosseous, rotary control during sagittal plane activity, feed
forward activation of the left hamstring (key repositioning muscle) needs to simultaneously
concur during left FA rotation. Rehabilitation and restoration activity must conclude with closed
kinetic chain activity.
Many continue to use rehabilitative strategies that accept high tone as an acceptable adaptive
strategy for muscle recruiting. The long-term consequences of premature muscle activation
(psoas), articular compressive degeneration (right FA joint), disuse atrophy (left gluteals), altered
joint reaction/balance, and delayed motor control lead to stronger faulty movement patterns and
reflexive adaptations.
Most joint afferent receptors are active only near the end of the range of motion thus probably
c b e ef e e a d a c ec a f e f e d fee .
Pelvic Floor Innervation

Integrated autonomic and voluntary nervous system innervation
Autonomic
Sympathetic hypogastric plexus
Parasympathetic sacral ganglia
Voluntary
Pudendal nerve
Obturator nerve
Femoral nerve

Additional Assessment Tests

A. Femoral Acetabular (FA) EXTENSION
1. Thomas Test
The patient is positioned in supine with each lower extremity (LE) extended. The LE
contralateral to the LE being tested is then flexed at the hip and knee, to bring the
thigh to the point that the lumber curve is flattened. According to Thomas, if a hip
extension limitation is present, the person will be unable to keep the tested LE fully
straightened.
2. Modified Thomas Test
The patient is positioned in supine with both thighs on the table. Both hips and knees
are flexed to the chest. Passively lower one leg over the edge of the table while
helping the patient hold the untested knee close enough to the chest to maintain the
low back against the table. Do not allow hip abduction to occur past zero degrees on
the tested extremity while passively dropping the FA joint into extension.
A positive test is indicated when the tested lower extremity (usually the left) is
restricted in hip extension because of the forward orientation of the tested side
compared to the other. If both femurs do not approach the edge of the mat or table the
patient is tested on, the innominates are rotated forward bilaterally and the psoas
ce ae ac . P ac e fe e a ac a ac e a e
femur in external rotation. This tightens the TFL and VL and restricts hip extension.
There is also a rotary component to this issue, especially seen with limitation in hip
extension on one side. Since the forward, anteriorly rotated pelvis accompanies sacral
rotation to the contralateral side (right rotation on a right oblique axis or left rotation
on a left oblique axis) the iliofemoral ligament will also limit extension when the
femur is externally rotated by the therapist, through testing with the femur in a
e a .
The femur in this case will not approach the patient support surface without femoral
e a a a d a ( e. c c ) f a e e fe a
head moving forward under the superior anterior condyloid labral rim of acetabulum.

3. Thomas TEST (with rectus femoris differential)
By flexing and extending the knee of the tested LE, one can determine if the test is
positive because of rectus length (one joint muscle structure vs. the two joint muscle
structures).
B. Femoral Acetabular (FA) Flexion
1. Ortolani
When the hip is flexed to a right angle and then abducted, the lateral aspect of the
thigh normally will reach or nearly touch the examining table and will form an angle
of almost 180 degrees if the other thigh is placed in a similar position at the same
time. If posterior subluxation of one or both hips is present (too much FA IR after
repositioning or with a neutral pelvis), abduction is distinctly limited, and the thigh
will come only within 45 degrees or less of the examining table. Telescoping or up-
and-down movement of the femur in relation to the pelvis may be demonstrated if the
hip is dislocating. The examiner may alternately push upward and downward on the
thigh with the fingers of one hand behind the greater trochanter while the thumb is on
e ASIS a d e e a e a e ee anteriorly.
2. Fabere Sign (Patrick)
Hip and knee on the side to be tested are flexed so that the heel lies beside or on top
of the opposite extended knee. The hip being examined is abducted and externally
rotated as far as possible. The presence of pain, muscle spasm, or limited ROM in the
tested hip is positive and suggests abnormality in that hip. Pain may be elicited in the
opposite SI joint, which requires differentiating from the positive response.
3. S a i g Hi Ma e e
E a e a d s placed on the inguinal crease as the hip is brought into flexion.

The thigh is then guided into abduction-extension, then permitted to return to the
neutral position. The examiner palpates for a click during the return to neutral phase.
A click represents an overly stretched adductor group and a lax anterior capsulo-
ligamentous structure.

Refining Your Ability to Execute an Accurate Hruska Adduction Lift Test

(HAdLT)
By Michael Cantrell, MPT, PRC
The Hruska Adduction Lift Test is a myokinematic f c a a e e fa a e ab

recruit specific muscles while simultaneously inhibiting others in opposing kinetic chains
(specifically the Anterior Interior Chains [AIC]). This functional test, in conjunction with the
Hruska Abduction Lift Test and the Standing Reach Test is the best myokinematic assessment of
the AIC position. The comparison of left versus right allows the examiner to gain an
understanding as to how obligatory one chain has become over the other. The results of the
exa a ca e be ed a a de f e ea ea e a a d ca a d e
therapist in understanding how much progress is actually being made in treatment. Details of the
exam are found in the Myokinematic Restoration course manual. These details outline the
specific musculature involved with each level of the test. During some stages of the exam, the
possibilities for mistakes on the part of the examiner are highlighted. Most examiner errors
cc f Le e 0 e e 2 f e e a . Closer scrutiny of the exam can reveal some of
the reasons why examiners can incorrectly score functional performance. Deeper understanding
of the biomechanics of the exam should aid in preventing assignment of erroneous scores.
LEVEL 0
As stated in the PRI Myokinematic Restoration course manual, the inability to raise the lower
a e ff e a ab e c de ed a 0 c e. T ab ef ec b a ea e
malpositioned obturator of the flexed lower extremity. However, for a variety of reasons
(outlined below) some patients cannot successfully assume the Hruska Adduction Lift Test
position. A common pitfall is to allow the patient to go ahead with attempted execution of step
one of the test while not being in the correct position for the test. If a patient cannot assume the
test position, then that must be reflected in the exam since the exam itself is an assessment of
myokinematic function. Obviously, good functional start position or mobility can be challenged
in some way due to influences of the left or right AIC (the very things being examined). This
level of immobility, therefore, must be understood and documented. Consequently, if a patient
cannot assume the test position then the test should be halted and a score of 0 should be assigned
before ever attempting to engage the obturator (Level 1 of the test).
Bottom Foot Elevation

Osseous and capsular restrictions in the femoral acetabular (FA) joint are a primary reason for
some less-than-obvious incorrect positioning during the Hruska Adduction Lift Test. When
these restrictions exist the examiner may witness elevation of the bottom foot off the mat as the
patient attempts to position themselves in left acetabular femoral internal rotation (AF IR) (or
under certain circumstances right AF IR) at the beginning of the exam.
Restriction of the posterior capsule or abutment of the femoral head against the posterior/inferior
f e ace ab , ca e c ed e e f e fe e ace ab ce
independent, rotational motion of the acetabulum on the femur and the femur on the acetabulum
ee . T c ed e e e b ed a e e a f e e f ff f e
mat or table. It is possible that the a e a e b c ed tion at the FA joint due

to recruitment of agonistic muscles like ipsilateral adductor magnus, piriformis and other femoral
external rotators. Therefore, the examiner must carefully look for foot elevation movement and
then see if the patient can lower the foot down to the table while maintaining the proper position
for the test. This would indicate that the patient can inhibit those agonists and a capsular
e c a be e e . If , e e c e a 0 bef e e e be e e .
Excessive Trunk Rotation

Another compensatory movement that patients may demonstrate is upper body misalignment
with lower body during positioning for the Hruska Adduction Lift Test. With limitations such as
a strongly patterned left AIC or Posterior Exterior Chain (PEC) the patient is likely to misalign
themselves by excessively rotating the trunk as the examiner asks the patient to assume the
sidelying position for the test. This maneuver is the result of limited transverse plane mobility at
e FA ( ee f ee a de c f c ed ) a d eff ec e
limitation can result in an awkward presentation of visible excessive leftward trunk rotation
(during a right HAdLT), along with possible elevation of the bottom foot off of the table. If this
abe a ca be c ec ed b e a e e a c e f 0 be e .

