Be Well Personal Training

Friday, July 25, 2014

A balanced hip: Part I

The hip is a neatly designed joint, organized in a way to allow functional mobility, but still has proper constraints in place to maintain stability, including 3 ligaments (Nam, 2011). These three ligaments are the ischiofemoral ligament, pubofemoral ligament, and iliofemoral ligament.

There are 6 deep muscles that stabilize the hip in the socket, followed by several layers of muscle that move the joint a variety of different directions, culminating with the gluteus maximus muscle which not only generates power and propels the body forward, but is also believed to be the point of load transfer from lower extremity to torso via the thoracolumbar fascia (Barker 2014). Directly opposing the lateral hip is the “groin” area. This area connects the abdomen and the lower limbs via the inguinal region, consisting of abdominal muscles (internal and external oblique, transverse abdominis, rectus abdominis, and the pyramidalis), the inguinal canal, and the femoral triangle (Valent, 2012). During movement, the pubis symphysis is stabilized synergistically by the abdominals and the erector spinae, and the adductor muscles work in an opposing manner to provide stability to the area during load transfer. In the front of the hip are your “hip flexors,” which flex the femur in the sagittal plane. One of these muscles, the psoas, has attachment points on the lumbar vertebrae and is believed to play an important role in lumbar spine stability in an upright stance (Penning, 2000). It also shares fascial connections to the diaphragm and some believe it may play a role in overall trunk stability, along with the diaphragm, transverse abdominis, multifidus, and pelvis floor (Sajko & Stuber, 2009). A variety of issues can occur in and around the hip joint, including minor issues, such as tendon snapping, and more serious pathologies such as femoral acetabular impingement syndrome (Byrd, 2007). Interestingly, hip pathologies usually present as a “pain in the groin,” rather than pain in the more centralized hip joint area. Obviously, the cause for these pathologies are multi-faceted in nature, and it is worthwhile to note that the hip receives innervation from branches of L2-S1, with the L3 dermatome innervating much of the medial thigh, so if you or someone you work with has chronic groin pain, refer to an M.D. to rule out serious hip or lumbar spine pathology and make sure exercise is cleared.

Clearly, the hip and the muscles surrounding the hip play an important role in movement. It can be unclear how to train this area (do I focus on hip internal rotation or external rotation? Do I stretch the hip flexor or instead think about glute activation?) Each person is unique and what works for some might not work for all; however, hopefully we can begin to examine ways to move the body and integrate the hip in a balanced way. It is important to first bring awareness to the area and see if the hips are balanced, or if any asymmetries exist. An easy way to check this is to lie down on your back and begin noticing the weight of the pelvis on floor. As you begin thinking about this area, ask yourself if the weight of the pelvis on the floor feels even or if it feels unbalanced. If it feels unbalanced, ask yourself which side feels heavier against the floor. (If you have a difficult time identifying the contact of the pelvis with the floor, I strongly encourage you to work on some breathing exercises and learn how to engage your core using your breath. It is possible that by simply focusing on the sensation of your exhale, you will begin to feel a stronger sense of weight of the pelvis). If your pelvis feels like it isn’t quite balanced, chances are this asymmetry will be present during movement. Consider that your muscles are designed to work in a specific manner depending on their length-tension relationships. If you have a pelvic asymmetry, muscles on one side of the pelvis will be in a different position than the muscles on the other side of the pelvis. Unless you begin to correct the imbalance, your muscles will be working differently on the two sides. Now that you have assessed your pelvic position in a supine position, sit down on a bench or chair with your feet flat on the ground. Glance down at your feet. How did you naturally sit? Is one foot slightly in front of the other, or are your feet even? If your feet aren’t even, can you pull the hip of the foot that is forward back a touch to even out the feet? Now, notice the contact of your sitting bones on the bench. Are they both rooted evenly, or is one in better contact than the other? If you can’t find or feel either sitting bone, I highly recommend some breathing work with an emphasis on core integration (you might begin to notice a theme). If you feel one better than the other, can you begin to root the sitting bone that you can’t feel and then relax back to what feels “normal?” Do this a few times and relax. See if there is a difference. Now, come into a standing position. Once you are in a position that feels comfortable for you, glance down at your feet and see if they are even. If they aren’t, can you move the foot back that is forward with your hip? Now, take your hands on your hips and look down and see if one finger appears to be slightly forward or higher than the other, or if they look balanced. Observe the contact of your feet with the floor. Are your feet balanced on the floor, or are you standing more in your heels or toes? Where is your weight more loaded? Is it more on your left foot or your right, or is it even? Find balance. What happens when you spread your toes and lift your arch? Do your feel any activity in your hips? If you have a high arch, what happens when you engage the center of the foot and press the arch towards the floor? Do you feel any activity in your hips?

Before training the hips, it is important to understand there can be imbalances and asymmetries in our pelvis. This influences how we perform movements and which muscles are activated during movement. Bringing awareness to the area is often the first step in recognizing asymmetries that might exist. Asymmetries also affect the body’s ability to move in an efficient manner. Part II will focus more on actually training the hips and integrating the movement with the rest of the body.

