Freeing Your Hips: A Guide to Hip Pain Relief
Here’s a topic that is near and dear to my heart! I have battled a chronic right hip problem since my early 20’s so I know the condition well. This has been complicated over the years, by an auto-immune condition that has severely affected my myofascial tissues over time. Fortunately, I was able to overcome the problem through perseverance and exploration into how I could treat myself to optimum hip health, along with seeking hands-on treatment including massage and Physical Therapy.
There are some must do's for correcting hip pain and preventing its return that can be easily made changes in your life.
Typically, hip joints are subjected to excessive forces due to many causes.
Weakness in the supportive musculature of the hip joints leaves the muscles unable to overcome the strain of movement throughout the day: sit to stand, in and out of a car, squatting to get something off of the floor.
The force generated by these daily movements places undue strain on the hip joint itself if the muscles are not taking the load!
Poor postural alignment can also place too much strain on the hip joint.
Too much sitting, whether at work, home or both puts way too much strain on the hip joints themselves and excessive sitting or poor posture can cause strain on the hip flexor muscles causing them to shorten and then that dynamic causes excessive force on the hip joint.
Even the way in which we walk can lead to severe myofascial restrictions/microtrauma over time in the supportive muscles of the hips and then the muscle’s functional performance becomes affected.
So one of the first things to look at, especially if you are having pain with walking or after walking, is the manner with which you walk-what’s called the “biomechanics” of your gait.
Typically, if someone is having pain with or after gait, it is often because they are walking in a manner that over-uses their hip flexor muscles. These are the muscles in the front of the lower abdomen and hip that allow you to bend your leg up at the hip like you are marching. The posture a body assumes with walking can lead to hip pain if you walk leaned back slightly at the torso (think The Swagger). This creates a position which forces your hip flexors to fire way more often than they are happy about! You are essentially lifting your leg with every step. This wreaks havoc for your hip flexor muscles! On the flipside, if a body uses a leaned forward torso position, essentially falling forward into your next step and catching yourself with your next step, the hip flexors aren’t working as hard. If you add an exaggerated toe push off as you prepare to swing your leg forward for your next step, this can easily propel your leg forward without much work from the hip flexors at all! This may be a difficult concept to get…we will practice this during the next class in the Pain Relief series: Freeing Your Hips: A Guide to Hip Pain Relief on June 27. I offer a pain relief series monthly which are held at the Ohana Room at Waikoloa Community Association starting at 5:30. So if you are having difficulty envisioning this gait pattern and/or how to change it, plan on joining us on June 27! There are multiple gait patterns that can negatively affect your hip joints, this is just one example.
Now, let’s take a look at your standing posture. Stand sideways in front of a mirror to assess your standing posture, a full-length mirror works best. If you have a full length mirror, start by looking at your ankles, and, if not, start at your knees if possible. If getting the knees in view is not possible, postpone your postural assessment: go over to a friend’s house that has a full length mirror and/or make sure to plan on joining us on June 27!
Starting at your ankles, lean forward all the way so that your weight is heavy on your toes, then return back to neutral. Then try the opposite direction, lean all the way back from your ankles so that your weight is more in your heels, but please catch yourself from falling back by not going too far into leaning back! Then, find the happy medium between the two where your weight is evenly balanced between toes and heels and firmly over your arches. Also, please make sure you are standing with your weight evenly distributed between your two feet, side to side! Habitually standing with your weight on one leg can easily cause a lot of problems with your hip, knee, IT Band or your back/sacroiliac joint!
Next, take a look at your knees. Are they right over your ankles? You want them to be. How about your hips? Are they in line with your feet and your shoulders? If you were to drop a weighted line from your ear, would it line up right in the center of your shoulder, center of your hip and the ankle bones that stick out on the sides. They should all line up! This is also something we will use at the “FREEING YOUR HIPS: A GUIDE TO HIP PAIN RELIEF” Seminar June 27 - follow the Therapeutic Connection Facebook page for announcement and details!
If your shoulders are behind your hips, perform a hip hinge to correct: this is where you tip your torso forward with a straight back-it will feel as though you're sticking out your butt behind you if you are doing it correctly. You are likely just getting into proper alignment and it won’t even look like your butt is sticking out behind you in the mirror!
