FAI and the importance of listening to the person in front of you...

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Jenn Pilotti
Be Well Personal Training

Re-thinking skill acquisition for the endurance athlete

Triathlon season and the running season are coming to a close, which means the quantity of swimming, biking, and running endurance athletes perform will be greatly reduced. For athletes that race regularly during the months of May-September, there really isn’t much time for many other movement hobbies, especially if there are work and family obligations (and, while blowing off work for a 5 hour bike ride so you can spend time with your significant other after work is awesome, it doesn’t always bode well with the boss on a regular basis). For athletes that have been nursing injuries or aches and pains, the off-season is an excellent opportunity to add movement variability and improve efficiency.

In an Australian survey of 113 triathletes, the factors that commonly led to injury in both short course and long course athletes were biomechanics/technique, training factors, demographics, designated training regimes, health and medical monitoring, and preparation (Gosling, et.al, 2013). Now, while demographics aren’t exactly something that can be changed, the off-season can be a great time to look at several of the other factors on this list. It is easy (and a bit of a no-brainer) to work on your weak link during the off season. But what if part of working on your biomechanics included stepping back from the perceived weak link, interspersing novel stimuli to look at the movement in a different way, and getting away from the idea that there is a “right” way and a “wrong” way to perform movement?

There are two factors that prevent us as athletes from moving forward in our ability to perform a task in a more efficient manner: motor control, or how our brain signals our body to coordinate the muscles needed for the task at hand, and physiological barriers, which include everything from tissue adaptations to cardiovascular limitations. Mark Latash points out in his book Fundamentals of Motor Control our body never signals the exact same intramuscular coordination for a task, so if you go for a 5 mile run, each step isn’t always exactly the same as the previous one, despite the fact the steps may look quite similar. As we fatigue, our movements tend to get sloppy and we no longer have the muscular endurance (physiological ability) to support our earlier gait pattern; to run the same speed, we need to find a different strategy. If we want to get better at a skill, it is important to train both motor control and the physiological aspects of strength and endurance. It is important to allow the musculoskeletal system to adapt gradually to increased demands in order to reduce injury risk. (Research supports this. A survey of 662 marathon runners found a correlation between injury and those training less than 30km/week, while those that trained 30-60km week reported less injuries. Physiologically, the runners that ran more were prepared for the demands of the marthon distance. It is worthwhile to note that previous injury also correlated to greater injury risk, (Rasmussen, et.al, 2013)).

The next question, of course, is how to apply this? Imagine you have an $8000 mountain bike and you only know how to use 2 gears. On the flat, paved road. What a waste of a great machine, right? This is how many of us treat our bodies. It is capable of amazing things, in a variety of environments, but we don’t really take the time to know how it works. And if you are thinking you know perfectly well how your body works, thank you very much, are you holding any tension in your neck, jaw, low back, feet, or hips while you are reading this? Without thinking too much about it, do you know if you are sitting mostly on your right sitting bone or your left? Do you have a tendency to sit in the same manner all of the time? Do you carry the same tension discussed a moment ago while you swim, bike, run, walk, or vacuum? Most of us don’t really have a good idea how this incredible tool works or how one thing might affect another, and even those of us that study and think about it all of the time are constantly discovering new things and new connections, just like an expert mountain biker who knows how to use his expensive gear is constantly learning how it handles on different terrain and at different speeds. Spend a month on the off season and make it your goal to learn how your body works, where you habitually hold tension, and how you can make it stronger. This means doing something new, that you can’t do on autopilot (this will help mentally prepare you for the running skill acquisition suggestions I describe later). Take Pilates, study yoga, try Gyrotonics, do some Feldenkrais, hire a personal trainer that focuses on how your body moves and what you are experiencing. If you don’t have the finances to afford learning how your body works because you are saving up for 2015 gear and races, spend $30 and buy either Better Movement by Todd Hargrove or Move your DNA by Katy Bowman (there are other books out there, but these are the two best that I have read this year on movement efficiency). Read them and DO THE EXERCISES. Even if they seem tedious. And don’t do them just once. Do them regularly for a month. Figure out your gear, how your body moves, and how you can make it move more efficiently.