Flexion of the Contralateral FA Joint

The final common compensatory maneuver noted with limited mobility while assuming the right
Hruska Adduction Lift Test position, is the tendency for the patient to align themselves with the
FA joint of the extended lower extremity in a state of flexion. The instructions for the test point
out that the subject should align the lower extremity, trunk and shoulder, but sometimes the
patient cannot do so. Of chief concern once again, is the limitation of FA mobility on the bottom
hip as described in the above paragraphs. Since the pelvis itself may be limited in ability to
rotate into left AF IR the patient may flex at the FA joint of the extended lower extremity (LE) in
order to feel as though they have completely shifted onto their left side and into that left FA
joint.
Another reason the patient might flex at the FA joint on the extended LE is to avoid excessive
lumbar extension which can occur if the patient has difficulty extending the FA joint to neutral.
If the patient has difficulty extending the top lower extremity at the FA joint, the inability to shift
completely into left AF IR is likely. Once again this is most commonly due to limitations in the
contralateral FA joint. Rather than extending the FA joint the patient simply compensates by
flexing the innominate (AF flexion) and extending the lumbar spine. The test should be halted
a da c e f 0 d be ad e ed f ac de a ed a d ca be
corrected.
LEVEL 1
To achieve a functional score of 1, the patient has to elevate the lower ankle to the upper knee.
This step in the test aids the examiner in determining if the patient has weakness of the obturator
and other ER muscles of the flexed LE. It also discerns weakness of AF stabilizers of the same
extremity since those AF stabilizers must be at least minimally active in order for the patient to
externally rotate the femur during the test without significantly changing pelvis position or
compensation from the psoas.
There are few difficulties encountered with regard to execution of this portion of the test.
LEVEL 2
At this point during the test, the client is asked to raise the lower knee off of the exam table.
This portion of the test is used to determine if the patient has the ability to utilize AF and FA
muscles while shifted into left AF IR. Multiple issues come into play while the patient is
attempting Level 2.
P e ing he E ended E emi Too Ha d In o he E amine Shoulder

The patient must be able to raise the lower knee off of the table without pressing down
e ce e ee a e de e e tremity. If the patient does indeed press
down too hard with the top LE, inability to overcome ipsilateral posterior capsular tightness or
osseous limitations in the FA joint during FA IR may exist. It can also indicate an inability to
maintain the left AF IR position with appropriate right AIC musculature, thus recruiting agonist
muscles to aid the weakness of the right AIC as well as weakness of the bottom lower extremity
FA and AF muscles (anterior gluteus medius and IC adductor). The strength of inappropriate
contralateral AF muscles (adductor magnus and possibly posterior fibers of gluteus medius [top

hip extension during adduction and internal rotation of the bottom femur]) also can become a
factor. Erector spinae can also come into play by aiding forward (sagittal plane) rotation of the
pelvis with accompanying thoracic-lumbar extension. These compensatory activities can all be
detected by the examiner as excessive pressure on the examiners shoulder.
Further, if the patient is unable to maintain engagement of the ipsilateral internal obliques and
transversus abdominis muscles during the Le e 2 f ee a ,a e e a
rotate the femur will result in loss of frontal plane control of the abdominal wall. When this
control i , e a e bea d ee a e de ec aaea e
extremity for stabilization. If the patient repeatedly presses down the top extremity into the
e a e de a d c ec e e e e ac ca be obtained during an
attempt at Le e 2 f e e , e e d be a ed a d a c e f 1 d be
administered.
Flexion of Contralateral FA Joint

The patient must be able to raise the lower knee off of the table without flexing the contralateral
FA joint. Flexion of that top hip is usually the result of an inability to maintain the pelvis in a
state of left AF IR while attempting left FA IR. T e ea f e a e ab ac e e
left FA IR is likely due to posterior capsular tightness of the ipsilateral FA joint or weakness of
ipsilateral FA IR musculature, or weakness of contralateral AF ER musculature. When any or all
of these conditions occurs the top hip rolls back giving the appearance of flexion of the top
(contralateral) FA joint. If flexion occurs and cannot be corrected, the test must be halted and a
c e f 1 be ad e ed.

Flexion of the Ipsilateral FA Joint

The patient may appear to succeed during the attempt of achieving a Level 2 score on the right
HAdLT by raising the lower knee off of the exam table, but may not truly have a score of 2/5.
When attempting to raise the lower knee, the patient might not actually internally rotate the left
lower extremity (FA IR), but instead flexes the left LE (FA flexion). This engages the left psoas
(not anterior glute medius and IC adductor) which is part of the Left AIC. Remember, the
examiner is actually trying to see if the patient can inhibit that Left AIC during this portion of
right HAdLT testing. So if the left FA joint flexes, the patient is unable to inhibit the Left AIC
while attempting to activate the left anterior glute medius along with the left IC adductor. A
score of 1 must be given, since the patient is unable to rotate the left LE off of the table (left FA
IR).
Normal L FA IR Normal L FA IR Aberrant L FA Flexion
Inability to Isolate Appropriate Musculature on Lower Leg

A major issue with the Le e 2 f e right HAdLT is an inability for the patient to
perceive activation of appropriate muscles on the lower leg during the FA IR attempt. The
muscles that should be felt working are the ipsilateral IC adductor and the gluteus medius. Both
f ee ce a ee e a a a ab d a a e f ef a ce . T fe e a e
is unable to feel the glute med during the Le e 2 a e . T e a ea f , e
loss of the tri-planar zone of apposition (ZOA) on the left side during the attempt. If the ZOA is
d a e ed e e 2 e a e ca , a d a d e , feel the left IC adductor engage
but the left glute medius will be more difficult to recruit. An understanding of the three planes of
the ZOA helps to clarify. Sagittal plane: e a b e (IO ) a d a e abd minis
(TA ) ce ad a ittal plane opposition to the pelvis and lower ribs. With sagittal plane
opposition, the pelvis can rotate into AF extension (necessary for true left stance). Frontal
plane: ef a a e e a e a IO a d TA f c b ec a a e a IO
a d TA a de e a ( ece a f ef a ce).

Transverse plane: ea f e e b ed cc d nk rotation,

must occur during left AF IR and is essential for opposition to the diaphragm. If the patient is
not truly in a a e f ef a ce meaning left AF IR with tri-planar ZOA then the left gluteus
medius is also not in a position of mechanical advantage for engagement and thus cannot turn the
femoral head completely into the left acetabulum. Further, other agonist muscles can create a
series of dyssynchronous contractions resulting in all manner of aberrant compensatory activities
(see above). If the patient cannot correct this phenomenon then the test must be halted and a
sc e f 1 be ad e ed.
When having the patient attempt the Le e 2 f e HAdLT e e a e d e

question the patient regarding which muscles are perceived by the patient as engaged or
e e e e . U the patient reports both IC adductor and glute medius
working simultaneously, a score of 1/5 must be issued.
Again, the purpose for the HAdLT is to aid the examiner in understanding if the patient is ready
for progression. If a patient is progressed through a PRI regimen too rapidly then failure with the
rehab program will be the likely outcome. If in doubt, it is always better to grade a patient too
low rather than too high on the test. Scoring too high can result in frustration on the part of the
patient and the clinician as both expect greater outcomes in the following visits only to be
disappointed when these outcomes are not achieved. All of this can be avoided simply by being
more careful and conservative in scoring the test.
Mentioned throughout this document is that the patient should have opportunities to correct poor
positioning or improper effort during the test. There is nothing wrong with helping the patient
with understanding specifically what it is you require of them during the test. Indeed, this will
aid you as you progress the patient through a non-manual regimen, since the patient will better
understand what it is that you require of them from the test perspective. Hopefully they can then
apply that understanding to the exercises prescribed.
When in doubt about position or patient ability to execute portions of the test, one may need to
review the Hruska Abduction Lift Test to recognize, correct alignment for the Hruska Adduction
Lift Test. This would aid in fully understanding what is required of the HAdLT. Further, the
Hruska Abduction and Adduction Lift Tests are complimentary to each other and can aid you in
more accurately determining true functional scores.

Avoiding Initial Pitfalls in the Management

of the Patient with FA Instability
By: Jennifer Poulin, PT, PRC and James Anderson, MPT, PRC
It is important to recognize the proper testing, treatment interventions and common

compensations to assure effective progression of techniques and successful outcomes when
treating a patient with FA instability. If the position of the left hip is not properly evaluated and
understood, patients can be progressed too quickly through an exercise program that can frustrate
both the clinician and the patient.
Expected test results in identifying a patho-compensatory Left AIC pattern in the left hip (laxity
of the iliofemoral and pubofemoral ligament):
- Extension Drop Test (left and/or right)

+ Adduction Drop Test (left and/or right)
Right Hruska Adduction Lift Test of 1 or 0
L FA IR / L FA ER
R FA IR / R FA ER
The treatment hierarchy begins by repositioning the pelvis in the sagittal and transverse planes
via the left hamstrings and/or ischiocondylar (IC) adductor.
1. Bicep Femoris (ER/EXT) repositions

Example: Supine 90-90 Supported Hip Lift with Hemibridge (appendix page 2)
After repositioning the pelvis in the sagittal plane with the bicep femoris, special attention
should be paid to approximate and seat the left femoral head into the acetabulum and then
continuing AF IR and FA IR stabilization activities with the left gluteus medius non-manual
techniques.
2. Ischiocondylar Adductor (IR)

Example: Right Sidelying Respiratory Resisted Left Adductor Pull Back (appendix page 26)
It is recommended that theraband be used as opposition to left AF IR to assist in recruitment

of the IC adductor. Once the patient demonstrates their ability to recruit the IC adductor
during this exercise the band can be discontinued per therapist discretion.
It is not uncommon for the a e c a f ca e d e

initial repetitions of this exercise technique, it is important to continue working through the
discomfort to properly achieve left AF IR. D f e e c a e e a e b ea e
correctly. Inhale upon pulling back, exhale upon pushing down. The femoral acetabular
(FA) joint will need to glide and approximate over the anterior rim into the acetabulum
during this exercise.

