Technique Of The Week

Sidelying Hip Lift

What?

A sidelying PRI facilatory technique used to increase integration of left abdominals with right femoral adductors via the pelvic floor, and left femoral adductors with right abdominals via the pelvic floor.  Because of its frontal and transverse plane demands it is also a technique used to decrease right low back, quadratus lumborum, psoas, iliacus, TFL, upper trap and sternocleidomastoid (SCM) and left tensor fascia latae, iliacus, psoas, upper trap and latissimus dorsum when in the left sidelying position. 
In the right sidelying position this technique facilitates right acetabular femoral rotators, mainly the right gluteus maximus and right low trapezius and right triceps.  As it isolates the left adductor it inhibits the right adductor (PRI’s Sidelying Trunk Lift technique in the left sidelying position promotes right trunk rotation from T8 while maintaining a left zone of opposition - In the right sidelying position, left upper thoracic rotation is promoted during right AF ER and left FA IR function and muscular opposition to the right brachial chain).

Why?

So often patients have a difficult time facilitating left IO’s and TA’s without promoting rectus abdominis and hip flexors.  Techniques that typically activate lateral abdominals during ipsilateral thoracic abduction, such as sidelying ‘planks’, do not incorporate enough torso rotation, diaphragm opposition in thoracic flexion and thoracic-scapular dynamics, therefore, the integration of abdominals in an integrated manner to reduce asymmetrical neuro-patterning (L AIC / R BC) is difficult if concomitant thoracic flexion, thoracic abduction and thoracic rotation is not encouraged or introduced.  The sidelying hip lift integrates thoracic flexion and abduction; while the sidelying trunk lift also incorporates thoracic rotation.  This tri-planar organization in a gravitational position breaks down strong anti-gravitational thoracic frontal and transverse plane function, or strong sagittal or extension gravitational function.  These PRI techniques were designed to give the user an opportunity to facilitate lower extremity abduction with ipsilateral thoracic abduction and upper extremity abduction, especially when performed in the left sidelying position with the Left AIC oriented patient; and contralateral lower extremity adduction with thoracic abduction and upper extremity abduction, especially when performed in the right sidelying position. 

When?

These techniques should be considered for individuals whom have difficulty with:
1) Adduction lifting (scores of 3 or above).
2) Isolation of AF glutes with contralateral AF adductors or AF adductors with contralateral AF glutes.
3) Pelvic floor hypertonicity and instability.
4) Limited thoracic-scapular stabilization at 90-degrees of humeral abduction in the supine position.
5) Upper trapezius respiratory overuse in standing (position patient on the side where upper trapezius and levator scapula are overactive).
6) Inhibiting hip flexors (position patient on the right to reduce right psoas and iliacus and left TFL during right AF ER and left AF IR; or right TFL and left psoas and iliacus during right FA ER and left FA IR - reverse position for opposite hip flexor inhibitory program).
7) Inhibiting upper traps, sternocleidomastoid and latissimus dorsi muscle (position patient on the right to reduce right upper trap and left SCM during right GH horizontal abduction and ER and left GH adduction and IR or right latissimus dorsum and left upper trap during right HG ER and left HG IR - reverse position for opposite GH and HG inhibition programs). 

Right Sidelying Position Hip Lift Inhibition of:

R Psoas as AF ER L Psoas as FA ER
R Iliacus as AF ER L Iliacus as FA ER
R TFL as AF IR L TFL as FA IR

*R upper trap during GH Hor Abd and GH ER
**L SCM during GH Hor Abd and GH IR
***R Latissimus dorsum during HG ER
****L Upper trap during HG IR

Left Sidelying Position Hip Lift Inhibition of:

L Psoas as AF ER R Psoas as FA ER
L Iliacus as AF ER R Iliacus as FA ER
L TFL as AF IR R TFL as FA IR

*L upper trap during GH Abd and GH ER
**R SCM during GH Add and GH IR
***L Latissimus dorsum during HG ER
****R upper trap during HG IR

*Upper trap normally contributes to GH horizontal abduction and GH ER, but because of position of head and trunk the upper trap can’t contribute to GH horizontal abduction and ER.

**Sternocleidomastoid (SCM) pulls mastoid forward and to the contralateral direction contributing to GH horizontal abduction and IR, but because of position of head on torso the SCM can’t contribute to GH horizontal adduction and IR.

***Latissimus dorsum is a HG IR muscle, but because of torso and humeral position and ER demands placed on the HG joint, the latissimus is inhibited.

****Upper trap contributes to GH ER and since the HG joint is functioning in HG IR secondary to torso position and arm placement the upper trap is inhibited.

Where?

The Sidelying Hip Lift is a technique that requires a minimum grade of 3 from the right Hruska Abduction Lift Test, therefore, it follows the Left Sidelying Left Abduction with Right Extended Abduction technique in the PRI left adduction technique progression.  Its high level of integration requires thoracic frontal and transverse control as well as lower trap and tricep opposition to the brachial chain.  Phasic mid range of ZOA is required for correct respiratory function during this technique, otherwise shoulders and back strain will be experienced.  The Sidelying Trunk Lift can also be found in the PRI integration techniques preceding more neurological demanding activity from the lateral abdominals, especially the transverse abdominals.  These techniques should be considered when the patient can isolate hip adductors from hip flexors, hip abductors from back extensors and when integration is needed from frontal plane lumbo-pelvic-femoral muscle and thoracic-scapula-humeral muscle. 

Who?

This technique is recommended for individuals who have a difficult time incorporating thoracic rotation or stabilization during unilateral hip adduction with contralateral hip abduction which is required during non-compensatory reciprocal gait.  A good technique to consider after using a PRI frontal sidelying approach and moving into an upright Left BC, left AF IR state of functional integration.  Extensor driven inhalation individuals who require specific isolated respiratory function to inhibit psoas, iliacus, TFL, upper trapezius, SCM or latissimus dorsum will benefit from these techniques that engage mid and lower trap, tricep, rhomboid, serratus anterior and subscapularis muscle. 

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