While figuring out how your body moves, it is possible you will find places you can’t access. These might be places that don’t move as well or seem sticky, or you might notice a lack of strength. Learn how to address these areas through a comprehensive, individualized strength and mobility plan. Remember, tissue elasticity and strength is necessary to explore moving in a variety of different ways, on different surfaces. If you have suffered from injury in the past, it is important to make sure you didn’t continue to move around the injury once the injury healed. If this is the case, it is worth the money to have an outsider (i.e., physical therapist) assess how you move. As noted above, previous injury increases risk of future injury. If there are weak links in your movement patterns, take the time to strengthen and mobilize, improving tissue quality and overall strength.

Now that you have a better connection with your body, you can move on to skill acquisition. I am going to suggest some things that are going to seem odd and contradictory, and I am going to suggest you do them for a month. The first thing I want you to do for this month of your off season, is to not run your “normal” run. I am not talking about the run that you do once in a while, or even the run that you do once a week. I am talking about your go to run, the one where you know every turn, every sight and smell, every stop sign. If you always walk out your door and turn left, I want you to turn right. If you love running by the ocean, that is great, but do it from a different direction. It turns out that transfer of learning works really well if you aren’t always studying or practicing in the same spot (Carey, 2014). This will allow you to be a little more mentally alert and focused on what you are doing, leading us to deliberate practice. When we run, we tend to focus on the numbers on our watch- how fast, how many miles, average heart rate. These are all great markers for fitness, but not so great when working on skill. Rather than running your normal 45 minutes/5 miles/same run/4 times a week, try running 2-3 times a week, with at least one day between, and split your run up into 2 times a day. If you are used to running 40 minutes, that is great; you are still going to run 40 minutes, just 20 in the morning, and 20 in the evening. This is the same amount of load on your tissues, but it will allow you to focus better mentally and begin to transfer what you learn. We tend to focus on the “right” and the “wrong” way of doing things. Below are some learning ideas that remove “right” and “wrong” from the picture, focusing instead on efficiency and increasing amount of ways we are capable of running.

Week 1: Remember where you were holding tension earlier? See if you are holding that tension when you run. Focus on that area, and see if you can find a way to relax it. That might mean adjusting shoulder position, playing with rib position, or unclenching your jaw or glutes. It is really difficult to focus for long periods of time (another benefit of the short runs), so focus for a little while, give yourself permission to day dream for a couple of minutes, and return to your focus. Did the tension come back? Can you relax again doing the same thing or making a different adjustment?

Week 2: Play with your running stride. Remember, for the purpose of this month, there is no “right” or “wrong.” The first 2-3 minutes of your run, notice how you run. What happens if you change your foot stride? Is it easier or harder? Do this for 1-2 minutes and then return to your normal running style. Does that feel smoother, or less smooth than what you were just doing? Continue playing with your running stride throughout your run, playing with length of steps, width of feet, how your feet land, spending 1-2 minutes playing and 2-3 minutes of “normal.” You can play with arm swing in the same manner, swinging the arms not at all, swinging them close to your body, across your body, far away from your body. Notice how this feels and notice how it feels to return to your “normal” stride. By the end of the week, see if your normal has changed at all to feel more efficient.

Week 3: Watch video of world class marathoners. Find one that resonates with you. You don’t have to put words to why you like this person’s gait better than another’s. Study it. Watch how he moves, watch his foot strike, watch his leg turnover, watch how his hips move. Try to internalize this person’s running stride. Periodically throughout your runs this week, try to run like that person. Is it easier or harder than your normal running gait? Similar to week 2, spend 1-2 minutes imitating and then 2-3 minutes returning to your normal gait. Again, at the end of the week, notice if you feel like you are running any differently.