Common compensations:
Patient does not remain in AF IR during FA adduction. Tightness in the
e / e ca e f e ef ca a a e ab a a e
shifted back position and they will shift forward upon adduction in the frontal plane.
Patient will extend their backs and potentially feel their left TFL during attempt at AF IR
as they compensate in the sagittal plane.
Patient will begin exercise in too much right thoracic abduction at the start of the
exercise. Position patient with right arm overhead and move right hip closer to the wall
or left hip toward shoulder to encourage left thoracic abduction. This must be maintained
during the entire exercise.
Pa e d e b ea e a e, ead f a a e e e e
femur back.
Any of these compensations may indicate a posterior capsule stretch is necessary before seeking
further progression through the hierarchy.
Once patient achieves left AF IR on a repositioned pelvis, it is now time to recruit a left anterior
gluteus medius to roll the FA joint into the acetabulum and secure it with progression of
concomitant retraining of the left IC adductor and the left anterior gluteus medius in both the
frontal and transverse planes.
3. Anterior gluteus medius (IR)

Example: Right Sidelying Supported Left Glute Med (appendix page 39)
Right Sidelying Supported Hemi 90-90 with Left FA IR (appendix page 39)
This exercise allows the clinician to also determine if the left hip is positioned properly on
the acetabulum following the adductor pull back exercise.
Common compensations:
The patient is unable to maintain a position of T-L flexion in the sagittal plane (the
patient arches their back on AF IR approximation).
The patient feels the left TFL or vastus lateralis.
The patient feels the left glute max.
The patient does not feel anything.
If the patient fails to feel the anterior fibers of the left gluteus medius, it is another indication of
tightness in the posterior superior left hip capsule that prevents the femoral head from rotating
properly into the acetabulum. This indicates an active or passive stretch should be performed
before proceeding through the algorithm to ensure non compensatory roll and glide onto the
acetabulum during FA IR.

4. Posterior Left Ischial Femoral Inhibition

Examples: Standing Posterior Capsule Stretch (appendix page 52)
Standing Wall Supported Ischial Femoral Ligamentous Stretch (appendix page 53)
Re-testing the Hruska Adduction Lift Test and seated goniometric measurements at this point
will assist the clinician in determining whether they need this step.
It is also important to determine if the contralateral inferior and/or anterior capsule or

musculature is restricted, a strong right AF IR position will be difficult to overcome and a
soft-tissue stretch of right side may also be indicated.
5. Anterior/ Inferior Right Capsule Inhibition

Examples: Modified All Four Inferior Glute Max, Adductor Magnus and Quadratus Femoris
Stretch (appendix page 56)
If these capsule and ligaments restrictions exist, a patient cannot fully achieve AF IR and
maintaining left gluteus medius activation will not be possible.
Once the soft tissue restrictions have been addressed, proper neuromuscular retraining of the
left gluteus medius and ischiocondylar adductor to stabilize dual hole control can commence.
Continued rechecking of the Hruska Adduction Lift Test will assure that you have properly
maintained the left hip on the acetabulum without compensations during your treatment
progression.
Once you achieve a 3/5 right Hruska Adduction Lift Test you can begin upright activities (a
patient may begin at a 2/5, but make sure to use wall support and/or table support to prevent
functional failure).
It is important to recognize the need for the anterior gluteus medius muscle to stabilize the
over lengthened lateral bar of the iliofemoral ligament in these patients. Without a strong left
anterior gluteus medius, these patients will continue to compensate into FA ER, when they
appear neutral during upright activities. The resultant compensations for this pelvic position
can be altered all the way up to Right Brachial and Right Temporomandibular Cervical Chain
resulting in neck hyperactivity.
The left sidelying PRI non-manual techniques should include attention to FA adduction and
IR with the IC adductor with concomitant activity of the left anterior gluteus medius. If a
patient does not feel their anterior gluteus medius, it is indicative to back up and retest the
Hruska Adduction Lift Test and or seated goniometric measurements.
As you move through your rehab program, into steps 4 and 5 and attain bilateral hole control
and step 6 standing dynamics, you must maintain the activity of the left IC adductor and left
anterior gluteus medius to ensure a successful PRI treatment plan. Without securing a left
hip into left AF IR, a Left AIC pattern will be fed and outcomes will be limited.

Kinetic & Kinematic Issues Related to

Pelvic-Femoral Dysfunction
Abdominal oblique and ipsilateral hamstring weakness
Anterior forward pelvic rotation
Hypertonic positional shortened psoas and rectus femoris
Hypertonic lengthened bicep femoris (long head), semitendinosus, and

accompanying sacrotuberous ligament
Obligatory positional elevated piriformis and gluteus maximus
Passive iliofemoral Compensatory hypertonic Passive internal orientation of

elevation positional lengthened femur (which is neutral relative
(Leg length discrepancy) piriformis and gluteus to the pelvis) with
maximus accompanying internal rotation
Over-active external weakness and increase demand
rotation of femur (hip pain) of vastus lateralis
Tibia (knee pain)
Increase in knee instability Limited range of active internal

and thigh foot angle rotation of femur and limited
adduction of hip
Poor femoralpatellar
congruence
Increase in lateral femoral

patella contact force and
patellar femoral
compression

Appendix - Myokinematic Restoration
PIRIFORMIS SYNDROME
Examination Considerations:
Lef Piriformis S ndrome Righ Piriformis S ndrome
Positive Left Adduction Drop Test Positive Left Adduction Drop Test
Decreased Seated Left FA IR Decreased Seated Right FA ER
2 or Lower Right Adduction Lift Test 2 or Lower Right Abduction Lift Test
2 or Lower Right Abduction Lift Test Decreased Seated Right FA ER Strength
GOALS:
Lef Piriformis S ndrome Righ Piriformis S ndrome
Decrease left AF ER compensatory Decrease sacral rotation and spinal

activity orientation via piriformis to the right and demands on the
femur attachment when in a Left right piriformis as a right AF ER
AIC pattern. muscle.
(Toward the end of treatment, if seated (Toward the end of treatment, if seated Right
FA ER Left FA IR strength remains weak, strength remains weak, then attempt
then work on Left Glute Med strengthening.) Left Sidelying Resisted Right Glute Max.)

Treatment Considerations: LEFT PIRIFORMIS SYNDROME

(appendix page 26)
Left Sidelying Knee to Knee

(appendix page 27)
Left Sidelying Foot Toward Foot

(appendix page 28)
Left Sidelying Left Adductor with Resisted Right Glute Max

(appendix page 34)
Left Sidelying Left Flexed FA Adduction with Right Extended

FA Abduction and Left Abdominal Co-Activation
(appendix page 41)
Left Sidelying Left Ischial Femoral Ligamentous Stretch

with Left FA Adduction
(appendix page 55)
Left Sidelying Supported Left Flexed FA Adduction

with Right Extended FA Abduction
(appendix page 29)

Treatment Considerations: RIGHT PIRIFORMIS SYNDROME

(appendix page 26)
Sidelying Obturator Restorative Technique

(appendix page 55)
Standing Wall Supported Ischial Femoral Ligamentous Stretch

(appendix page 53)
Seated Supported Left AF IR with Right Psoas

and Iliacus and Right FA ER
(appendix page 51)
Retro Stairs with Resisted Glute Max

(appendix page 23)

ILIO-SACRAL STRAIN
Right IS Strain Left IS Strain
Focus on Right Glute Max & R AF & FA ER Focus on Left Ischiocondylar Adductor and
activity with concomitant L AF IR Left FA IR (after achieving Left AF IR)
1. Left Sidelying Right Glute Max 1. Right Sidelying Respiratory Resisted Left
(appendix page 32) Adductor Pull Back
(appendix page 26)
2. Supine Hooklying Adductor Magnus

Inhibition 2. Left Sidelying Knee Toward Knee
(appendix page 48) (appendix page 33)
3. Supine Hooklying Resisted Right Glute