Ok, now, for sitting posture: Perhaps you perch? When sitting, do you use the back of your chair or are you perched on the edge of the chair? Perching on the edge of your chair forces your hip flexor muscles to be working continuously. They begin to complain over time and you won’t even realize they are unhappy until you have an ache in the front of your hip and wonder why.
The easy way to check to see if your hip flexors are in a tightened state is to first put your fingers into your belly button. Then on the side that you're wanting to check out your hip flexor muscles, move your fingers slightly out towards your waistline (about an inch) from your belly button and gently push into your abdominal tissue. Do this on the other side as well. Compare the difference between the two. The kind of difference you are looking for is this: your fingers don't sink into the tissue as much on the tighter side. If there is no difference between the two, you are either not in a tightened state in your hip flexor muscle (it has a cool name, the psoas muscle, pronounced “So-as”) on either side, or, you're in a tightened state on both sides. The tighter side will feel more rigid, less forgiving towards having your fingers squish into the muscle tissue! If this is what you feel and you've been having some pain in that hip or in the hip region that you're pressing on, leave your fingers there and press into your muscle and hold for a while. Soon you may feel the muscle soften under your fingertips with applying steady pressure to the muscle tissue. Usually you will feel this happen in less than a minute. This technique works the majority of the time, quite fortunate for us. 😃
There are also hip flexor muscles originating from the bone of your pelvis that sticks out in the front. This is another good area to self-assess to see if you have tightened tissue. Compare side to side, starting at the pelvic bones that stick out in the front and going diagonally down the front of the hip towards the inner thigh where your leg meets the bottom of your pelvis-right where the crease is at the point your thigh and your pelvis meet at the groin.
Another common place for myofascial restriction that affects the hip are your lateral quadriceps. Start again with your fingers on the bone that sticks out of your pelvis in the front and this time go diagonally out towards the bone that sticks out on the outer thigh. Then move your fingers slightly below that bone and you should be on the vastus lateralis muscle. In sitting, press your fingers into this muscle to assess its status. If it feels that your fingers do not sink into the tissue at all, it's tight and needs to be released.
There are several ways to do this and one of them is bound to work. Start off with the tennis ball self massage similar to my previous newsletter. Go back and read that for a how-to for DIY massage if you don't remember or haven't read that one yet. You'll put a tennis ball against the wall and put your outer thigh against the tennis ball and be the bear scratching its back on the tree, except you are massaging your outermost quadricep muscle not scratching your back. If that doesn't loosen it, there's many other things to try: using a massage gun in the same area if you have one available, stretching the muscle with contract-relax stretching if you know how to perform a contract relaxed quadricep stretch. If none of these are successful, I recommend you schedule a 30 minute tune-up visit where I perform a spot specific, quick, directed evaluation and show you how to do these myofascial release techniques.
Usually, in painful areas, not just your hip, there are strong muscles compensating for weak ones which can be very difficult to overcome. Your brain always defaults to the path of least resistance. If it takes more calories to use a weak muscle and more brain power to try and use a weak muscle, it's not going to use it. Your brain will fool you into thinking you are doing a good strengthening exercise for your hip when in fact you are simply reinforcing a bad movement pattern by repeatedly making an overused muscle work more. I think this is why I have seen so many people who have chronic hip pain for so long and have previously gone to physical therapy or they have been using exercises that they found on the internet and not getting any better, or getting worse. The primary stabilizing muscle for your hip joint to have good mechanics is the gluteus medius. In over 90% of my patients with hip pain, the gluteus medius muscle is weak. Sometimes it is inhibited by myofascial restriction, sometimes it has just been kicked off the brain's radar and other hip musculature is compensating for it. I have a great video that I uploaded on YouTube channel @TherapeuticConnection that will take you through how to try to overcome using stronger muscles to substitute for the weaker ones and activating the gluteus medius muscle!
Hip pain can be complicated and intricate. It can stem from many sources and usually multiple sources at the same time. Getting to the root of the problem often involves looking into altered posture, poor biomechanics with day-to-day activities, weak or inhibited muscles, and sometimes joint degeneration. Most of the time, once we have gotten to the root of the problem which can have multiple origins, quality physical therapy can be extremely beneficial for overcoming hip pain. In trying to heal my own hip, I have developed a new technique of Physical Therapy that I am calling the Silan System. If you are suffering from hip pain and you have tried and failed in getting it better, give the Silan System a chance to work for you. Schedule an appointment and find relief today!