Week 4: Practice running efficiently. For your runs this week, if at all possible, pick some different terrain than you are used to and every 2-3 minutes, try to run find ways to run as smoothly and efficiently as possible. Remember the area of tension you worked on in week 1? Make sure that area is relaxed and focus on running smoothly up hill, down hill, on trail, on the sand. Pick up the speed a little bit. Can you maintain that smooth and efficient feeling? What about when you slow down? What is required for you to move in an effortless manner?

After your month is over, return to your normal, 45 minute run, taking a left out your front door. Does your run feel differently than it did one month ago?

Verrell et.al, examined the differences between how novice cellists played versus how professional cellists played. The novice cellists used their entire arm to move the bow, allowing them only one way to play their instrument. The expert cellists, on the other hand, used a much finer wrist motion to play, allowing many more variations and expressions of moving the bow to be expressed. If we only have one way to run, we are like the novice cellist. If conditions call for something different, we are unable to adapt and if we don’t practice in a focused, engaged way, we will never advance. Unfortunately (or fortunately, depending on how you look at it), our lives don’t require movement for survival, so are tissues aren’t always adapted to handling the load required to run well and our movement vocabulary is often limited. Make it your goal to change that. View movement as a skill and know that you are capable of so much more than you think.

Yours in health and wellness,
Jenn

Gosling, C.M., Forbes, A.B., & Gabbe, B.J., (2013). Health professionals’ perceptions of musculoskeletal injury and injury risk factors in Australian triathletes: a factor analysis. Physical Therapy Sport, 14(4), 207-212.
Latash, M., (2012). Fundamentals of Motor Control. Academic Press: New York.
Rasmussen, C.H., Nielsen, R.O., Juuls, M.S., & Rasmussen, S., (2013). Weekly running volume and risk of running-related injuries among marathon runners. International Journal of Sports and Physical Therapy, 8(2), 111-120.
Carey, B. (2014). How We Learn: The Surprising Truth about When, Where, and Why it Happens. Random House.
Verrel, J., Pologe, S., Manselle, W., Lindenberger, U., & Wollacott, M. Coordination of degrees of freedom and stabilization of task variables in a complex motor skill: expertise related differences in cello-bowing. Experience Brain Research, 224(3), 323-334.

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,
Jenn

Self-perception

I was standing in line at Starbuck's the other day, looking around at nothing in particular. I noticed a woman waiting for her drink with an adolescent daughter or niece. "Wow," I caught myself thinking, "it's hard to believe adults can really be so little." As I paid and went over to the same counter to wait, I realized she and I were the same size. If anything, she may have been a touch taller.

Self-perception is a funny thing. I noticed early in my training career that when I asked some of my female clients to place their feet hip distance apart, they would set up with their feet wider than their hips. Their perception of their hips and the reality were different (I have also had the opposite happen, with people setting up more narrow than their actual hips). Becofsky et.al, found in 401 individuals with osteoarthritis, perception of disability was more strongly correlated with depression than actual reduction of physical functioning; those with reduced functioning that didn't view their condition as a disability were actually in a better place psychologically than those with less reduced functioning, demonstrating that perception can affect both our physical and mental health. Our perception of our physical selves and abilities can be our biggest barrier (or our most powerful aid) in attaining our athletic potential. I often wonder how we get so out of touch with our physical bodies. Is it because we don't use them very much? Or that we are inundated with press about knee replacements, arthritis medication, and the obesity epidemic? Many of my clients that come to me as new exercisers don't trust their bodies to be strong. They wait for something to go wrong, assuming their bodies will fail them. It is my job to teach them their bodies are capable, and if they are patient, their body will perform feats far greater than they expected. The reverse is also true. Sometimes there is an expectation that "I should be able to do x because I could 30 years ago." While "x" might still be an attainable goal, if a person's body is different than it was 30 years ago, "x" might have to be achieved in a different way or on a different time schedule. A yoga teacher once said what we think we look like we while we are practicing yoga and what we actually look like are two different things. There are times where I think I must be in the deepest backbend ever, only to find my hands and my feet are miles apart. As a result, my perception of my ability to backbend is that I am not "good" at it and probably won't ever be able to do poses that require a lot of back mobility. This is in contrast with my perception of my ability to handstand. I know I can handstand in the middle of the room (I have accomplished this on several occasions, just not consistently); as a result, my perception is that eventually I will be able to always handstand in the middle of the room. My perception for handstands translates to confidence, while my perception of back bending borders on self deprecation ("I cannot currently backbend; therefore, I will never be able to backbend").

