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@themovementparadigm.com or text 302-373-2394 to schdule. We’d love to help you get healthy again!

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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 the 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, and 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.

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, 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, which 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.

If you need help on your journey to better health, contact drarianne@themovementparadigm.com to schedule.

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