Max with Right AF ER 3. Left Sidelying Supported Left Flexed FA
(appendix page 31) Adduction with Right Extended FA Abduction
(appendix page 29)
4. Supine Hooklying Supported Resisted

Right Glute Max with Left Glute Med 4. Supine Hooklying Supported Resisted Right
(appendix page 42) Glute Max with Left Glute Med
(appendix page 42)
5. 90-90 Resisted Right Glute Max with

Right FA ER (appendix page 31) 5. Left Sidelying IO/TA and Left Adductor with
Right Glute Max (appendix page 28)

HIP BURSITIS (RIGHT)

Seen usually in women with weakness of the right gluteus maximus, left hamstring, left
ischiochondylar adductor, and restrictive, tight right adductor magnus; resulting in the inability
to adduct on the left lower extremity and shift adequately their center of gravity over the left
lower extremity. The smaller external rotators on the right are overworked as is the posterior
fiber of the gluteus medius, secondary to ipsilateral weakness of the inferior lengthened and
malpositioned gluteus maximus. These patients usually have difficulty rotating their trunk to the
right while standing or shifted on left lower extremity. They usually walk with poor arm swing
and improper swing of upper extremities with lower extremities. High compressive, torsional
sheering forces on the small external rotators and the posterior gluteus medius muscle produces
inflammation of this superior posterior trochanteric attachment soft tissue. This same soft tissue
is further aggravated during eccentric abduction and external rotation during right stance phase
of gait.
Notes:
Poor co-activation of left ischiocondylar adductor (FA IR) and right gluteus maximus (FA ER).
1) Adduction Drop Test
2) Trunk Rotation via Supine Passive Leg Rotation
3) Level 3 or lower on Right Hruska Adduction and Abduction Lift Tests
Intervention:
Left hip adduction integrated program to increase AF adduction (active and passive) on the left
and AF abduction and ER on the right.
1) Left Sidelying IO/TA and Left Adductor with Right Glute Max
(appendix page 28)
2) Supine Hooklying Adductor Magnus Inhibition

(appendix page 72)

OSTEITIS PUBIS (PUBALGIA)

A condition in which there is an injury to the insertion of the adductor muscles into the
symphysis pubis. Usually there is a gradual onset of localized pubis pain and tenderness over the
pubic ramus that may radiate to the groin or to the lower abdomen. The insertions of the rectus
abdominus and adductor muscles and of the inguinal ligament may be tender in the ischiopubic
region.
Clinically, this presenter finds a correlation between symphysis pubis pain and excessive internal
rotation at one FA joint and excessive external rotation of the other. Repeated minor trauma
from excessive, repetitive biomechanical shearing leads to compensatory patterns of lumbar
lordosis or hemilordosis (anterior pelvic rotation on one side). Pain is often aggravated by
pivoting on one leg, kicking a ball, sprinting, climbing stairs, or sitting up.
Notes:
Poor concomitant facilitation of adductors with contralateral abdominal obliques and transverse
abdominis
Hruska Adduction Lift Test
Seated FA IR and ER
Intervention:
Increased integration of LEFT AF IR with LEFT internal obliques and RIGHT external obliques;
Increased integration of RIGHT AF IR with RIGHT internal obliques and LEFT external
obliques

TIBIAL STRESS FRACTURES

Most often seen with excessive femoral and tibial internal rotation and resultant foot pronation.
The tibia and femur rotate medially on initial contact, and loading response phases of gait. Then
they laterally rotate at midstance, terminal stance, and pre-swing. Initial, mid, and terminal
swings require medial rotation. Transverse rotation or torque through the tibia increases with
excessive femoral external rotation weakness, excessive femoral internal rotation, and strong
plantar flexors at heel strike through midstance. Torque across the tibia increases when there is a
premature active supination in an attempt to assist with stabilizing the ipsilateral anteriorly
rotated hip.
Notes:
Excessive femoral and tibial IR, poor hip extension influencing anterior pelvic rotation and
obligatory FA IR, overuse of ipsilateral supinators
Gait Analysis, SLR Test, Extension Drop Test, Ankle Dorsiflexion
Intervention:
Reciprocal swing of upper extremity with contralateral lower extremity; retro walking with
concomitant FA IR, appropriate stretching of hip flexors and back extensor

HAMSTRING STRAINS & RUPTURES

The literature mentions several factors associated with hamstring muscle strain. They include
flexibility, strength, hamstring/quadriceps strength ratio, eccentric muscle contraction, fatigue,
adverse neural tension, and improper warm up. However, very little research reflects the
relationship between hamstring strains and strength of gluteals, FA rotators, and adductors
(including contralateral and ipsilateral).
Muscles with a high percentage of type II (fast twitch) fibers are more likely to be injured
because of the implications of faster contraction of muscle. Hamstrings are primarily composed
of fast twitch fiber. No research can be found to support the suggestion that fast twitch fibers in a
muscle that is in a long resting state takes on slow twitch fiber characteristics.
Bicep Femoris (ER) strains occur on the ipsilateral side of an anteriorly rotated hemi-pelvis. This
pelvic position results in delayed hip extension during early heel strike or late swing phase.
Excessive demands are placed on the lengthened hamstring as it attempts to eccentrically control
internal rotation. These strains can also occur contralateral to the side of the anteriorly rotated
hemi-pelvis secondary to concomitant femoral internal rotation.
Semitendinosus (IR), Semimembranosus (IR), and Adductor Magnus (IR) strains occur on the
ipsilateral side of an anteriorly rotated hemi-pelvis. This is secondary to the medial hamstrings
acting as an antagonist to an overactive psoas that concomitantly externally rotates the femur
during midstance, terminal swing, and preswing. These individuals usually have an overly
stretched anterior capsule (Adduction Drop Test is positive, Extension Drop Test is negative and
ca a a c c ).
EXAMINATION CONSIDERATIONS
1) How much FA internal and external rotation do they have? TFL or Gluteus Medius?
2) Can they adduct their lower extremities on a stable pelvis?
3) Can they extend their femur without extending their back?
4) Do they have equal strength upon resisted knee flexion in sitting with the femur positioned
internally in the acetabulum and with the femur positioned externally in the acetabulum?
5) When does strain occur? When did the pull occur?
6) Is it a bicep femoris or a semi issue?

INTERVENTION
1) Reposition pelvis if appropriate through hamstring activation on the appropriate side.
2) Determine status of anterior acetabular femoral capsule. If stretched or lax you will need to
increase IR strength from gluteus medius and ischiocondylar adductor; not the tensor fascia
latae.
3) Retest FA PROM and AROM, FA adduction and extension.
4) Design a home program:
Bicep femoris strain (a femoral external rotator and a pelvic extensor):
Restore position
Maintain hamstring activity
Strengthen gluteus maximus
Strengthen external rotation concurrently with hamstring activity and gluteus

maximus activity (prone)
Possibly need to strengthen internal rotators with seated reciprocal activity to

maintain neutral pelvic position
Semitendinosus / semimembranosus strain (femoral internal rotators, hip extensors, and

adductors):
Restore position
Maintain hamstring activity
Strengthen gluteus medius
Strengthen internal rotation concurrently with hamstring activity and adductor

activity
Possibly need to strengthen external rotators with seated reciprocal activity to

maintain neutral pelvic position
Strengthen adductors in open chain

(when closed chain control is demonstrated i.e. neutrality is maintained with gait)

HAMSTRING CONSIDERATIONS
Medial hamstring should be active:
18 to 28 percent of stance phase (initial contact)
40 to 58 percent of initial swing phase
Last 20 percent of swing phase (terminal swing)
Control of knee is reduced with poor hip extension (gluteals, hamstrings, obliques) Eccentric
quadriceps activation upon deceleration creates a large magnitude of anterior translation force at
the proximal tibia without co-activation of the hamstrings and pelvic control.
Initial Swing Hamstrings act concentrically at the knee to produce knee flexion
Midswing Maximum hamstring concentric activity occurs
Late Swing Hamstrings act eccentrically to control knee extension and to re-extend the hip
Decreased dynamic hip extension promotes overuse of plantar flexors, gastrocnemius and soleus.
Contraction of hamstrings leads to posterior translation of the tibia and its tuberosity and
concomitant flexion of the patella.