Perception also affects how people with chronic pain move and and their ability to perceive where their body actually is in space. Wand et.al, found 50 out of 51 patients with chronic low back pain endorsed items on a questionnaire suggesting distorted body perception. (Body-perception distortion was found to be infrequent in the healthy control group). Recently, I trained a gentleman that had suffered from bilateral sciatica in the past year. While he was feeling better, he still suffered from a bit of pain, particularly walking up and down stairs. The first time I had him come into a supine position with his knees bent and feet flat on the massage table, I noticed his right pelvis was pressing heavily into the bed while his left pelvis was barely in contact with the surface. "Which side of your pelvis feels like it is most in contact with the bed?" I asked, assuming he would say his right. "My left," he responded with certainty. "My right feels like it's barely touching it." Though I learned a long time ago not to assume anything about how a person feels or experiences movement, I was a little bit shocked that his perception of his body and the reality were so different. His perception wasn't wrong; it simply didn't resemble what my eyes saw, further demonstrating the importance of asking rather than assuming what a person is feeling or experiencing.

Something that I find interesting about self-perception is the ease with which it can change. The new exerciser that perceives movement as a potential threat to injury with the right guidance can begin to view her body as strong and able. Using imagery and focused attention over time has allowed my client with low back pain to begin to perceive both sides of his back and where they are in space. I doubt I will look at a person while waiting in line again and think about how little she is, knowing now that that is a more accurate representation of me. While I think about movement and how my body moves a bit obsessively, I don't think much else of my physical self. If someone asked about my self-perception, I would describe myself as strong, not short or little, though I would probably qualify it with, "stronger than average, but there are many that are stronger than I am." If asked about my flexibility, I would quickly say my flexibility leaves something to be desired. Perception is relative and largely depends on one's frame of reference. Watching women regularly perform incredible feats of athleticism on the yoga mat and in the weight room (thank you, Youtube) gives me a different frame of reference of strength and flexibility, leading me to feel that compared to my peers, both could be improved upon. However, it could probably be argued that my strength and flexibility are above average when compared to the normal population. It is impossible to know a person's frame of reference and one's perception of his physical self. The client who has always been told her hips are bigger than her torso will probably regularly set up with her feet a little too wide, while the client that has been told she is frail might balk if given heavy weights too soon. The value of asking, "how does that feel," shouldn't be overlooked, either as a trainer, or as self-reflective question. Conversely, our experience of proprioception and how we move might be impacted by pain, our movement vocabulary (how much or how little time we spend thinking about movement), or our current psychological state. Connecting with our physical selves and beginning to paint an accurate picture of our body in space can improve athletic performance, self-confidence, and overall well-being.

Yours in health and wellness,
Jenn






Becofsky, K., Baruth, M., & Wilcox, S., (2013). Physical functioning, perceived disability, and depressive symtoms in adults with arthritis. Arthritis, 2013.
Wand, B.M., James, M., Abbaszadeh, S., George, P.J., Formby, P.M., Smith, A.J., & O'Connell, N.E., (2014). Assessing self-perception in patients with chronic low back pain: development of a back-specific, body-perception questionnaire. Journal of Back and Musculoskeletal Rehabilitation.

