In the last blog we talked about the lower extremity as a whole and in today's we will discuss the hip joint itself and some of the reasons why we experience hip joint pain. Below is a picture of the hip joint. Sometimes we or our clients say I have hip pain but oftentimes it is because it is in the vicinity and not the actual hip joint. That pain will also be discussed as we go through this area of the anatomy.

Hip Joint consisting of the Femur and Pelvic bone

This joint has the capability of moving in 8 different directions and because of inappropriate use often gives us an area of pain that is unnecessary. The many methodologies used in PT, MT, and most forms of physical medicine address the pain but rarely the cause. How I like to explain this joint to my clients is that it is meant to pivot around an axis. By that I mean the hip joint is not meant to be the primary joint of walking, standing and/or running. It is meant to be the transitional joint when moving to a standing position or bending forward, it really is not made for any significant amount of torsion.

In this picture of a student on the Reformer, an apparatus that we use in our Fundamental Movement Therapy(SM), (for more info on Pilates go to our website www.chagrinvalleywellness.com) the feet are placed on the bar and there is minimal spring tension for resistance. The normal inclination for the student is to generate the force down through the hip joint and use the larger bone to create the impetus. What this does is engage the low back in such a way that a dynamic thrust is used to raise the Femur, by the Psoas or hip flexor, and eventually creates a stress point in the lower back. This will explain why people have back pain after they walk for awhile. This is because many people walk, powering down from the hip through the knee into the ankle and foot. Instead of the hip joint pivoting  and the head of the Femur staying centered it is forced up and down in the socket. This constant compression of the cartilage will eventually wear the padding down. As this wearing takes place the compression against the sensory nerve endings will create the pain symptoms. Once we are able to balance the joint, the client is informed to shorten the stride and focus on one joint, the knee. This will force the individual to bio-mechanically move correctly.

The hip is a delicate joint that is often overworked and because of the musculature that surrounds it can create many problems. The Piriformis muscle  attaches to the Femur and when that muscle is involved the Sciatic nerve can be involved. The Psoas Major muscle if compromised by an imbalance to the hip joint can also encumber the Lumbar spine. The Gluteal muscles also connect here and with the interconnection of the Lattismus Dorsi with the Gluteus Maximus shoulder issues could be possible. Once again we strengthen muscles that create an unnatural tensegral pull on the skeleton that eventually creates a stress point that will contribute to pain. As you can see there are many areas that come into play if the hip joint is wrongly used.

So if you are treating someone with hip discomfort, or are someone who is suffering from long term hip pain, remember you have altered movement patterns that have created compensation. It is important that we prevent chronic hip pain by maintaining a positive tension on the skeletal structures and we are cautious with our movement patterns. On our web site we have archived You Tube videos of our Movement of the Month (www.chagrinvalleywellness.com) that shows how we reprogram the neurological system to educate the body into properly moving. Many times the pain will continue to reappear until we change the movement pattern, that is what our Fundamental Movement Therapy(SM) accomplishes.

I encourage individuals who suffer from chronic hip pain or therapists that struggle treating this painful condition to contact us at [email protected]. If you know someone who suffers from this and would benefit from a consultation session, either at our office or on the phone, forward this blog to them. In the next few blogs I will be including videos that further show how to determine the proper Q angle and how to help recreate it. We will also be continuing on with the knee, ankle and foot and some tips on how to prevent these painful happenings. Thank you and please enjoy the holiday season.

A Reason and Season of HOPE!

Dennis

How many individuals suffer from hip and knee pain and either go the anti-inflammatory route or resolve themselves to "I will probably need to have them replaced one day." Another one that I often hear is that I injured my knee and although the MRI didn't show anything I did a series of Physical Therapy and I guess it did good because it doesn't hurt anymore but I (whatever they don't do anymore) limit my activity. The big one of course is Arthritis. If this pertains to you or someone you treat as a therapist read on or email me at [email protected] and I will try to address here or to you personally. I will keep everyone's name in total confidentiality. If you know someone who is experiencing this discomfort and feel they would be well served and would like a FREE consultation have them contact this office at 216-364-0152 or [email protected]. If you know someone that would benefit from this information just forward the email to them or send us their email address at [email protected].

The lower extremity is a complex organ as it helps us do multiple activities. It stands, walks, helps us to stand from a seated position, it drives a car, it runs, it is used as leverage when we lift or move heavy objects and probably a few other things that I haven't mentioned. The lower extremity consists mechanically of the Femur, Tibia, Fibula, and a whole bunch of bones in the ankle and foot. Structurally the center of gravity traverses through the Femur, Tibia and right through the center of the Talus bone. We will discuss in this blog on how to prevent imbalance, clumsiness, and even maybe a walker in the future. It is held into place with a series of intricate ligaments in the foot, ankle, knee, and hip joint. The musculature is complex and performs movements such as flexion and extension at the hip, knee, ankle and metatarsals. It also has the ability to abduct, adduct, and rotate at both the hip and ankle joint. So as you can see there are many complex movements that can and will take place simultaneously.

