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 By Barbara Fuller PT, FAFS

The late-seventyish woman looked at me with a bit of skepticism mixed with a little fear. After I introduced myself to her she said, “Before we start, I want you to know that I would like for you to address my low back pain, but I don’t want you to mess with my hip.” When I urged her, she further explained that she’d had problems with her right hip for a long time, with x-rays revealing severe arthritis and necrosis of the femoral head. She had been to an orthopedist who told her to come back for a total hip replacement when she could not stand the pain anymore. She was not ready for that. Her back pain was relatively new, but it was making her even more miserable, as well as making her unable to do the yard work she loved doing or taking a walk. Most telling was the account of her last experience in physical therapy when her hip was forced passively beyond what she could tolerate, thus resulting in increased pain. Needless-to-say, she never went back. Before I even touched this patient, or put her through any functional movement assessments, I felt a strong need to educate her about the hip – especially its relationship to the lumbar spine. I told her that the hip is the low back’s best friend. I explained how a normally functioning hip, one that moves well and is strong in all three planes of motion, allows the low back to function normally by protecting it from excessive motion and wear and tear. I demonstrated how a hip, with a decent amount of extension, propels the body forward, but without that extension, the task falls to the low back causing all sorts of problems. I told her that her hip had let her low back down and was probably the cause of her low back pain. All that being said, I then told her that I really felt that I needed to at least take a look at the hip or I would be doing her a disservice. I also promised her that I would not do anything she did not agree to me doing and that I would be very gentle. She agreed. In addition to the hip being quite friendly, the hip is BIGGEST of the BIG rocks in our body! Big rocks are the areas of the human body that provide a foundation for normal mobility and stability (mostability). But if they are not functioning well, then they become the culprits of pain and dysfunction in joints above and below. For the hip, that includes its closest neighbors – the lumbar spine and the knee – but it can also include more distant neighbors like the opposite shoulder or elbow. Also, the hip is our power source. We can understand this when we consider the powerful muscles of the back and front butts, and their core connections, including the pelvic floor (with connection through the hip adductors and rotators) and the thoracic diaphragm (with connection through the abdominals to the thoracic spine and rib cage). It is through hip extension that we can most effectively load our abdominals. As promised, I was gentle with my patient and started her functional assessment with neutral standing (XXX) while hanging on to a counter top with both hands. She was limited bilaterally in lateral pelvic glides and rotations. Most significant, though, was her lack of right hip extension in a left stride stance (LXX). She also demonstrated to me a successful short squat – something that applied to her goal of continuing with yard work. Her home-workable exercise program (remember the test becomes the exercise and the exercise becomes the test) became XXX with right and left lateral glides and rotations of the pelvis for a warm-up, which was then followed by LXX anterior and posterior glides. After these, I asked her to do some of her short squats (start with success). On her next visit she beamed and said, “I’ve had very little pain since my first visit!” She progressed beautifully through her physical therapy. Although she did not get full mostability back in her right hip, she gained just enough that on the day when she was able to complete a common lunge matrix (anterior lunge, same side lateral lunge, and same side rotational lunge) – no hands – she looked at me and said, “I feel so empowered!” Wow! I did not heal this patient, but provided an environment in which her body could improve. By giving her complete control, her fears were addressed. By educating her about the truth of the hip, her skepticism was addressed. And by giving her a home-workable program, she was empowered … and so was her hip! This is the beauty of Applied Functional Science.

Get Strong! Stay Strong! (and don’t forget to be functional!)

Chris

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Comments
  1. […] Chriskolba had a guest PT write an article about a patient with hip pain. […]

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