REFERENCES
Asymmetry
Arun, CP. The importance of being asymmetric: the physiology of digesta propulsion on
Earth and in space. Ann NY Acad Sci, 2004; 1027: 74-84.
Chibulka, MT et al. Changes in innominate tilt after manipulation of the sacroiliac joint
in patients with low back pain. Physical Therapy, 1988; 68: 1359-1363.
Hruska, R. Pelvic stability influences lower-extremity kinematics. Biomechanics, 1998
(June); 23-29.
Krawiec, CJ et al. Static innominate asymmetry and leg length discrepancy in
asympotomatic collegiate athletes. Manual Therapy, 2003; 8(4): 207-213.
Lee, H. et al. The association between asymmetric hip mobility and neck pain in young
adults. Journal of Manipulative and Physiological Therapeutics, 2013; 23: 364-368.
Levangie, PK. The association between static pelvic asymmetry and low back pain.
Spine, 1999; 24: 1234-1242.
Vallortigara, G and Rogers, LJ. Survival with an asymmetrical brain: Advantages and
disadvantages of cerebral lateralization. Behavioral and Brain Sciences, 2005; 28: 575-
633.
Wolpert, L. Development of the asymmetric human. European Review, 2005; 13(2): 97-
103.
Zaidi, ZF. Body asymmetries: Incidence, etiology and clinical implications. Australian
Journal of Basic and Applied Sciences, 2011; 5(9): 2157-2191.
Adductors
Arnold AS, Delp SL. Rotational moment arms of the medial hamstrings and adductors
vary with femoral geometry and limb position: implications for the treatment of internally
rotated gait. Journal of Biomechanics. (2001) 34:437-447.
Boyle, KL. Clinical application of the right sidelying respiratory left adductor pull back
exercise. The International Journal of Sports Physical Therapy, 2013; 8(3): 349-358.
B SM, M NS, a . T add c a a : MRI a a a c
and potential pitfalls. Skeletal Radiol. 2016;45:213-219.
Ford KR, Myer GD, Hewett TE. Valgus knee motion during landing in high school
female and male basketball players. Medicine & Science in Sports & Exercise.
35(10):1745-50, 2003 October.
Obey, MT, Broski SM, et al. Anatomy of the adductor magnus origin: Implications for
proximal hamstring injuries. The Orthopaedic Journal of Sports Medicine. 2016;4(1).
Accessed online January 2016 ahead of publishing.
Reimann R, Sodia F, Klug E. Die umstrittene Rotationswirkung ausgewahlter Muskeln
im Huftgelenk. Ann Anat (1996) 178: 353-359.
Warwick R, Williams P. Grays Anatomy 1973; (5)566.

Willett GM, Keim SA, et al. An anatomic investigation of the ober test. Am J Sports
Med. Published online January 11, 2016.
Athletic Pubalgia/Osteitis Pubis
Dahan R. Rehabilitation of muscle-tendon injuries to the hip, pelvis, and groin areas.
Sports Med Arthroscopy Rev. 1997; 3: 326-33.
Fricker PA. Osteitis pubis. Sports Med Arthoroscoy Rev. 1997; 5: 305-12.
Fricker PA, Taunton JE, Ammann W. Osteitis pubis in athletes: infection, inflammation
or injury? Sports Medicine. 1991; 12(4): 266-279.
Hamstring Length & Flexibility
Bandy W, Irion J. The effect of time on static stretch on the flexibility of the hamstring
muscles. Physical Therapy. Sept 1994; 74(9): 54-59.
Bandy W, Irion J. The effect of time on static stretch on the flexibility of the hamstring
muscles. Physical Therapy. Sept 1994; 74(9): 54-59.
Bandy W, Irion J, Briggler M. The effect of time and frequency of static stretching on
flexibility of the hamstring muscles. Physical Therapy. Oct1997;77(10): 1091-1096.
Cameron D, Bohannon R. Relationship between active knee extension and active straight
leg raise test measurements. JOSPT. May 1993;17(5): 257-260.
Clark S, Christiansen A, Hellman D, Hugunin JW, Hurst KM. Effects of ipsilateral
anterior thigh soft tissue stretching on passive unilateral straight leg raise. JOSPT.
1999;29(1): 4-12.
Corbleet S, Woolsey N. Hamstring muscle length in school-aged children using the sit-
and-reach test and the inclinometer measure of hip joint angle. Physical Therapy. Aug
1996;76(8): 850-855.
Gajdosik R. Hamstring stretching and posture. Physical Therapy. Apr 1997;77(4): 438-
439.
Gajdosik R, Rieck M, Sullivan D, Wightman S. Comparison of four clinical tests for
assessing hamstring muscle length. JOSPT. Nov 1993;18(5): 614-618.
Gajdosik, Lusin. Hamstring muscle tightness-reliability of an active knee extension test.
Physical Therapy. July 1983;63(7): 1085-1088.
Garrett W, Safran M, Seaber A, Glisson R, Ribbeck B. Biomechanical comparison of
stimulated & nonstimulated skeletal muscle pulled to failure. The Am Journal Of Sports
Med. 1987;15(5): 448-454.
Li Y, McClure P, Pratt N. The effect of hamstring muscle stretching on standing posture
and on lumbar and hip motions during forward bending. Physical Therapy.
Aug1996;76(8): 836-845.
Moore M, Kukulka C. Depression of hoffmann reflexes following voluntary contraction
and implications for proprioceptive neuromuscular facilitation therapy. Physical Therapy.
Apr 1991;71 (4).
Moore, Hutton. Electromyographic investigation of muscle stretching techniques.
Medicine and Science in Sports and Exercise. May 1980: 322.
Osternig L, Robertson R, Troxel R, Hansen P. Muscle activation during PNF stretching
techniques. Am Journal Physical Med. 1987; 66(5): 298-307.

Valenza MC, et al. The immediate effects of doming of the diaphragm technique in
subjects with short hamstring syndrome: a randomized controlled trial. Journal of Sport
Rehabilitation. June 2015.
Wallin D, Bjorn E, Grahn R, Nordenborg T. Improvement of muscle flexibility a
comparison between two techniques. Am Journal of Sports Med. 1985;13(4): 263-268.
Worrell T, Smith T, Winegardner J. Effect of hamstring stretching on hamstring muscle
performance. JOSPT. Sept 1994;20(3): 154-159.
Hamstring Strains
Almekinders L, Gilbert J. Healing of experimental muscle strains and the effects of

nonsteroidal anti-inflammatory medication. Am Journal of Sports Med. 1986;14(4): 303-
308.
Best T, Garrett W. Hamstring strains expediting return to play. The Physician and
Sports Medicine. Aug 1996;24(8): 37-44.
Burkett L. Causative factors in hamstring strains. Medicine & Science in Sports. Spring
1970;2(1): 39-42.
Christensen C, Wiseman D. Strength; the common variable in hamstring strain. Athletic
Training. 7(2): 36-40.
Garrett W, Califf J, Bassett F. Histochemical correlates of hamstring injuries. The Am.
Journal of Sports Med. 1984;12(2): 98-103.
Garrett W, Rich R, Nikolaou P, Vogler J. Computed tomography of hamstring muscle
strains. Med & Science in Sports & Exercise. 1989;21(5): 506-514.
Goom T, Malliaras P, et al. Proximal hamstring tendinopathy: Clinical aspects of
assessment and management. JOSPT. 2016;46(6):483-493.
Hoskins W, Pollard H. The management of hamstring injury part 1: Issues in diagnosis.
Man Ther. 2005;10:96-107.
Hoskins W, Pollard H. The management of hamstring injury part 2: Treatment. Man
Ther. 2005;10:180-190.
Liemohn W. Factors related to hamstring strains. J. Sports Med. 1978;18: 71-76.
Mason DL, Dickens V, Vail A. Rehabilitation for hamstring injuries. Cochrane Database
Syst Rev. 2007.
Nikolaou P, Macdonald B, Glisson R, Seaber A, Garrett W. Biomechanical &
histological evaluation of muscle after controlled strain injury. Am Journal of Sports
Med. 1987;15(1): 9-14.
Prentice W. Rehabilitation techniques in sports medicine, 2nd Ed. Nov 1993 Mosby-Year
Book, Inc. 387-394.
Turl S, George K. Adverse neural tension; a factor in repetitive hamstring strain? JOSPT.
Jan 1998;27(1): 16-21.

Obstetrics & Gynecology
Boyle K. Managing a female patient with left low back pain and sacroiliac joint pain with
therapeutic exercise: a case report. Physiotherapy Canada, Volume 63, Number 2.
Hulme J. Roll for control, moving beyond kegels to treat incontinence. Physical Therapy
Products. Sept 2002: 34-36.
Hamstring Strength
Kaminski, Wabbersen, Murphy. Concentric vs enhanced eccentric hamstring strength.

Journal of Athletic Training. 1998;33(3): 216-221.
Molczyk et al. Reliability of testing the knee extensors and flexors in healthy adult
women using a cybex II isokinetic dynamometer. JOSPT. July1991;14(1): 37-41.
Worrell, Perrin, Gansneder, Gieck. Comparison of isokinetic strength & flexibility
measures between hamstrings injured & noninjured athletes. JOSPT. Mar 1991;13(3):
118-125.
Hamstrings & ACL
DeMont R, Lephart S. Repetition drives neuromuscular recovery after ACL Injury.

