Posts Tagged ‘tight hip flexor’


 

Yes, I said dormant butt syndrome, DBS for short! I see it all the time in the clinic. In athletes and people of all ages. The cause of DBS is usually tight hip flexors, again, which most people have. This is due to repetitive hip flexion from walking, running, sitting, driving and sleeping in the fetal position.  Other causes include injury and inactivity.   If you remember back to previous posts the gluteus maximus generally attaches proximally to the sacruum, and illiac crest and wraps around the hip to distally attach to the greater trochanter (the big bony bump on side of hip).  Although we think of the gluteus maximus as a powerful hip extender it is actually built for rotation.  Just look at the fiber orientation (yes, you may have to crack open the old anatomy book).  So, functionally its main function is to eccentrically control internal rotation of the femur in the transverse plane during the loading phase of gait or running, eccentrically control hip flexion in the sagittal plane and assist the gluteus medius in stabilizing hip adduction in the frontal plane.  The ability to appropriately load enhances their ability to concentrically contract during the unloadong or propulsive phase.  If the gluteus maximus is inhibited (which V. Yanda taught us) from a tight hip flexor, then the hamstrings and erector spinae group  become overactive to compensate.  This leads to the possibility of hamstring strains, low back pain, knee pain and possibly even plantar fascia.  A simple way to check for DBS is to have patient lie prone and ask them to do a leg lift.  Palpate the gluteus and the hamstring and see which contracts first.  Many times I feel the hamstring contract then the gluteus.  It should be gluteus then hamstring.  Sometimes ive seen people have a 5/5 manual muscle test and not even fire the gluteus.  They used all their hamstring and erectors to lift/hold the leg up.  Some general strategies include a basic muscle re-education of laying prone over table or bed and actively squeezing butt then lifting leg.  Sequence can also be done with bridge exercise.  Stretching the tight hip flexor, of course, and functional hip dominant exercise like single leg balance w/ arm reaches, multi planar lunges, sled walks, various step up and downs.  So now get moving and wake that sleepy butt up!

Get Strong! Stay Strong!

Chris

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Shoulder pain can range from nagging to debilitating depending on the problem and severity.  Generally, in the under 40 crowd shoulder problems usuually consist of impingement and instability.  Impingement occurs when the “ball” of the ball and socket joint “rides” up during shoulder movement and pinches the rotator cuff and bursae.  This can result from trauma or fatigue from repetitive movement.  Instability is from a laxity in the capsule (fibrous tissue.  Like the wrapper of a lollipop) that holds the ball and socket joint together.  This can occur from repetitive motion or trauma.  Some people are born with more laxity in their joints that predisposes them to these typess of problems.  These are the people that are “double jointed.”  They don’t actually have 2 joints they are just very flexible in their joint tissue.  This can range from mild to severe.  This creates “extra” movement in the joint that can irritate the tissue, rotator cuff and/or injure the cartilage of the socket (the labrum).  The over 40 crowd usually suffers from rotator cuff tears, although they can also have impingement and tendonitis.  Aging of tissue and the longevity of activity makes the older individual more prone to rotator cuff tears.  This can happen through gradual wear and tear leading to the cuff tear or from trauma such as a fall or heavy pulling movement.

Many factors can lead to shoulder problems and multiple steps can be taken to prevent or at least reduce your risk of shoulder injury.  Posture is a big problem for many people.  The rounded shoulders compromise the shoulder joint space and contribute to muscle imbalance and impingement.  Tight hip flexors can also contribute to shoulder pain.  The tightness in the hip flexor can “pull” the pelvis forward which can pull the shoulders forward leading to pec tightness which further pulls the shoulder forward.  Taken further this shortens the abdominal muscles (shutting them off) and contributes to an unstable back.  When looking at movement through a functional eye you would see that overhead activity requires extension and rotation through the spine and the same side hip.  So for example, if your hip flexor is tight and/or your shoulders or upper back was rounded and you were trying to change a light bulb, even if your shoulder motion was normal, your ability to work overhead would be limited and your chances of developing shoulder pain would be high.  The moral of the story is that it is all connected and that to successfully correct shoulder problems you must try to find and address the cause.  This requires understanding the functional relationships of the body.  Many times easier said than done.

In general, make sure your exercise programs are balanced and you are not just working the “mirror muscles,” stretch your hip flexors, watch your posture especially when sitting, drink plenty of water (most of your tissue is water) and eat a balanced, nutritious diet (give your body the nutrients it needs to be healthy and support the growth and repair processes).

Get Strong! Stay Strong!

