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This blog is for those of you who have hip pain, groin pain, hip impingement, sciatica, SI joint pain, or low back pain. And if you don't have any of these, then you are lucky and prevention is the best medicine!
Hip mobility is paramount for a healthy body and spine. During an evaluation I like to observe a static standing assessment, a functional movement assessment, and then perform a passive mobility assessment.
People with back/hip/groin pain often have a postural position of "butt gripping" (read a great article about it here Diane Lee). In this position, the pelvis is thrust forward and the deep hip rotators are contracted. When these muscles are overactive, they push the head of the femur into the front part (anterior) of the hip capsule which can interfere with hip motion: hip flexion (bringing the knee toward the chest) and internal rotation (turning the thigh inward).
On the functional exam I will see an inability to go into a deep squat, or the hips will shift to the opposite side during the squat. On the passive motion test there will be a limitation in hip flexion, and they may express pain with a combination of movements: hip flexion, adduction and internal rotation.
Standing in alignment and learning how to let go of the grip in the rotator muscles is essential for healing, as well as reprograming the normal glide of the head of the femur. In normal motion, as the knee moves toward the chest, the head of the femur should glide back and down. Due to the tightness of the rotators, the back (posterior) hip capsule can be restricted. Restoring the tissues and the hip motion can be achieved through simple self mobilizations.
3. Hip Release and Hip Glides: this is a video demonstrating how to do the self mobilizations to regain normal motion.
The quadricep muscle group is comprised of 4 muscles that all share a similar attachment to the lower leg bone, the tibia. The muscles converge at the knee at the patella (knee cap) and inserts onto the tibial tuberosity. The muscles are named for their location on the thigh:
The main action of this group is to extend (straighten) the knee and the rectus femoris will also flex the hip. Quadricep control is important for walking, running, going up and down stairs, lunging, squatting, basically every move we make. Having supple quadriceps is key not just for healthy knees, but for healthy feet, hips and spine. Restrictions in the quads will affect proper loading of the foot and knee during gait. Tightness in the rectus femoris can pull the pelvis forward into anterior rotation which increases lumbar extension and spinal compression, and can limit hip extension (being able to bring the leg behind you).
How to stretch the quadricep
Let's face it. Many of us are super tight, and it feels good to pull on the leg as far as you can to get a deep stretch. The stretch always feels good, but the muscles never fully let go and we have to keep stretching forever and ever. One possible reason why the muscles don't make lasting changes is that we have a stretch reflex within the muscles that serve as a protective mechanism: if the muscle is stretched too far beyond its limit, it will contract to prevent injury. During stretch sessions, you may be moving beyond your tissue limit so the muscles never change! One way to refine and meet your tissues is to scale back and use alignment markers to guide you into your stretch.
How to release the rectus femoris (hip flexor and knee extender)
This month I was interviewed by a colleague of mine from the Neurokinetic Therapy™ Community, Eric Nelson. Eric Nelson is a chiropractor and owner of Nelson Chiropractic and Pilates Center.
Not many people specialize in pelvic health, so he wanted to pick my brain about pelvic health. He asked me some great questions about pelvic health so I thought that it would be a good idea to share the interview on my blog.
Some of the topics discussed:
Inside the Brain Of: Susan McLaughlin, PT
I have been working with a client for a few visits. His main complaint: L low back pain and L hip pain. He has made some good progress and will feel good for about a week or so and then the discomfort will come back. In our last session we found that he couldn't lift his left thigh off of the table when he was on his stomach, and it really hurt his back. I could see that his back muscles on his left side were really working hard. I released the back muscles and his discomfort went away, but he still couldn't lift his leg. His left gluteus maximus was not responding what so ever!
This last weekend I attended a training called "Finding Center" by Gary Ward of Anatomy in Motion. The first day of training we spent 4 hours exploring the 3D movement of 6 key muscles in the body. One of these muscles was the gluteus maximus. Many of us know the glute max actions: hip extension, hip external rotation and hip abduction. Typical ways to strengthen this muscle is through concentric contractions as in clam shells, fire hydrants, bridges, lunges and squats.
