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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3 AREAS IN YOUR BODY YOU HOLD YOUR STRESS

Did you know that there are three primary areas of the body that typically hold tension? All of us have preferred places in our body where our pain, worry, and fears are most readily expressed in muscular tension. The three key areas in the body, that have the potential to be most affected by emotional forces, and that is the pelvic floor, the diaphragm, and the jaw. Many of you have experienced tension in your neck and jaw and tightness in your low back. This can be driven primarily by emotions. If we think of it this way, pleasurable experiences typically will cause us to relax, energize, and expand. Conversely, unpleasant experiences are going to typically cause us to contract, be tenser, and possibly even depressed. We must recognize that this stress or muscular tension that we are holding in these three primary areas is subconscious and that rather than just addressing the symptom, we have to focus on what is the root cause. Is there another way for you to express your emotion? Meditation, mindfulness, yoga, journaling, and talking to a friend or talking to a psychologist are all really powerful and often necessary. I’m going to discuss some quick bio hacks that can help with addressing these tensions and hopefully make you feel great.

  1. Jaw: Many people tend to clench their jaw or grind their teeth, whether that’s during the day or at night. This is a subconscious behavior indicating that the nervous system is in a survival mode. Here are two easy things that you can do while you’re brushing your teeth and then also during your workday that are very simple to relieve jaw tension and hopefully retrain and reprogram yourself to not clenching your jaw.
  • The first thing is to make sure that you have the optimal tongue position. Make sure that the tongue is resting on the roof of the mouth and the back of the front teeth. You’ll want to make sure that your teeth are slightly apart and your lips are gently closed. If you make a humming sound, your tongue will naturally be in the ideal position. Practice this multiple times a day to make sure you are tuning in. Also, when you are breathing diaphragmatically, your tongue would be in it’s resting position.
  • Another aspect of jaw tension is when your jaw is compensating for other things. For example, if there’s a lack of core stability and tension in the abdomen, you could be clenching your jaw to create stability. You do want to be properly evaluated but if you know that your jaw is tight you can do this release. Your masseter muscle is right on the outside of the jaw. Then you have your lateral pterygoid, which points up toward the ear and then the medial pterygoid, which goes down toward the bottom of the jaw, like scissors.  You can take your toothbrush in your mouth and move it up toward your ear to release the lateral pterygoid. You do this by holding your toothbrush in your mouth in that direction on the right side and then moving your jaw down, left, up, and then to the right. Then to release the medial pterygoid you would stick your toothbrush in your mouth again but this time toward the bottom of your jaw. Then, while holding the toothbrush on the right side you will move your jaw down, left, and then close. Now, to release the masseter, you will hold your fingers against the outside of your jaw on the left and then move your jaw down, right, and then close. You can do all of these on both sides. You can also use this as an assessment to see how tight your jaw is. 

2. Diaphragm: This tends to be an area where we can hold a lot of emotional tension and grief. We breathe 20 to 25,000 times a day so how you breathe matters. It’s not just about if you’re breathing to stay alive, it’s how you’re breathing. With practice and conscious regulation of this muscle, we can regulate our response and our emotions. However, during times of high stress, like right now in the world, the diaphragm can become very restricted which therefore can cause one of your most common complaints which is neck tension. Many will say “I hold my tension in my neck,” but that’s because they are breathing from the neck and shoulders, as opposed to the diaphragm.

You can check out my other video on how breathing is your superpower. But, for now, try to take three diaphragmatic breaths every hour. This means that you’re breathing in through the nose, ideally out through the nose, if possible, and you’re expanding your abdomen 360 degrees. That means that your chest will not rise up and down, but your abdomen will expand. The longer the exhalation, the more of a relaxation response you will have. You want to start with a breath that feels comfortable for you. For example, three seconds in and three seconds out. As you feel more comfortable please try to extend your inhalation, exhalation, and even your pauses at the subtle shift before your exhalation, and then before your inhalation. This can be calming for the nervous system, but it also allows you this opportunity to tune in with what’s happening in your body, to be mindful, to understand what your emotions and thoughts are, and what your physical sensations are.

3) Pelvic floor. This is often considered taboo, however, is one of the primary areas for men and women, where we unconsciously store emotions. This is also based on Eastern and Western medicine as it relates to the chakras, but also science. The pelvic floor is critical for our emotional and energetic health. Think of dogs when they are expressing their emotions or they have done something wrong and their owner is upset; the dog will tuck their tail between their legs. That is the same concept of what happens where as humans, we create this tension in the pelvic region and we don’t even know it’s there. Pelvic floor issues very commonly present as hip pain, low back pain, and sometimes even knee pain.  It can be something that is an underlying issue that is often overlooked but very common. Here are two exercises that you can do to relax your pelvic floor.

  1. Rock on your forearms: Place your elbows outside of your shoulder, knees outside of your hip, and keep your eyes gazing towards your fingertips. Inhale as you rock back, exhale as you rock forward. Make sure you keep your spine nice and straight. Your eyes gazing forward will allow that to happen. Inhale as you go back to relax the pelvic floor, exhale as you go forward belly button will go in towards your spine.

2. Happy baby:  Lie on your back, grab your toes, outside of your shin, or inside of your shin. Inhale all the way down to the pelvic floor to relax it and you can rock gently back and forth.

In summary, start with the tongue on the roof of the mouth and resting on the back of the teeth. When you inhale, your pelvic floor is relaxing. The deeper your diaphragmatic breath, as that intra-abdominal pressure goes down, your pelvic floor is lengthening and relaxing. When you exhale, your abdomen tightens up like a corset. Just your breath alone with the proper positioning of your tongue can address all of these areas of emotion or muscular tension. Then, you can integrate that into your movement. When you are doing the happy baby or rocking on your forearms, make sure you integrate all those aspects together. Especially during this challenging time, make sure to be kind to yourself and the emotions you are feeling right now.

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

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