Yudu - sportEX dynamics - 1999-2010

SOFT TISSUE THERAPY

Gluteus medius

Piriformis Pectineus

Gluteus minimus

Pectineus

Vastus lateralis

Rectus femoris

Vastus medialis

Quadratus lumborum

Erector spinae

Adductor brevis

Adductor magnus

Gracilis

Figure 2: Main hip flexors

warranted for individuals with a difference of 6-7mm or more. Soft tissue or structural therapy is possible if asymmetry is present. A programme of physiotherapy, podiatry and strength conditioning is beneficial.

Functional differences Functional differences occur with symmetry of pelvic alignment, asymmetrical pronation or supination or unilateral contractures (4).

CASE STUDY

I was supporting the Tour of Tasmania, Australia in 1998 when I was presented with the following case.

The cyclist was suffering with the following symptoms while he was racing. He present- ed with mild to moderate right lower back, buttock pain with tightness in his left hamstring. He also had anterior-lateral lower leg tightness and aching followed by poorly localised bilateral hip adductor soreness. Associated with these symptoms was a feeling of fatigue and weakness on hill climbs and efforts in breakaways and on low/moderate gradients.

The symptoms had started a week before the tour and had gradually increased. The cyclist sought my help on the third day of the tour. Previously he had been compet- ing in Belgium Kermesse races, where he had recently crashed, badly bruising his

8 right shoulder and hip.

My soft tissue assessment revealed a restriction in the range of movement of the following muscles: ■ Right hip flexor - short (psoas major/ rectus femoris)

■ Right iliac - height (quadratus lumbo- rum)

■ Left hamstring - short ■ Left tensor fascia/gluteus medius ■ Left passive lumbar rotation ■ Left peroneus longus and brevis ■ Right lateral gastroncnemius - short (dorsiflexion)

■ Right hip adductors - short ■ Right external rotatore stretch produced buttock pain.

Treatment Soft tissue treatment was aimed at restor- ing mobility and length to the right hip

flexors, right trunk lateral flexors, left hamstring/sacrotuberous fascia, left antero-lateral lower leg, right (medical) tibialis posterior, left internal hip rota- tors, right hip adductors and right hip external rotators.

During the next day of competition there was a fairly flat stage with mild to moderate gradients. At the end of the stage the cyclist reported that the stage went fairly well and the symptoms had reduced considerably with slight adduc- tor/hamstring tensions. However lower back symptoms and weakness on effort had dissipated and a feeling of strength had returned.

As the tour continued I provided ongo- ing treatment throughout the rest of the tour with a complete resolution of symptoms.

www.sportex.net

Figure 3: Deeper trunk muscles affected in pelvic muscle imbalances in cyclists

Physical assessment As per the structural assessment if it is dif- ficult to clearly assess. Possible causes Rotational patterns, usually medial, inter- nal rotation of the pelvis, knee and/or foot and ankle. Soft tissue shortening in pelvic muscles lead to pelvic tilts or rotations and even soft tissue lumbar and thoracic restrictions.

Figure 4: Main adductor muscles

Treatment Soft tissue therapy concentrating on the pelvic asymmetry muscle imbalances of the thoracic and the lumbar regions. Again a programme of physiotherapy, podiatry and strength conditioning is beneficial. Treatment aims ■ Restore balance to agonist and antago- nist muscle relationships

■ Restore the range of movement to