Biomechanics. Apr 1998: 31-37.
Maitland M, Ajemian S, Suter E. Quadriceps femoris and hamstring muscle function in a
person with an unstable knee. Physical Therapy. Jan 1999;79(1): 66-75.
More R, Karras B, Neiman R, Fritschy D, Woo S, Daniel D. Hamstrings an ACL
protagonist. Am Journal of Sports Med. 1993; 21(2): 231-237.
S M, Ba a a R, Z BH, S H, B W, B c C, D A b a R. T
synergistic action of the ACL & thigh muscles in maintaining joint stability. Am Journal
of Sports Med. 1987;15(3): 207-213.
Supplement to Biomechanics. Special report ACL injury. Jun 1998.
Hamstrings & Athletes
Canale S, Cantler E, Sisk D, Freeman B. A chronicle of injuries of an American inter-

collegiate football team. Am Journal of Sports Med. 1981;9(6): 384-389.
Heiser T, Weber J, Sullivan G, Clare P, Jacobs R. Prophylaxis & management of
hamstring muscle injuries in intercollegiate football players. Am Journal of Sports Med.
1984;12(5): 368-370.
Jonhagen S, Nemeth G, Eriksson E. Hamstring injuries in sprinters; the role of concentric
& eccentric hamstring muscle strength & flexibility. The Am Journal of Sports Med.
1994;22(2): 262-266.
McMaster W, Walter M. Injuries in soccer. Am Journal of Sports Med. 1978;6(6): 354-
357.
Ross M, Dahlke B. On the run: assessment of hamstring function following injury. Phys
Ther Products. May/June 2000:13-16.

Hamstrings & SLR Testing
Bohannon. Cinematographic analysis of the passive straight-leg-raising test for hamstring

muscle length. Physical Therapy. Sept 1982;62(9): 1269-1274.
Bohannon. Effect of repeated eight-minute muscle loading on the angle of straight -leg
raising. Physical Therapy. Apr 1984;64(4): 491-497.
Bohannon R, Gajdosik R, Leveau. Contribution of pelvic and lower limb motion to
increases in the angle of passive straight leg raising. Physical Therapy. Apr 1985;65(4):
474-476.
Hsieh, Walker, Gillis. Straight Leg-Raising Test. Physical Therapy. Sept 1983;63(9):
1429-1433.
Hamstrings Related to Back & Hip
Bohannon, Gajdosik, Leveau. Relationship of pelvic thigh motions during unilateral and
bilateral hip flexion. Physical Therapy. Oct1985;65(10): 1501-1504.
Tenney HR, Boyle KL, and DeBord A. Influence of hamstring and abdominal muscle
activation on a positive ober's test in people with lumbopelvic pain. Physiotherapy
Canada. 2013;65(1)4-11.
Gajdosik R, Albert C, Mitman J. Influence of hamstring length on the standing position
& flexion range of motion of the pelvic angle, lumbar angle, & thoracic angle. JOSPT.
Oct 1994;20(4).
Gajdosik, Simpson, Smith, Dontigny. Pelvic tilt-intratester reliability of measuring the
standing position and range of motion. Physical Therapy. Feb 1985;65(2): 169-174.
Gold K, Franklin C, North C, Keating C. Effects of hamstring specific exercise in
chronic low back pain patients. NE Spine Center, LLP, Omaha, NE.
Sihvonen T. Flexion relaxation of the hamstring muscles during lumbar pelvic rhythm.
Arch Phys Med Rehab. May 1997;78.
Stokes I, Abery J. Influence of the hamstring muscles on lumbar spine curvature in
sitting. Spine. Nov/Dec 1980;5(6): 525-528.
Youdas J, Garrett T, Harmsen S, Suman V, Carey J. Lumbar lordosis and pelvic
inclination of asymptomatic adults. Physical Therapy. Oct 1996;76(10): 1066-1081.

Hip Impingement
Azevedo DC, Paiva EB, et al. Pelvic rotation in femoroacetabular impingement is

decreased compared to other symptomatic hip conditions. JOSPT. November
2016;46(11):957-964.
Cibulka M. Sacroiliac joint dysfunction as a reason for the development of acetabular
retroversion: a new theory. Physiotherapy Theory and Practice. 2013; Early Online:1-5.
Dandachli W, Islam S et al. The influence of pelvic tilt on acetabular orientation and
cover: a three-dimensional computerised tomography analysis. Hip Int. 2013;23(01):87-
92.
Finnoff JT, Bond JR, et al. Variability of the ischiofemoral space relative to femur
position: an ultrasound study. Physical Medicine and Rehabilition. 2015;7: 930-937.
Henebry A, Gaskill T. The effect of pelvic tilt on radiographic markers of acetabular
coverage. AJSM Online PreView. August 27, 2103.
Lewis CL, Sahrmann SA. Acetabular labral tears. Phys Ther. 2006;86(1):110-121.
Martin RL, Enseki KR, Draovitch P, Trapuzzano T, Philippon M. Acetabular labral tears
of the hip: examination and diagnostic challenges. J Orthop Sports Phys Ther.
2006:36(7):503-515.
Masek, J. Femoroacetabular impingement mechanisms, diagnosis, and treatment options
using postural restoration®: part 1. Sportex. March 2015.
using postural restoration®: part 2. Sportex. Oct 2015.
using postural restoration®: part 3. Sportex. January 2016.
Narvani A, Tsiridis E, Tai C, Thomas P. Acetabular labrum and its tears. Review of Br J
Sports Med 2003;37:207-211.
Nicholls R. Intra-articular disorders of the hip in athletes. Physical Therapy in Sport,
2004.
Simoneau G, Hoenig K, Lepley J, Papanek P. Influence of hip position and gender on
active hip internal and external rotation. JOSPT 28 (3) Sept 1998.
Zaltz I, Kelly BT, et al. The crossover sign overestimates acetabular retroversion. Clin
Orthop Relat Res. 2013;471:2463-2470.
Orthopedic
Adler KL, Cook PC, et al. Current concepts in hip preservation surgery: Part 1. Sports
Health. Nov-Dec 2015;7(6): 518-526.
Arendt E. Management of patellofemoral disorders. Orthopedic special edition.
2001:7(2).
Bedi A, Warren RF, et al. Restriction in hip internal rotation is associated with an
increased risk of ACL injury. Knee Surg Sports Traumatol Arthrosc. Published online
September 2014.
Bohannon R, Gajdosik R, & LeVeau B. Relationship of pelvic and thigh motions during
unilateral and bilateral hip flexion. Physical Therapy. 1985;65(10): 1501-1504.

Cooperstein R, Lew M. The relationship between pelvic torsion and anatomical leg
length inequality: a review of the literature. Journal of Chiropractic Medicine.
2009;8:107-118.
Cummings G, Scholz P, Barnes K. The effect of imposed leg length difference on pelvic
bone symmetry. Spine.1993;18(3): 368-373.
Dananberg H. Subtle changes in walking posture may be the root of many painful
conditions. Advance for Directors in Rehab. March 2002:47-51.
Defazio G, et al. Primary cervical dystonia and scoliosis; a multicenter case-control
study. Neurology 2003;60: 1012-1015.
DeRosa C, Porterfield J. Weightbearing. Biomechanics, December 2000:14-30.
Dowling R, Hruska R. Hamstring injuries require triplanar assessment. Biomechanics,
Feb 2003.
Dunn J, Graham S. Treating dancers. Advance for Physical Therapists and PT Assistants.
Feb 4, 2002:37-40.
Eckhoff D, Brown A, Kilcoyne R, & Stamm E. Knee version associated with anterior
knee pain. Clin Orthop. 1997 Jun;(339): 152-5.
Eckhoff DG, Montgomery WK, Kilcyne RF, Stamm ER. Femoral morphometry and
anterior knee pain. Clin Orthop. 1994 May; (302): 64-8.
Fowler C. Muscle energy techniques for pelvic dysfunction. In: Grieve GP, ed. Modern
manual therapy of the vertebral column. Edinburgh, Churchill Livingstone;1986: 805-
814.
Frey L, Haftel H. Shoulder, knee, and hip pain as initial symptoms of juvenile ankylosing
spondylitis: a case report. JOSPT. Feb 1998; 27 (2):167-172.
Friberg O. Clinical symptoms and biomechanics of lumber spine and hip joint in leg
length inequality. Spine. 1983;8(6): 643-650.
Gray G, Dowling R, Gambetta V. Back out again? Training and Conditioning. Dec
2000:15-21
Henebry LT and Gaskill T. The effect of pelvic tilt on radiographic markers of acetabular
coverage. AJSM. Preview, published online August 27, 2013.
Hesch J. Letter to the editor. Sacroiliac joint. The Journal of Manual & Manipulative
Therapy. 2000;8(1): 29-31.
Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for
the first-episode low back pain. Spine, Vol 26(11). June 1, 2001.e243-248.
Hodges PW. Is there a role for transverses abdominis in lumbo-pelvic stability? Manual
Therapy. 1999;4(2): 74-86.
Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis in
low back pain associated with movement of the lower limb. J Spinal Disord. 1998;11:46-
56.
Hruska RJ. Management of pelvic-thoracic influences on temporomandibular
dysfunction. Orthopedic Physical Therapy Clinics of North America. June 2002; 11 (2):
263-284.
Hruska RJ. Pelvic stability influences lower extremity kinematics. Biomechanics. 5(6):
23-29.

