Why you should stop “stretching” your hip | HIP PAIN

Do you have hip pain that you are continually trying to stretch, roll, or smash, and nothing seems to get better?  Before we get into the role of the psoas, one of your key hip flexors, let’s speak about the local stabilizers and global stabilizers of the body. This is important to understand how you are going to treat your hip flexors and hip pain.

Think of the local stabilizers as being muscles that are close to the joint. They create more of an isometric contraction versus concentric (shortening) or eccentric (lengthening) contraction. They control the joint centration which means keeping the joint centered in its axis. It’s also independent of the activity of motion so if you raise your arm overhead, the deep stabilizers in my spine are going to activate before your arm goes overhead. Essentially these local stabilizers are imperative for stabilization in the body so that we can have proper movement.

Our global stabilizers are equally as important. However, they have a different role, so they have more of an eccentric contraction. They decelerate the range of motion, are continuous with motion, and are farther away from the joint.

Now getting back to the psoas, which is what everyone wants to stretch when they have hip pain.  The posterior or the back of the psoas is a local stabilizer. Think of it as one of our deep core muscles that is helping to stabilize the spine and also prevent the femur, our leg bone, from shifting forward in the hip joint. The anterior or front of the psoas serves as a global stabilizer. So, it is necessary to think of the psoas muscle as a stabilizer. Not only is it a stabilizer but it works in an integrated unit with all of the other muscles, including the pelvic floor, diaphragm, multifidus, the deep five rotators in the hip, and the transverse abdominus. All of these have to work together, and once again in this integrated fashion to be able to stabilize the low back and the pelvis during any kind of movement.

For example, if you performed a chest press with 30 pound in each hand on a bench and then transitioned into doing that on a stability ball, your weight would naturally go down. Why? Because you now have an unstable platform to work from and therefore can not generate as much force.

There are a lot of different hip pathologies that we won’t get into today, but when you have hip pain it typically happens from losing the deep stability of the hip. There are two common muscle imbalances that will exist. One is the TFL(tensor fascia latae) muscle, which is right in the front lateral side of the hip, can get tight, especially with increased sitting. Based on this attachment, it will pull the hip forward, and that will therefore inhibit or shut down the psoas. The other common muscle imbalance is the hamstring muscles, which can get tight for various reasons, inhibiting the glute muscles. The hamstrings can push the femur forward and that also leads us to lose that optimal position on the hip joint. Overtime if we have these muscle imbalances, instead of the hip being centered in the axis, it will start to shift forward and up. This will cause all types of pain issues and pathologies. Whether that’s a labral tear, hip impingement, tendinopathy, bursitis, and so on. So, it is important to get the hip stabilized and centered in the joint in order to decrease pain and ultimately improve function.

You can begin to do this through a four-step process. This is a great way to begin to address your pain, as well as any kind of movement compensation, and most importantly, integrate your foot with your core, in a very integrated manner. First is inhibiting the tissue, in this case we inhibited the TFL muscle that typically pulls the hip joint forward and creates that inhibition of the psoas as a deep stabilizer. Then, mobilize the hip joint to center the hip joint. Remember that when it is not in that center position it’s shifting forward enough so we’re shifting it back to the center position. Next, stabilize it by activating the deep stabilizers, such as our diaphragm, pelvic floor, etc. Then we’re integrating it with the ground. This is super important because the foot is part of the core and they work as an integrated unit. To get those deep stabilizers of the hip firing, short foot, i.e. foot to core sequencing, allows us to do that in a very integrated fashion.

4 Steps

1. Inhibition

For the TFL release, place the ball right on the outside of the hip. When you lie down, you’ll naturally rotate the hip in, which will expose the TFL muscle. With the other leg, anchor it up at a 90-degree angle and come down to your forearms. Holding that position your leg will be nice and long, naturally rotated in, and breathing throughout the exercise trying to relax into it.

2. Mobilization

For the hip mobilization with a band, you’ll place the band high up in the groin. You’ll have it back at a 45-degree angle away from you. You’ll start in a table position rocking forward 15 times, making sure your spine stays nice and long, and you’re breathing. Then rock away from the band, so to the opposite side, once again about 15 times, making sure you’re breathing throughout the exercise.