Chris

This is an excerpt from an article I wrote for USA Gymnastics.  Again, although written for gymnastics the functional relationships and concepts can be applied to any movement. The lumbopelvic hip area consists of the lumbar spine, pelvis, and hip joints. The major muscles include the low back, abdominals, gluteals, and hip flexors.  Optimal strength and flexibility are required for all parts to function efficiently and harmoniously in an effort to complete a task. Compensation patterns and faulty movement occur as a result of flexibility deficits and muscle imbalances. This in turn leads to decreased performance and increased risk of injury. The hip flexors, calves, hamstrings and chest muscles are most prone to tightness simply due to the patterns of daily living. For example:  sleeping in the fetal position 6-8 hours per night, sitting in school all day, driving, sitting to read, eat, study, etc. Not to mention fatigue and over training. The human body is very adaptable and efficient. When flexibility deficits or muscle imbalances are present, the system cannot operate efficiently. But the body will find a way (compensate) to get the job done.  For example; when the hip flexors are tight, the gymnast will not be able to fully extend the hip and will compensate by increasing extension through the low back. Over time this can lead to low back pain and stress fractures. Many female gymnasts are observed to have an increased curvature of the low back, a pelvis that tilts forward and a lengthened abdominal area. Let’s look at the functional relationships of this posture and discuss how this can lead to a myriad of movement/performance problems. An anteriorly tilted pelvis is usually associated with tight hip flexors, weak abdominals, tight low back muscles, tight hamstrings and weak gluteals. Tight hip flexors will pull the pelvis forward. As a result, the curve in the low back increases which puts increased stress on the joints. 

This stress coupled with the repetitive back bending and twisting can lead to pain and stress fractures. Also, any time you need to extend through the hip (move the hip forward or the leg backward), the tightness in the hip flexor will not allow it and guess where you will get the extension…that is right, through the low back. When the pelvis tilts forward it increases tension in the hamstrings by causing them to lengthen. This creates a higher risk of hamstring strains and contributes to weakness/decreased control of the abdominals. Ultimately leading to poor trunk control. An interesting neurological phenomenon occurs as a result of muscle tightness. It is called reciprocal inhibition. Simply stated, it means that if a major muscle is tight it will inhibit the muscle that opposes it. In our example, when the hip flexor is tight it will limit the gluteus maximus muscles function. That would mean the gluteals ability to powerfully extend the hip (take off, jumping), absorb shock upon landing, and control motion of the entire lower extremity, especially rotation would be diminished. You can imagine the performance and injury risks this poses to the athlete.  Tightness in the low back will inhibit the deep abdominal muscles that are important for trunk and lumbar stability. So, not only does tightness lead to compensation but also interferes with strength. For example, when doing a split leap, the front leg is at risk for a hamstring strain because it is tight from the anteriorly tilted pelvis and it will be very difficult to get the fully extended position of the back leg/hip due to tightness of the hip flexor. This article discusses the lumbopelvic hip area and will review the anatomy and the functional relationships of the musculature. The article also describes stretches and exercises to address the problems described in the lumbopelvic hip area. Additionally, the gymnasts will have decreased strength to push off the ground to get airborne and the gluteus maximus will not have the strength (reciprocal inhibition from the tight hip flexor) to extend the hip by pulling the leg back. The gymnast will most likely compensate by extending through the low back, not to mention hurry to get her feet back on the ground due to lack of height off the ground from a diminished push off. One more thing, while we are on the subject; tightness in the hip flexor will limit maximum extension of the hip while jumping in which the body will compensate, often by hyper extending the knees thereby leading to patellar tendonitis and knee pain. Keep in mind there are just a few examples relating to the hip/pelvis that can lead to compensation, injury and poor performance. With proper stretching and strengthening many of the above mentioned problems can be avoided and proper muscle activation and control can be achieved. With gymnastics requiring a combination of 

flexibility, strength, power and balance/control; it is important to recognize the functional relationships and devise exercise strategies that are effective in optimizing performance and minimizing injury. Hopefully, this article shows how one tight muscle can lead to a series of compensations and altered muscle firing patterns that effect strength and control around the hip/pelvis area. Now we will focus on a few flexibility and muscle activation exercises to address the problems identified above. Initially, once a muscle tightness is identified it should be stretched utilizing the “traditional” static stretches. Paying close attention to posture and form to ensure the appropriate area is being stretched. Unfortunately this is the only way many continue to stretch. The next step should be to incorporate dynamic multi plane flexibility exercises. Knowing that gymnastics requires dynamic movement in all three planes of motion simultaneously, a question to ask is why do we only do static stretching that is isolated to one plane of motion? Yes, it can increase flexibility, but is it the best way to improve, maintain and carry over flexibility to performance? Maybe not.  Stretching dynamically in all three planes of motion better prepares a muscle to move in those planes and complete a skill such a back hand spring without unwanted compensations that could lead to injury. The benefits of dynamic stretching include increased neurophysiologic input to the system which enhances its ability to perform a task or series of tasks and maintain flexibility. This is because the muscle and the joint are getting stimulated similarly to the activity taking into account momentum, gravity and ground reaction forces in three planes. These are the things that turn on and drive the muscles. 

See this full article with pictures of the stretches at

www2.usa-gymnastics.org/publications/technique/2004/5/hip.pdf.

Get Strong! Stay Strong!

Chris