According to Gary Ward, the first rule of movement is: "Muscles lengthen before they contract." His theory is that you want to lengthen the muscle as far as it can go, and it has nothing to do but contract. I applied this concept when I returned from my training.
My client came in this week with his left back and hip a little aggravated. I tested my client again on his stomach. He could not lift his thigh off of the table, and he had incredible pain in his back. I had him stand up onto his left leg and move through the single leg squat and 3D reach. I had him allow his hip and knee to move into flexion, adduction and internal rotation (prior to this training, I would have controlled for knee adduction and internal rotation). After completing about 10 repetitions he says, "I don't have the pain in my glute anymore." We moved through a few more patterns, got him back on the table and retested his ability to lift his thigh off the table: Full lift without any pain! He was completely amazed, and quite honestly so was I! He got off of the table, took a walk and didn't have any pain. Next time you feel like you are stuck in your training, or you have a case of "dead butt", remember: muscles lengthen before they contract.
I have included one of the movement patterns I went over with my client in the video below. Rather than tapping down with the foot, you can also try reaching your arm out to touch the floor in a clockwise fashion.
3D Glute Max
If you didn't know already, the squat is hot. Everybody is doing it..... The squat is one of the most effective ways to strengthen your glutes. But.... not every body is ready to bust the move and go deep into the squat position without losing their balance or hurting their knees.
This post demonstrates how to perform a double leg squat and a single leg squat with a vertical shin. A vertical shin helps take the load from the knees and puts the weight back into the posterior chain: hamstrings and glute max. The single leg squat also engages the gluteus medius, which is important for stabilizing the pelvis.
Below is a video sequence to address spinal mobility and upper back tension. Before you begin, lie on your back with your legs out straight. Notice the contact of the back of your legs, your low back, lower ribs and shoulder blades to the floor. After you complete the sequence, lie on the floor again and notice the change of your muscles and your connection with the floor. Enjoy!
Recently I had a conversation with a doula about fetal positioning. She and many of her doula colleagues have noticed an increase in clients that struggle during labor due to posterior positioning of the fetus. Posterior occiput position is when the baby's head is down and facing mom's belly. A normal presentation is when the head is down and the baby's head is facing the mom's sacrum as in the picture to the left. I would like to share some information from the workshop I presented to our Salt Lake Birth Circle group.
Incidence and consequences of Occiput Posterior (OP):
Why are babies malpositioned?
Penny Simkin, PT and author of The Labor Progress Handbook attributes fetal malposition to cultural habits and trauma.
What can we do about it?
Stand and Sit Alignment
Release Tension in your Hip Flexors and Pelvic Floor
If you are in the Salt Lake area you can learn about the topics introduced in this blog and more, in my prenatal workshop, Birth Mechanics: Get Your Body Tuned up for Delivery. The next workshop is coming up February 15, 9:30-noon. Find out more here!
Hands down, one of my favorite muscles in the body is the psoas major. Mostly because I have had personal experience in "rehabing" my own psoas strain (took me 2 years for it to get back to "normal"), and chronic back and SI pain. As you can see from the picture, this muscle covers some real estate: Attaching superiorly at the spine (to the transverse processes and lateral surface of thoracic vertebra 12 to the last lumbar vertebra and corresponding discs) and traversing down and forward through the pelvis to attach to the inside of the upper leg (lesser trochanter). Understanding and visualizing the position of this muscle should help you appreciate the relationship of the psoas to the function of the trunk/spine, pelvis, and extremities. It is involved in everything! As soon as I began to respect the stress and excessive loads that I was placing on my psoas (there are two, one on each side), my groin strain went away and so did my back and SI pain. As I work with clients with back, pelvic, hip and SI pain, a psoas release is one of the first steps toward decreasing tension and moving toward healthy tissues!