3. Activation

Now it’s time to activate the deep core, so you can do this by diaphragmatic breathing. Inhale, breathing into the abdomen and into the base of the pelvis allowing the abdomen to expand 360 degrees. Exhaling, letting the abdomen contract and the belly button in towards the spine. Once you feel like you have this established, then on your inhale allow the pelvic floor to relax, so you can exhale and gently lift the pelvic floor about 20% contraction to get a deeper integration. You want to think of this as a rhythmical balance, so nice and fluid. Inhaling to the base of the pelvis and exhaling gently lifting the pelvic floor.

4. Integration

Lastly, it’s time for integration. This is to be done with short foot. Standing on one leg, sitting the hips back, knees slightly bent, taking a breath in, while your foot relaxes then exhale and gently root the tips of the toes into the ground. That will naturally lift the arch and lift the metatarsal heads or ball of the foot.

So whether you have hip pain or hip tightness and are constantly stretching your hips, hopefully, this video will give you a little bit of insight to allow you to think about your hip differently and recognize that it is part of an integrated unit. It is really important to understand how that works as it relates to stabilization and movement

If you’d like to schedule a free 15 minute virtual discovery session, please email drarianne@staging.movementparadigm.flywheelsites.com or text 302-373-2394 to schdule. We’d love to help you get healthy again!

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Why should you lift heavy weights

Why should you lift weights, but more importantly, why should you lift heavy weights? It can be so profound in not only your physical strength but also your mental and emotional strength.

Strength training can help improve your self-awareness, your confidence, your overall ability to create, to explore, to move through the world differently, and in a way that you are more resilient. You have better adaptability to change, stress, and loads. It can have a profound difference on your overall well-being.

Let’s dive into eight ways that lifting heavy can improve your health. 

1. Boost confidence

Lifting heavy weights has been shown to decrease anxiety and depression, and improve self-awareness and confidence. When you are lifting heavy and you are strong, you are going to move through the world differently. If you haven’t tried it, and you know someone that has, take a look at them and ask them about their experience with strength training and you will find the same thing. 

2. Increase power and muscle mass

When you are strength training you are increasing your muscle mass. Many women will say that they want to get “toned.” In essence, that is increasing muscle mass. When we are stronger, that means that we can produce more force and we’re able to adapt to different loads more effectively. You will find that moving a heavy box or moving a couch is much easier because you have generated the ability, over time, to adapt to these loads and forces. 

3. Burn fat

We often think about burning calories. You’ll jump on the elliptical or go for a run and you’re thinking about how many calories you’ll burn during that session, for example. Instead, we want to be thinking about burning fat, and also burning calories well beyond that particular exercise session. This does not mean that cardiovascular activity is bad. It just means that we can get a ton of benefit from strength training well after the actual session.

After a session, our body still has to continue to repair the muscle, and it’s still burning energy. Therefore, we’re burning more calories and fat after an exercise session than we are in an aerobics session, for example, that we’re only doing that in that particular session. 

4. Increase in muscle size, i.e., hypertrophy

For each pound of muscle we have, we’re going to burn an additional six to 10 calories per day just for it to maintain itself. This can be powerful in fat loss. This is the reason you want to start strength training early.

So, if you have kids that are just getting into fitness you want them to start strength training early because it can have a profound impact on their bodies later in life. This is because the more muscle they gain, over the years, the better their metabolism is going to be and the more muscle mass they’re going to have. It can be so powerful to start early in life, but it’s never too late. 

5. Improve bone density 

This is one of the most powerful things that we can do for our bone health. If you’ve been diagnosed with osteopenia or osteoporosis, please don’t hesitate to start a strength training program. Of course, you also want to prevent these things. Strength training can help our bone mass as we age, to prevent things like fractures and things that can completely impact our quality of life. 

6. Fight aging

Each decade after the age of 35, we are losing anywhere from 3-10% of our lean body mass. However, if we are lifting heavy weights we can preserve that lean body mass and even reverse some muscle loss. 

7. Improve our brain health

Lifting heavy weights can increase our growth hormone which can help with cognitive processing and function. It can help to decrease the cognitive changes that we may experience as we age. 

8. Improve our resilience

It can help us to decrease and prevent injuries by improving the adaptability of our tissues. We’re loading tissues so that we can become more resilient. In life, we constantly have to load and stress our tissues for them to remain healthy, strong, and elastic. If we don’t load them properly that’s when we begin to get into an injury cycle. So one of the most important things to preventing injury is lifting weights and specifically heavyweights. 

