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Lower Extremity Alignment: A Proximal Rehabilitation Approach

presented by Steven Dischiavi, PT, DPT, SCS, ATC, COMT

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Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Utilizing the hip to influence dynamic lower extremity alignment has gained considerable attention within the physical therapy related literature. There is evidence to support a proximal control theory, but there also appears to be a limit to its effectiveness, particularly with regard to sport related tasks. This course will examine the proximal control approach to rehabilitating the hip. There will be a brief functional anatomy review as well as a review of the EMG activity of some commonly utilized hip exercises. The course concludes with the introduction of the idea of expanding from a proximal theory and adopting a more global and dynamic approach to organizing human movement.

This course is part of a three part series with Steve Dischiavi. View the courses in the following sequence:
  1. Lower Extremity Alignment: A Proximal Rehabilitation Approach
  2. Global Dynamic Functional Stability for the Hip & Pelvis
  3. Exercise Prescription for Hip & Pelvis Movement: Part 1
  4. Exercise Prescription for Hip & Pelvis Movement: Part 2

Meet Your Instructor

Steven Dischiavi, PT, DPT, SCS, ATC, COMT

Dr. Steven Dischiavi is an assistant professor in the Department of Physical Therapy at High Point University (HPU), as well as the Director of Rehabilitation for the Department of Athletics at HPU. Dr. Dischiavi brings over 20 years of experience in sports medicine to MedBridge, including 10 years with a professional sports team. Dr. Dischiavi…

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Chapters & Learning Objectives

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1. Historical Review of a Hip Focused Proximal Control Theory

Hip impingement surgery rate has increased by over 600% among newly trained surgeons from 2006-2010. It will be expected that the physical therapist become an expert in the prevention and rehabilitation of the hip, particularly with the growing post-operative population. This chapter will describe local, regional, and proximal interventions and discuss the evidence for each.

2. Dynamic Lower Extremity Alignment

Dynamic lower extremity alignment refers to the position of the lower extremity under certain dynamic conditions. The literature has different names and ways of describing the way this dynamic alignment is quantified; these concepts are discussed in this chapter.

3. Functional Anatomy and EMG Literature

This chapter will outline the functional anatomy related to the hip and its surrounding musculature. Particular attention is paid to the three dimensional nature of muscular control on the skeletal system, and how the pelvis is stabilized functionally in three planes. The chapter concludes with a review of EMG literature and how it impacts exercise selection.

4. Evidence-Based Review of Hip Focused Literature

The final chapter of this course will discuss the current state of the literature for hip focused exercise interventions. The concept of strength as a non-linear progression is presented and will be a tenet of the following courses. The course concludes with the introduction of the Global Dynamic Functional Stability paradigm and the concept of Dynamic Kinetic Chain Integration.

More Courses in this Series

Global Dynamic Functional Stability for the Hip & Pelvis

Presented by Steven Dischiavi, PT, DPT, SCS, ATC, COMT

Global Dynamic Functional Stability for the Hip & Pelvis

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
This course will explore the evidence with regard to proximal control rehabilitation programs. As noted in course 1, strength is not a linear progression to achieving improved biomechanical efficiency of lower extremity alignment, particularly with regard to sports related tasks. This course will identify the missing components in todays evidence based hip focused programs and will present a comprehensive approach to achieving Global Dynamic Functional Stability. Utilizing the concept of Dynamic Kinetic Chain Integration, the clinician will learn to integrate multiple polyarticular muscular chains to achieve complex orchestrated functional movements.

This course is part of a three part series with Steve Dischiavi. View the courses in the following sequence:
  1. Lower Extremity Alignment: A Proximal Rehabilitation Approach
  2. Global Dynamic Functional Stability for the Hip & Pelvis
  3. Exercise Prescription for Hip & Pelvis Movement: Part 1
  4. Exercise Prescription for Hip & Pelvis Movement: Part 2

View full course details

Exercise Prescription for Hip & Pelvis Movement: Part 1

Presented by Steven Dischiavi, PT, DPT, SCS, ATC, COMT

Exercise Prescription for Hip & Pelvis Movement: Part 1

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
The concept of Dynamic Kinetic Chain Integration is implemented into the design of hip-focused therapeutic exercise programs. The global connectivity of the human kinetic chain is considered as exercises are designed with the goal of increasing efficiency of movement by utilizing the hip and pelvis. The goal of integrating the kinetic chain in a dynamic method makes the athlete utilize multiple muscular myofascial chains in an orchestrated manner while being in a position of greater stability. The organizational challenge of the exercises is increased as the exercises are progressed from a position of increased stability to positions requiring the athlete to learn how to improve stability independently.

This course is part of a three part series with Steve Dischiavi. View the courses in the following sequence:
  1. Lower Extremity Alignment: A Proximal Rehabilitation Approach
  2. Global Dynamic Functional Stability for the Hip & Pelvis
  3. Exercise Prescription for Hip & Pelvis Movement: Part 1
  4. Exercise Prescription for Hip & Pelvis Movement: Part 2

View full course details

Exercise Prescription for Hip & Pelvis Movement: Part 2

Presented by Steven Dischiavi, PT, DPT, SCS, ATC, COMT

Exercise Prescription for Hip & Pelvis Movement: Part 2

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
The concept of Dynamic Kinetic Chain Integration is implemented into the design of hip-focused therapeutic exercise programs. The global connectivity of the human kinetic chain is considered as exercises are designed with the goal of increasing efficiency of movement by utilizing the hip and pelvis. The goal of integrating the kinetic chain in a dynamic method makes the athlete utilize multiple muscular myofascial chains in an orchestrated manner while being in a position of greater stability. The organizational challenge of the exercises is increased in Part 2 to reflect movement in the upright position and to challenge the clinician to create exercises in a progressive manner with a return to sport as the goal.

This course is part of a three part series with Steve Dischiavi. View the courses in the following sequence:
  1. Lower Extremity Alignment: A Proximal Rehabilitation Approach
  2. Global Dynamic Functional Stability for the Hip & Pelvis
  3. Exercise Prescription for Hip & Pelvis Movement: Part 1
  4. Exercise Prescription for Hip & Pelvis Movement: Part 2

View full course details

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