Innes K. The pronated foot and the lumbo-pelvic area. CD Scarborough, Ontario
Canada.
Jansa S. Femoralpatellar dysfunction. Advance for Physical Therapists and PT Assistants.
Feb 1, 1999.
Juhl JH, Ippolito Cremin TM, Russell G. Prevalence of frontal plane pelvic postural
asymmetry part 1. JAOA. 2004;104(10):411-421.
Karski T, Karski J. The biomechanical aetiology of the so-called idiopathic scoliosis. The
a a d a d a a d d .
Surgical Science. 2014;5:33-38.
Klein KK. Progression of pelvic tilt in adolescent boys from elementary through high
school. Arch Phys Med Rehabil. 1973; 54: 57-59.
Klein KK, Buckley JC. Asymmetries of growth in the pelvis and legs of growing
children. ACTJ. 1968;22(2):53-55.
Krengel W & King H. Scoliosis: diagnostic basics and therapeutic choices. Journal of
Musculoskeletal Medicine. 1995;12(9): 54-69.
Lee D. The pelvic girdle (2nd Ed.) An approach to the examination and treatment of the
lumbo-pelvic-hip region. Edinburgh, London, New York, Philadelphia, Sydney, Toronto:
Churchill Livingstone, 1999.
Manoli A, Graham B. Cavus foot diagnosis determines treatment. Biomechanics. Jan
2001:55-69
Marshall C, Knutzen K. Female knee reclaims strength after ACL injury. Biomechanics.
Jan 2001: 43-52
Matava M, Hollman J, Deusinger R. Knee kinematics underscore gender differences.
Biomechanics. Feb 2002:77-85.
Maxwell GM and McCrackin H.J. Geometrical constraints on the rotational function of
the femoral adductors in man. J Biomed, Eng. Jul 1983;5: 253-256.
Meknas K, Christensen A, Johansen O. The internal obturator muscle may cause sciatic
pain. Pain. 2003 Jul;104(1-2):375-80.
Moore K, Dalley A. Clinical oriented anatomy, 4th Edition. Lippincott Williams and
Wilkins, 1999.
Noonan KJ, Weinstein SL, Jacobson WC, et al, Univ of Iowa Hospitals and Clinics. Use
of the Milwaukee brace for progressive idiopathic scoliosis. J Bone Joint Surg. Apr
1996;78-A: 557-567.
Norkin C, Lebangie P. Joint structure and function: a comprehensive analysis, 2nd
Edition. FA Davis, Philadelphia.
Nourbakhsh MR, Arab AM. Relationship between mechanical factors and incidence of
low back pain. JOSPT. 2002;32(9):447-460
Oliver, GD. Powering the windmill: Lower body mechanics of softball pitching. Lower
Extremity Review (online edition). June 2011.
Pearson WM. A progressive structural study of school children. J Am Osteopath Assoc
1951;51: 155-167.
Pearson WM. Early and high incidence of mechanical faults. J Osteopath 1954; 61:18-23.
Roach SM, San Juan JG, et al. Passive hip range of motion is reduced in active subjects
with chronic low back pain compared to controls. IJSPT. Feb 2015;10(1):13-30.
Roos H. Hip pain in sport. Sports Med and Arthroscopy Review. 1997; 5:292-300.

Rothbart BA. Relationship of functional leg-length discrepancy to abnormal pronation.

Journal of the American Podiatric Medical Association. 2006;96(6):499-504.
R JM. Ed N :W a d ca .P ca T a . Oc
2002;82(10).
Schamberger, W. The malalignment syndrome, implications for medicine and sport.
Churchill Livingstone 2002.
Sikorski JM, Peters IW. The importance of femoral rotation in chondromalacia patellae
as shown by serial radiography. Journal of Bone and Joint Surgery. Nov 1979;61-8( 4).
Smith JA, Popovich JR, Kulig K. The influence of hip strength on lower-limb, pelvis, and
trunk kinematics and coordination patterns during walking and hopping in healthy
women. JOSPT. July 2014; 44(7):525-531.
Song K, MD & Herring J, MD. Early recognition and assessment of idiopathic scoliosis.
J Musculoskel Med. 1993;10(4): 63-76.
S da N. W dc a d ab a . 2001. A P b , I c.
Timm KE. Randomized controlled trial of Protonics on patellar pain, position and
function. Med Sci Sports Exerc. May 1998;30(5): 665-70.
Valmassy R. Clinical biomechanics of the lower extremities, 1st Ed. Mosby, 1996.
Van Dillen L, Bloom N, Gombatto S, Susco T. Hip rotation range of motion in people
with and without low back pain who participate in rotation related sports. Physical
Therapy in Sport. May 2008;9(2):72-81.
Vleeming A, Mooney V, Dorman T, Snijders C, Stoeckart R. Movement stability & low
back pain. The essential role of the pelvis. Churchill Livingstone, 1997.
Neurology
Chong D. Stop pushing. Advance Dec 2006;32-34.

Cowan S, Bennell K, Hodges P, Crossley K, McConnell J. Delayed onset of
electromyographic activity of vastus medialis obliquus relative to vastus lateralis in
subjects with patellofemoral pain syndrome. Arch Phys Med Rehabil. Feb 2001; 82.
Grabiner MD, Koh TJ, Draganich LF. Neuromechanics of the patellofemoral joint. *
Medicine and Science in Sports and Exercise, August 1993
Hebert LJ, Gravel D, Arsenault AB, Tremblay G. Patellofemoral pain syndrome; the
possible role of an inadequate neuromuscular mechanism. Clinical Biomechanics 9(2):
93-97.
Reisman D, Scholz JP. Aspects of joint coordination are preserved during pointing in
persons with post-stroke hemiparesis. Brain 2003;(126):2510-2527.
Travell and Simons. Myofascial pain and dysfunction, the trigger point manual, the lower
extremities. 1992. Williams and Wilkins Volume 2, page 259.
Voight ML, Wieder DL. Comparative reflex response times of vastus medialis obliquus
and vastus lateralis in normal subjects and subjects with extensor mechanism
dysfunction; an electromyographic study. The American Journal of Sports Medicine.
1991; 19(2).
Witvrouw E, Sneyers C, Lysens R, Victor J, Bellemans J. Reflex response times of vastus
medialis oblique and vastus lateralis in normal subjects and in subjects with
patellofemoral pain syndrome. JOSPT. Sept 1996; 24(3): 160-165.

Patellar Tracking/Knee Impairments
Biomechanics. By the numbers: patellofemoral pain. Biomechanics, July 2005.

Denton J, Willson J, Ballantyne B, Davis I. The addition of the protonics brace system to
a rehabilitation protocol to address patellofemoral joint syndrome. J Orthop Sports Phys
Ther. April 2005;35(4):210-219.
Dolak K et al. Hip strengthening prior to functional exercises reduces pain sooner than
quadriceps strengthening in females with patellofemoral pain syndrome: a randomized
clinical trial. Journal of Orthopaedic and Sports Physical Therapy. August 2011; Vol
41(8):560-700.
Grelsamer R. The argument for in vitro testing of the patella. Biomechanics. Mar 1997:
29-33.
Jette D, Jette. Physical therapy and health outcomes in patients with knee impairments.
Physical Therapy. Nov 1996;76(11): 1178-1187.
Mangine R, Bilbo J, Mangine M. Knee rehabilitation examining external supports for
patella pathology. Biomechanics/Phys Ther. May 1997: 7-9.
Meira, E and Brumitt J. Influence of hip on patients with patellofemoral pain syndrome: a
systematic review. Sports Health Vol 3(5):455-465.
Piva S, Goodnite E, and Childs J. Strength around the hip and flexibility of soft tissues in
individuals with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther.
2005;35(12):793-801.
Powers C, Landel R, Perry J. Timing and intensity of vastus muscle activity during
functional activities in subjects with and without patellofemoral pain. Physical Therapy.
Sept 1996;76(9): 946-955.
Powers C, Perry J, Hsu A, Hislop H. Are patellofemoral pain and quadriceps femoris
muscle torque associated with locomotor function? Physical Therapy. Oct 1997;77(10):
1063-1075.
Tiberio D. Kinetic chain. Biomechanics/Phys Ther. May 1997: 15-16.