Hopefully, this was enough to get you started lifting weights if you’re not already, and if you are please continue on that journey and remember to keep challenging yourself. You don’t want to do the same weights over and over again because you want your body to continue to adapt to new stresses. Make sure that you’re challenging yourself with heavier weights and variability.

This goes without saying, but make sure not to add fitness on top of dysfunction. Get your movement patterns assessed and cleaned up before you start to load heavy.

Reach out for a 15-minute FREE discovery session to see how we can help you on your journey.

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How to train your core without crunches

Did you know that you do not have to do crunches and sit-ups to train your core? In fact, crunches, sit-ups, and many other similar core exercises can negatively impact your core, especially if they’re not done properly. How can you train your core without doing crunches?

Rather watch or listen?

What comprises our core?

Let’s break the core down. We have our local stabilizers, global stabilizers, and global mobilizers.

Our local stabilizers include our pelvic floor (base of our core), diaphragm (breathing muscle), multifidus (along the spine), transverse abdominals (like a corset), deep posterior psoas (hip flexor), and the deep hip stabilizers (deep five). These muscles are close to the joint and isometrically contract to create stability and control the joint positioning. This improves what we refer to as joint centration, maintaining our joint on its center axis.

Next, we have our global stabilizers. This includes our glute medius, obliques, spinalis muscles in the back, and quadratus lumborum. These muscles are also geared toward stabilizing, but they create more of an eccentric range of motion. They decelerate motion.

Lastly, is our global mobilizers. This includes rectus abdominis, latissimus dorsi, and quadriceps, and so on. These muscles produce force. They initiate force and movement. All of these are equally important. However, one has to come first, and that is the local stabilization. We have to be able to stabilize our joints to be able to produce force and power from a stable foundation. If you don’t have a stable foundation to operate from, an injury will occur.

Why is it important?

When we refer to the deep core and how it is intimately connected with your feet, and the rest of your body, I like to use the reference of the deep front fascial line. This connects from the bottom of the foot fascially all the way up through the inner thigh, pelvic floor, deep stabilizers, diaphragm, and even the neck. The beautiful representation of this fascial tensegrity is a great visual of how our body is connected, and how our feet are actually part of our core.

Another great way to appreciate this deep local stabilization and the importance of the local stabilization before the global stabilization is a hernia.

Whether you or someone you know has had an umbilical hernia, inguinal hernia, abdominal hernia, or sports hernia, this is a perfect example of where the deep core was not stabilizing efficiently. There was so much stress on the outer core musculature and poor pressurization in the abdomen that it caused a tear in the abdominal wall, or in the case of a sports hernia in the fascial tissue.

In the case of a sports hernia, which is very common but often much overlooked and misdiagnosed, the fascial tissue most often affected connects the rectus abdominus and the adductor. The adductor muscle will have a mechanical advantage so when there is a loss of deep stability, it will create a tear in the fascia in the rectus sheath. You cannot rehab this since you’ve lost the integrity in this force transmission system.  It can only be surgically repaired.

Now, back to the deep stabilizers. It is important to train the deep inner local system before the deep outer global system to prevent things like hernias, back pain, hip pain, and neck pain You can have an optimal foundation to work from to generate force with power and be able to do the things that you want to do. If you are doing crunches, sit-ups, or leg lowers without a proper foundation, read on.

What exercises can you incorporate in your routine?

Here are five different exercises that you can incorporate into your routine or refine if you’re already doing them so that you do not need to do crunches and sit-ups, but you can do these exercises to maximize the potential of your core.

1) Diaphragmatic breathing with pelvic floor contraction

As you inhale lengthen the public floor, relax, and then as you exhale gently lift the pelvic floor about 20 percent contraction in the direction of your head. Repeat this for eight to ten breaths working on the coordination and rhythm of the breath with the pelvic floor contraction.

2) Step by step hollow

Take a breath in and flatten your back as you exhale. Next, take a breath in, exhale, and lift your head and shoulders, reaching through your fingertips. Take another breath in, exhale, and pull your hamstring in towards your body, and then repeat with the other side. If that feels appropriate there stay in that position for a couple of breaths. If you’d like to progress, take a breath in, exhale, and raise your arms overhead keeping the hollow position and the tension. Then reach with the other arm. If you’d like to go to the full progression if that feels appropriate to you, then you would extend one leg, and then extend the other leg.