Below is a video demonstration of how to get into my most favorite psoas release position. I have shared this release in other posts, and received feedback that it would be helpful to do a "how to" video. So, here it is! Enjoy!
I have written about the psoas before in other posts, please take a look:
A Song To My Psoas: Please Release Me Let Me Go....
Ten Exercises For A Healthy Psoas
Pain In The Hip And What To Do About It
Top 10 Exercises For Hip And Spine Health
Results from a systematic literature review suggest that women experience foot pain more than men, and that the most common site of pain are the toes and the forefoot, AND that two-thirds of the population studied described moderate disability for daily living. You can't walk very far if you feel like you have a pebble in your shoe, or every time you take a step you feel burning pain or tingling at the base of your toes.
A bunion occurs from pressure at the side of the big toe (hallux). This pressure shifts the big toe toward the others and the joint can become swollen, sore and enlarged.
A neuroma occurs at the bottom of the foot typically under the 3rd and 4th toes. The pressure at the forefoot irritates the plantar nerve and the tissue around the nerve can become dense and hard. Because the nerve is irritated, people may experience burning, tingling, or numbness between the toes and foot.
What contributes to bunions and neuromas?
Simple Steps to Eliminate Foot Pain
1. Take a piece of blank paper. Stand barefoot on the paper and outline your foot with a pen. Take this paper to your closet and compare the width of your shoes to the outline. Don't wear the shoes where you can't fit your toes in the toe box, and the outline extends beyond the shoe. Notice that the shoe sits inside of the outline in some places; don't wear these shoes! Find shoes that do not have a heel. If you are used to wearing a higher heel you will need to gradually transition to lower heels so your tissues have time to adapt (give yourself 4-6 wks before you transition for each .5 to 1 inch).
2. Learn how to stand in alignment. See pic above. Or read this blog.
3. Wear toe spacers. Yes, you should be able to see space between your toes! There are many products on the market. These are my favorite: Correct Toes. Cool thing about these is that you can wear them in your shoes! Very comfortable (but you have to have a wide enough toe box in your shoe). If you have a bunion you may want to test to see if this will be comfortable for you before purchase: take your big toe and pull it away from your other toes as far as you can, and then lift it up. If there is discomfort in the joint then your toe is probably compressed, and it would be good for you to see me, or your local PT (or chiro, osteo, etc) to work with you.
Exercise your feet
Almost a year ago I wrote about the pectoralis minor's referral pattern into the shoulder blade and shared a lovely release using a tennis ball (you can read about that here). I am back at it again with another post highlighting the pectoralis minor and pectoralis major. Due to the location of their attachment sites on the skeleton, they can affect the function of the head, neck, shoulder and arm.
Pectoralis Minor attaches to the coracoid process of the scapula and to the outer surfaces of the third, fourth and fifth ribs. Restriction here can pull the shoulder blade forward (you will see the bottom/inferior portion of your shoulder blade lift away from your body wall), potentially bringing the entire arm with it).
Pectoralis Major is a big fan shaped muscle that is attached to the chest at the sternum (breast bone) and clavicle (collar bone) . The fan shaped fibers coverge at the arm and attach into the bicipital groove of the humerus. Restriction in this muscle will pull the arm in front of the body and rotate your arm into internal rotation (with your arms at rest at your sides, look in the mirror: where are your elbow creases facing? If they are turned toward your body, that is called internal rotation. In neutral, the arms should rest at the sides of the body with the elbow creases facing forward).
Just get it off your chest and feel more free!
Before you begin with the exercises, do a motion assessment first. Stand with your elbow creases and palms facing forward. Lift your arms up and see how far you can lift without arching your back or letting your lower ribs lift away from your body wall. Complete the movements as show below and then repeat the assessment. For the first exercise you can use a tennis ball, but I prefer the high grip rubber of the Yoga Tune Up massage balls.
Reassess your arm motion: Hopefully you have more freedom in your movement!