Sunday, September 21, 2014
The case of the “sore” hip
My left hip has been sore. For months. More accurately, the front of my left hip felt like it needed to be stretched, and while it felt good when I stretched it during yoga, the sensation of tightness remained. I thought it was just something I would have to live with, and since there wasn’t any pain and I could do everything I enjoyed, I didn’t really devote much thought or attention to it. I should qualify this by saying I could do everything I enjoyed except backbends. (Not that I have ever truly loved backbends, but they are part of my yoga practice and many, many years ago backbends taught me how to use my lower traps and get rid of neck pain, so they hold a special place in my life as something that helped heal). My backbends were downright awful. They didn’t hurt, I was able to disperse the load in my spine, I just couldn’t lift up into any sort of arc shape. This was a new thing. I used to be somewhat good at backbends, though for a long time they didn’t feel good. Now they felt fine and looked awful.
3 weeks ago I went to DNS Movement Skills down in Carlsbad. I had a great time, and would definitely recommend it to people that study DNS and enjoy the exercise component. I had a really good partner for most of the course named Jonathon. At the end of the first day, we were working on the deadlift using DNS principles and despite a fairly good understanding of how to move my body, I couldn’t finish the lift. It was as though my brain didn’t understand how to move my femurs back and my hips forward. Jonathon told me I needed to learn how to use the posterior third fibers of my gluteus maximus or I was going to end up with a shortened gait cycle (chiropractors and physical therapists work with so many dysfunctional movement patterns, I think they tend to catastrophize a little bit, but that’s a personal opinion). Martina, the instructor, came over at one point when Jonathon was struggling with getting me to go into full hip extension. “You need to work on moving your femurs back."
Learning to use the posterior third of my gluteus maximus and moving my femurs back made sense. I began learning PRI about 18 months ago. I fit the worst pattern, and designed a restoration program for myself, both for personal gain and to understand how PRI worked. The PRI viewpoint is that the patterns are like an onion. At the deepest layer is PRI “neutral” which means a balanced pelvis in the sagittal, frontal, and transverse plane along with a balanced ribcage and shoulder girdle region. Layers add, starting with a transverse plane femur pattern, working all of the way up to complete lack of sagittal plane control, or “superior T4 syndrome,” which was me. PRI, like chiropractors and physical therapists, uses verbiage that can be a little disconcerting. Knowing I had a “syndrome” that could potentially lead to all of these awful things definitely prompted me to be a little obsessive about being “syndrome free.” Over the span of 4 months, I peeled away the layers from superior T4, to right BC, to patho PEC (yes, patho is short for pathological. Counseling may be required if your PRI professional tells you the names of some of these things), to L AIC until finally, I became “neutral.” Now, neutral didn’t solve all of my problems, but it did improve the efficiency of my movement. A lot. And it eliminated tightness in the mid back, improved mobility, and allowed access to muscles I hadn’t really been using. It also left me with a sore left hip.
If we look at the anatomy, it is pretty easy to see why. Let’s say the first layer of the onion developed when I was 13 (that is probably being generous. There is a good chance it was earlier than that because I was a high strung child, but I am giving young me the benefit of the doubt). The first layer of the onion involves my left pelvis living forward of my right pelvis in all situations. There are several muscles that cross the hip joint and attach and flex the hip, including the psoas major, the iliacus, the rectus femoris, and the sartorius. Now, imagine the left pelvis has been tipped forward for two decades, altering the length tension relationship of those muscles with the gluteus maximus. If you buy into the whole PRI thing (and I must say, for those of us that fit the patterns it can be hard to ignore), I had not had access to full hip extension with the pelvis in a neutral position on that side for 20 years. I was using the part of the muscle I knew how to use, and I definitely wasn’t using those lower fibers of gluteus maximus. That area had been in a lengthened position. I didn’t have the ability to use that part of the muscle for a very long time, and my brain didn’t know how to access that part of my body. (It is worthwhile to note I had the same problem on the right side as well, just not as severe, and I didn’t have any sense of chronic soreness on the right side. From a PRI perspective, this makes sense. The right side hadn’t been that way for as long).
The solution was surprisingly simply. I needed to learn to extend my hip. And so with the same tenacity I used when changing my “syndrome,” I taught my femurs how to extend. I used the supported lunge position, I used the finishing position of the deadlift, I discovered a very cool way to do this in a doorway. (Face doorway. Come into 1/2 kneeling position with back knee pressing into doorway to give you feedback. Exhale, allow ribs to come into expiratory position, inhale begin pressing thigh into doorway to create space between pelvis and femur and focus on moving femur back engaging the glute. The doorway keeps you honest and prevents your from cheating with your back). I began using the range of motion I had access to, which meant my hip soreness went away. Almost completely. It’s only been 3 weeks, but the fact that something that was there for at least 6 months has decreased 90 percent makes me pretty sure I can take care of the last lingering 10 percent of sensation in the next 2-3 weeks. More importantly, now that I understand how to extend my hips with my new range of motion, my backbends are dramatically improving, and since yoga is all about how pretty the asana looks, this makes me very happy. When people complain of things like tightness, it can be ease to assume it's a tissue quality problem (stretch more!) when sometimes, tightness is simply a motor control issue.
Yours in health and wellness,