3) Beast

The beast position is in a stable position with your index finger parallel and spreading your fingers wide. Then corkscrew your shoulders, tuck your toes under, and lift your knees approximately two inches or so above the ground. Use your breath as your repetition. You can do this for as many breaths as you can hold. You can also progress into a crawling motion.

4) Side plank

This helps with lateral stability. The first progression is with your elbows underneath the shoulder, the bottom knee bent, and the top leg straight. If you’d like to progress this you can go into a staggered stance or even a stacked posture.

5) Foot to core sequence

Standing on one leg in an athletic position, take a breath in, as you relax your foot relax your pelvic floor, exhaling rooting the toes into the ground. Repeat that for five to eight breath cycles. As you do that you’re rooting the tips of the digits into the ground. You can then move into a bowler or any other type of dynamic motion, inhaling back and exhaling short footing, and coming back to the standing position.

There you have it—five different ways you can begin to shift your core training to focus on local stabilization before moving to global stabilization and movement. You can use these as ideas. There are endless exercises that can fit into this category but this is just to get you thinking a little bit differently about how to train your core the best way possible so that you can improve your performance, decrease your injury prevention, and feel your best.

Reach out for a 15-minute FREE discovery session to see how we can help you on your journey.

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WHAT IS A HEALTHY PELVIC FLOOR?

Let’s discuss a much-overlooked topic in modern medicine, especially as it relates to rehabilitative medicine… the pelvic floor. Yes, both men and women have a pelvic floor, and both can be compromised and contribute to many different conditions including but not limited to incontinence issues, sexual issues, and chronic pain.

The pelvic floor is essentially the base of our core. It has to be integrated with the rest of the surrounding anatomy. That means the organs, the bowel and bladder, the connective tissue, and the ligamentous tissue all have to be deeply integrated and fine-tuned for everything to work in this rhythmical dance back and forth.

It also helps to support our daily functions, prevent urinary and fecal incontinence, improve sexual function, and many other functions that we’ll discuss.

So, what does a well-activated pelvic floor actually do?

1) We are constantly transmitting force through the body. So, a well-activated pelvic floor is going to attribute to the closing force to prevent any leakage of urine, fecal, or gas.

2) Research shows that between 60 to 80% of women with stress urinary incontinence can cure it or significantly improve it with pelvic floor retraining.

3) A well-activated pelvic floor is also going to allow the appropriate relaxation response of the pelvic floor muscles to allow for proper emptying of the bladder and to prevent any post dribble or leakage after you’ve finished urinating.

4) It should also be relaxed enough for proper evacuation of the bowel, but provide enough resistance for optimal defecation.

5) It supports internal organs such as the vagina, the bowel, and the bladder. Especially as it relates to women and pregnancy, the more intact the pelvic floor musculature is, the less likely there will be a prolapse.

6) It increases the tone which allows for greater sexual awareness. You need to have a pelvic floor that can relax completely so that you can have more pleasurable pain-free sex.

7) A well-activated pelvic floor will relax and significantly stretch during vaginal delivery.

8) A well-activated pelvic floor will work in coordination with your diaphragm and the rest of the abdominals. This is very important in looking at overall movement and movement efficiency.

Why is a well-activated pelvic floor important?

In summary, a well-activated pelvic floor is important for so many necessary functions. When it is not functioning well, it can contribute to a whole host of problems. One of which, that we see consistently in our office is pain.

Chronic pelvic pain, low back pain, hip pain, and even knee pain can all be driven by pelvic floor dysfunction. It’s way more common than you think!  It’s also an area where we tend to hold our emotions. So, I want to point out that as important as it is for the pelvic floor to contract, it is equally important for the pelvic floor to relax.

If it is always tight, then we are not able to fully contract and fully relax it. This can contribute to the same issues. That is why it is very important to get evaluated properly. If you are having any type of symptoms that might indicate you have a pelvic floor issue, please contact our office to schedule a pelvic floor examination.

Reach out for a 15-minute FREE discovery session to see how we can help you on your journey.

For more content, make sure to subscribe to our YouTube channel here.

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