Nam, D., Osabahr, D.C., Choi, D., Ranwat, A.S., Kelly, B.T., & Coleman, S.H., (2011). Defining the origins of the iliofemoral ischiofemoral, and pubofemoral ligaments of the hip capsuloligamentous complex utilizing computer navigation. HSS Journa, 7(3), 239-243.
Barker, P.J., Hapuarachchu, K.S., Ross, J.A., Sambaiew, S., Ranger, T.A., & Briggs, C.A., (2014). Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint. Clinical Anatomy, 27(2), pp. 234-240.
Valent, A., Frizziero, A., Bressan, S., Zanella, E., Giannotti, S., & Masiero, S., (2012). Insertional tendinopathy of the adductors and rectus abdominis in athletes: a review. Muscles, Ligaments and Tendons Journal, 2(2), 142-148.
Penning, L., (2000). Psoas muscle and lumbar spine stability: a concept uniting existing controversies. Critical review and hypothesis. European Spine Journal, 9(6), 577-585.
Sajko, S., & Stuber, K., (2009). Psoas Major: a case report and review of its anatomy, biomechanics, and clinical implication. Journal of Canadian Chiropractic Association, 53(4), 311-318.
Byrd, J.W.T., (2007). Evaluation of the hip: history and physical examination. North American Journal of Sports Physical Therapy 2(4), 231-240.

Monday, July 7, 2014

Meditation and exercise

Meditation has been showing up in my world a lot lately. It could be argued that as a yoga practitioner, meditation should show up daily, but it is easy to put that portion of the practice on hold for the physicality of asana. It could also be argued that yoga is moving meditation, and I definitely think that it can be, but first a brief explanation of what meditation actually is and how it can be applied to all realms of exercise, not just asana.

Lately, I have been a bit dissatisfied with the fitness industry, or more accurately, the air of negativity and self righteousness that permeates the online scene. Perhaps this is the downside of social media- often the ones with the loudest voices are also the ones with the strongest opinions. I study a variety of systems in an effort to find the most effective way to get people moving well, get them strong, and prepare them for the demands of life. The systems I study all provide aha moments, but I find them incomplete. Each one is missing something and so I am constantly searching for the answer, the one system that will help all of my clients lead pain free lives. I find many people in my profession like to make absolute claims regarding movement, (“Distance running will kill you!” “Yoga will make you weak!” "Kettlebells cure everything!") all while claiming a specific system/methodology/philosophy is the solution to movement dysfunction. This frustration led me to run away to a yoga festival in Boulder and study with several well respected teachers and turn off my phone. Meditation came up in two of the classes, and I found the teachers saying things that made sense. Jason Crandall said that meditation is really the observation of thoughts without judgement, and Maty Ezraty said her cues (which were given while we were shaking in deceptively simple postures) were meant to help focus our thoughts and move us towards a more meditative state. 

According to Wikipedia, “meditation is a practice in which an individual trains the mind or induces a mode of consciousness, either to realize some benefit or as an end in itself.” A meta-analysis performed by Morgan,, (2014) found mind-body therapies are effective at reducing markers of inflammation, and it is well-accepted that meditation can be an effective way to reduce blood pressure, reduce anxiety, and decrease cortisol. The term meditation can indicate several different techniques. A fascinating paper Debarnot (2014) examines the influence meditation can have on expertise (if you have any sort of interest in mastery, this is well-worth the read. The link can be found below). They categorized meditation into two different groups: focused attention and open monitoring. Focused attention is the concentration of a particular external stimulus while ignoring all other input. This was the type of meditative practice Maty was hoping we would achieve by listening to her cues rather than fixating on what our bodies were feeling or thoughts of “this is too hard.” This type of practice can develop sustained attention and enables the practitioner to redirect attention to the desired object, in my example, Maty’s voice. On the opposite end of the spectrum is open monitoring, which aims to enlarge focus to all incoming sensations, emotions, or thoughts without any judgement. This was what Jason was emphasizing during his arm balance class. He wanted us to notice what we felt and observe the thoughts associated with the asana without judging them (harder than it seems if you are at all type A). This type of practice is believed to develop awareness, and improve executive attention. John Ratey, Richard Manning, and David Perimutter point out in their book “Go Wild” there is a belief that meditation is about relaxation and bliss when it is actually about hyper attention and focus. From an evolution perspective, this makes sense. Hunter gatherers needed to use this hyper focus and awareness to both stalk their prey and perceive danger. This requires both focused attention and open monitoring, and the beauty of understanding meditation in this way is that it can be applied to several areas of motor learning and performance.

The easiest way to begin improving awareness is by leaving the cell phone at home or in the car prior to engaging in physical activity. This was one of the things I appreciated about my timel in Boulder. I am not someone that is necessarily tied to the phone; however leaving it at the hotel while I participated in 6 hours of yoga was freeing and allowed me to focus, not just on the yoga, but on my surroundings. While much of the technology built into the cell phones is great for data collection, I will argue that leaving the cell phone when one hikes or runs is a way to increase both open monitoring and focused attention. The ability to observe our surroundings and  thoughts without technology is powerful, and actually focusing on body sensing during movement allows us to recognize unnecessary tension and ease of movement (Danny Dreyer discusses this in depth in his book, “Chi Running”). What “mind-body” disciplines all have in common is they require the practitioner to focus on what is going on, a sort of focused attention to the task at hand. Not using electronics, minimizing music, and choosing movements that require focus are all ways to ensure a movement meditation. While this type of training is harder for the teacher or trainer, the mental benefits could be significant, and perhaps improve our overall health. I frequently cue clients to think about  the breath during “regular” exercise movements in an attempt to keep them focused on the task at hand and ask clients to notice how one part of the body responds when another is moving. Instead of viewing meditation as a separate activity, if we try and incorporate it into our everyday lives and particularly into our movement regimens, we might find an increase in performance, attention, empathy, and health.

Yours in health and wellness.

Morgan. N., Irwin, M.R., Chung, M., & Wang, C., (2014). The effects of mind-body therapies on the immune system: a meta-analysis. PLoS One, 9(7). 
Debarnot, U., Sperduti, M., Di Rienzo, F., & Guillot, A., (2014). Experts bodies, experts minds: how physical and mental training shape the brain. Frontier of Human Neuroscience, 8.