Posture
Boyle K, Demske J. Management of a female with chronic sciatica and low back pain: A
Case Report. Physiotherapy Theory and Practice, 25(1):44-54,2009.
Chaudhari A, McKenzie C, et al. Lumbopelvic control and days missed because of injury
in professional baseball pitchers. Am J Sports Med. Published online August 26, 2014.
Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A. Three dimensional
preparatory trunk motion precedes asymmetrical upper limb movement. Gait Posture.
2000;11:92-101.
Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine
associated with low back pain. A motor control evaluation of transversus abdominis.
Spine. 1996;21:2640-2650.
Hodges PW, Richardson, CA. Transversus abdominis and the superficial abdominal
muscles are controlled independently in a postural task. Neurosci Lett. 1999;265:91-94.
Inglis JT, Horak FB, Shupert CL, Jones-Rycewicz C. The importance of somatosensory
information in triggering and scaling automatic postural responses in humans. Exp Brain
Res 1994;(101):159-164.
Sahrmann, S. Diagnosis and treatment of movement impairment syndromes. St. Louis:
Mosby, 2002.
Spence, H. Case study report: postural restoration: an effective physical therapy approach
to patient treatment. Techniques in Regional Anesthesia and Pain Management, 2008; 12:
102-104.
Tenney HR, Boyle KL, and DeBord A. Influence of hamstring and abdominal muscle
activation on a positive ober's test in people with lumbopelvic pain. Physiotherapy
Canada. 2013;65(1)4-11.
Zink, JG and Lawson, WB. An osteopathic structural examination and functional
interpretation of the soma. Osteopathic Annals, 1979; 7(12): 433-440.

MEDICALLY INFORMED CONSENT

(EXAMPLE)
I voluntarily consent to physical therapy treatment and services deemed necessary by my

physical therapist and /or physician. I am aware that the practice of physical therapy is not an
exact science and I acknowledge that no guarantees have been made to me as to the results of
these services at ___________________. I c c c d ca
process, from billing to treatment and eventually discharge from our services. Therefore, if
a d- a a c c a a b d a , c &
postural alignment are not understood, it is my responsibility to obtain a clearer understanding of
a a b c a d c a ,a d / ac
This consent shall be ongoing for a period not to exceed one year.
I (or________________________ for ________________________) have read this form and

fully understand and accept its terms and conditions.
Patient or Person Authorized to consent for Patient/Relationship Date/Time
Reason patient was unable to consent
Witness Signature

PRI EVALUATION FORM

Myokinematic Restoration Examination
Left Right
Adduction Drop Test + - + -
Extension Drop Test + - + -
Trunk Rotation _____inches _____inches
Straight Leg Raise _____degrees _____degrees
FA IR R.O.M. _____degrees _____degrees
FA ER R.O.M. _____degrees _____degrees
FA ER Strength 1 2 3 4 5 1 2 3 4 5
FA IR Strength 1 2 3 4 5 1 2 3 4 5
FA IR Muscle TFL / Glute Med TFL / Glute Med
Hruska Adduction Lift Test 1 2 3 4 5 1 2 3 4 5
Hruska Abduction Lift Test 1 2 3 4 5 1 2 3 4 5
Pelvis Restoration Examination

Left Right
Pelvic Ascension Drop Test (PADT) + - + -
Passive Abduction Raise Test (PART) + - + -
Posterior Outlet Mediastinum Expansion Test + - + -
Functional Squat Test ______ ______
Standing Reach Test _____inches ______inches
Postural Respiration Examination

Left Right
Apical Expansion with Contralateral Opposition Limited Limited
Shoulder Horizontal Abduction _____degrees _____degrees
Shoulder Flexion _____degrees _____degrees
HG IR _____degrees _____degrees
Subclavius Flexibility Limited Limited
Elevated and Externally Rotated Ant. Ribs on: ______ ______
Cervical Revolution Examination

Left Right
Shoulder Horizontal Abduction _____degrees _____degrees
Cervical Extension With Cranial Retraction Without Cranial Retraction
Cervical Axial Rotation Limited Limited
OA Lateral Flexion Limited Limited
Cervical Lateral Flexion Limited Limited
Mandibular Protrusion With PCR Without PCR
Mandibular Opening _____mm
Mandibular Opening
with Non-Reducing Disc _____mm _____mm
Mandibular Lateral Trusion with Protrusion _____mm _____mm
(Bilateral temporal IR)
Mandibular Lateral Trusion without Protrusion _____mm _____mm
(Bilateral temporal ER)
Advanced integration Examination

Left Right
Hruska Alternating Reciprocal Rotation Test 1 2 3 4 5 1 2 3 4 5

基础动力学讲义

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基础动力学讲义

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MYOKINEMATIC RESTORATION

An Integrated Approach To Treatment of

Lumbo-Pelvic-Femoral Examination and Assessment

Femoral Internal and External

Left AIC Related Pathomechanics

The materials and information provided to you during this

Date of last revision: January 3, 2017

Copyright 2000-2017 Postural Restoration Institute® ii

SECTION TWO: APPENDIX

Copyright 2000-2017 Postural Restoration Institute® iii

Pelvis Restoration – An Integrated Approach to Treatment of Patterned Pubo-Sacral

Postural Respiration – An Integrated Approach to Treatment of

Cervical Revolution – An Integrated Approach to Treatment of Patterned Cervical

Copyright 2000-2017 Postural Restoration Institute® iv

Myokinematic Restoration – An Integrated Approach to Treatment of

Pelvis Restoration – An Integrated Approach to Treatment of Patterned Pubo-Sacral

Postural Respiration – An Integrated Approach to Treatment of

Posterior Exterior Chain (PEC) L Internal Obliques/Transversus B Paravertebrals, R Quadratus Lumborum

Cervical Revolution – An Integrated Approach to Treatment of Patterned Cervical

Copyright 2000-2017 Postural Restoration Institute® v

ANTERIOR INTERIOR CHAIN (AIC)

Copyright 2000-2017 Postural Restoration Institute® vi

Copyright 2000-2017 Postural Restoration Institute® vii

Copyright 2000-2017 Postural Restoration Institute® viii

Dynamic Movement and Balance

Copyright 2000-2017 Postural Restoration Institute® ix

Copyright 2000-2017 Postural Restoration Institute® x

- Ron Hruska, MPA, PT

Copyright 2000-2017 Postural Restoration Institute® xi

Copyright 2000-2017 Postural Restoration Institute® xii

Copyright 2000-2017 Postural Restoration Institute® xiii

3) The study of myokinematic dysfunction is the study of motion adaptation patterns.

4) Never confuse movement with action Earnest Hemingway

Copyright 2000-2017 Postural Restoration Institute® 1

Copyright 2000-2017 Postural Restoration Institute® 2

Pattern vs. position

Describes an individual that is neuro-

PRI Stance Myokinematic Patterns

Left Stance in Left AF IR position = Right AIC Pattern

Right Stance in Right AF IR position = Left AIC Pattern

Left Stance in Right AF ER position = Right AIC Pattern

Right Stance in Left AF ER position = Left AIC Pattern

Copyright 2000-2017 Postural Restoration Institute® 3

Left Anterior interior chain (AIC) Pattern

Illustration by Elizabeth Noble for the Postural Restoration Institute®.

Copyright 2000-2017 Postural Restoration Institute® 4

BIOMECHANICAL Influences of the

Normal Anterior Pelvic Position

Copyright 2000-2017 Postural Restoration Institute® 5

SOFT TISSUE Influences oN the

ANTERIOR PELVIC POSITION POSTERIOR PELVIC POSITION

Vastus Lateralis Rectus Femoris Semitendinosus

Copyright 2000-2017 Postural Restoration Institute® 6

PELVIC INFLUENCE ON LUMBAR SPINE ORIENTATION (LORDOSIS)

< 30° ~ 30° > 30°

Copyright 2000-2017 Postural Restoration Institute® 8

LUMBO PELVIC (LP) JOINT DYNAMICS

a. Iliolumbar (blends with the quadratus lumborum)

2) Posterior Ligaments of Pelvis:

a. Posterior Sacroiliac Ligaments (2 Parts) (Netter 335, 334)

B. Muscular Structures of Pelvis (Netter 337, 339, 356)

Copyright 2000-2017 Postural Restoration Institute® 9

3) Iliococcygeus and pubococcygeus