What personal trainers could learn from mind body practices

I am taking an online yoga training right now on "The Art of Sequencing." The instructor, Jason Crandall, teaches in a clear, concise manner. Part of the course is to take themed yoga classes taught by him. The interesting thing that he does, which is very similar to how I train, is he takes an area, brings awareness to that area, and then threads that awareness through the class in different postures. What happens when classes are taught like this is when the class is over, the student is more in tune with holding patterns in that area and how that area responds and is affected by other movements. This is similar to some of the Feldenkrais ATM lessons- the participant is taken through a series of movements with an emphasis on a specific region of the body and how that region responds to a variety of conditions. It heightens the participant's awareness and in Feldenkrais lessons, usually results in a substantial increase in mobility due to improved motor control and better neuromuscular organization.

There are, of course, multiple ways to coach and many ways to cue exercises. I am not going to discuss word choice for cueing, though much has been written about this topic. Sam Leahy wrote a great blog reviewing the research and discussing the application of how to cue which can be found here: http://samleahey.com/science-of-coaching-cues/.  What I find works best for my clients is if I pick an area to emphasize during the warm-up, I start asking general association cues regarding that area, and I bring awareness to that area throughout the session. For instance, I am currently training a gentleman I will call Jim. Jim had significant sciatica in the past, and has done quite a bit of physical therapy. He is 69 and wants to be able to walk and play with his grandchildren. I quickly realized (after both assessing some general things and watching him move) that he was disconnected from a sense of center and I decided to start with improving his awareness of his inner thigh connection to the pelvis and abdominals. All of his warm-up activities included holding a foam block between his thighs, which I instructed him to imagine he was holding with his pelvis. I had him do some isometric adductor squeezes, just to bring a little more awareness to the area, and we moved on to standing exercises. For the remainder of the session, whenever he would set up for an exercise, I would ask him to pretend like he was holding the block with his pelvis. We had established what that meant earlier, giving him a movement vocabulary for that action. As the session progressed, I asked him to notice what the sensation of holding the block did to his abdominals (made him feel them) and what it did to his feet (made them less duck footed). Because this was foreign for Jim, I cued it often, though I always gave him the opportunity to set up before I said anything. About 30 minutes into his session, he was paying much more attention to foot placement and inner thigh engagement without feedback from me. The next time I saw him, he commented that he was much more aware of his general tendencies towards external rotation, and he was practicing keeping his knees straight ahead when he sat down. Jim had learned something during our session, done a little bit of homework and his own, and this allowed us to move forward to connecting the hip to the weight of the foot, which is where I went next.

People like Jim are a fairly common occurrence in my practice, though occasionally I get someone like Kate*. Kate danced when she was in college and is a Pilates teacher. Kate has a very large movement vocabulary, and if I help her make an association once, she will retain the cue and implement it without me asking. Kate has a strong bias towards internal rotation, which sometimes leads to stress underneath her knee. I started with teaching her how to engage her glutes and not let her thighs fall into internal rotation in various kneeling and 1/2 kneeling positions. When we moved into standing work, I found she had a difficult time maintaining a neutral calcaneus with hip external rotation. We have been working on keeping a neutral foot and a balanced hip in every exercise. She has a difficult time dissociating the hip from the foot, though as we explore it in a variety of ways, it is improving. She tells me she thinks about glute engagement during barre class, and she thinks about her position when she is demonstrating exercises on the reformer. Like Jim, she was able to make an association about how her body moves and is applying that general awareness to activities performed outside the gym.

Training in this way is powerful because it empowers the client and allows him to take ownership of movement patterns. Experienced yoga teachers do this naturally, though their emphasis is usually on improvement on a specific posture. However, the principles are the same. I am regularly told by clients that they leave sessions feeling like they learned something. I strongly believe that if I want to improve movement ability and increase everyday activity in my clients, it is necessary for them to begin to understand how their bodies work and how they have control over their movements.  I do think part of my job as a trainer is to educate and improve body awareness, one association at a time.

Yours in health and wellness,
Jenn

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 et.al, 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 et.al. 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 et.al, 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.