Once again I want to reiterate that the ligaments have four properties that we need to consider. The first is position, as they hold the skeleton in its proper spacing to allow the joint to have proper gapping. Secondly, they stabilize the skeleton's joints which allow the body to initiate movement. Third, is the control of movement and last but not least is the fourth property controls the speed. As we go through these next few writings I will explain the interconnection between the ligaments, tendons and muscles and how they all rely on each other to help us move.

The reason to remember these qualities is that they are the ones most overlooked when thinking about discomfort in the lower extremity. We talk about the meniscus in the knee, plantar fasciitis or that wretched pain when we first get up in the morning that makes it hard for us to walk, shin splints, and that deep aching pain that I experience in my hip joint. We try to think of what we did to hurt ourselves or we just blame it on aging.

During these next few articles I will be addressing the issues that affect and cause pain in the lower extremities. Oftentimes it is not one specific incident but a combination of traumas that are allowing the discomfort to develop. If you have a question and/or are experiencing lower extremity discomfort please forward it to [email protected].

As the holiday season gears up into hyper speed this week and the weather starts to get colder and the snow and ice develop, many stresses affect the body and the low back and lower extremities feel the effects. This would be a great time to visit one of the practitioners to help align and balance the natural tension on your skeleton, call or write this office for an appointment or consultation.

There is HOPE!

Dennis
[email protected]

In my last article I talked about a gentleman that had Rotator Cuff Syndrome and how the therapist needed to look at many different angles to find the cause. This article will pertain to both the elbow and knee joints but will focus on the upper extremity.

The picture to the left is a turnbuckle, commonly used in construction to draw two opposite ends together without loosening the tension on the opposing ends. How does this relate to Rotator Cuff Syndrome? Very simply this is how the body works. There needs to be a stabilizer in place so the joints distal to the stabilizer to will allow a rotational capability.

A key point to remember here is in movement the brain will set the proximal point (shoulder joint) and literally move from distal to proximal (wrist to shoulder). It is when this system is over ridden that trauma ensues. An example of this would be when someone is using the computer, their hands will be in a pronated (palm facing downward) position, so when the wrist is pronated the head of the humerus needs to shift posterior and this will set the Scapula (shoulder blade) in its' proper position. 

Individuals that suffer from chronic shoulder pain will often create microscopic tears in the tendons of the Rotator Cuff Muscles. These tears over a period of time create scarring and limit range of motion more and more. As range of motion is limited the joint becomes more susceptible to severe trauma if needed to move in a fight or flight moment.

What needs to be addressed by both the therapist and individual is proper placement of the ligaments, release of abnormal tension on the skeleton and proper fiber alignment of the tendons and muscles. Muscle Release Therapy, MRTh® addresses these issues in a point specific manner. The Muscle Release Therapy, MRTh® practitioner will assess the improprieties in the musculature by determining where they are in the action potential and assist the neurological connection to complete movement properly. This works opposite of motile movement because it works from the muscle to the ligament and when reset by the brain the ligament is better able to inform the tendons and muscles of their appropriate action.

If the ligamentation of the wrist is not stabilized, the ligamentation of the shoulder will not be able to reset completely. If these two joints are at odds and not moving in opposite directions, the elbow becomes very susceptible to injury. Do you know someone that has chronic Tennis or Golf Elbow? What about someone with Carpal Tunnel Syndrome? These are two very treatable areas that will maybe help someone prevent having future surgery.

To learn more about Muscle Release Therapy, MRTh® visit our web site at www.chagrinvalleywellness.com and just click on the link. If you know someone with chronic shoulder or arm pain forward this article to them.

Any questions or comments please feel free to email me at [email protected] and I will get back to you.

Continue to HOPE!

Dennis

A Reason to HOPE!

As 2011 comes to a rapid conclusion I would like to share some information that I have found useful in my private practice that has really given many individuals in chronic pain great HOPE!

An example of this just happened yesterday, I had a gentleman who suffered trauma to his rotator cuff area approximately twenty years ago. He was guided to Physical Therapy and seemed to be okay. Over the years he experienced episodes but they too would seem to resolve. As normally is the case there does come a time when resolution does not happen and the body rebels because it has no other choice.

What should a bodyworker look for in this case? The individual has been given a full range of motion blessing by the Orthopedic Doctor, a series of strengthen exercises by the Physical Therapist and still he could not put pressure on the shoulder joint without pain. During the interview part of the assessment I was able to watch his attempt at movement and saw many limiting aspects during his attempt to show me full range of motion. This led me to the following conclusion, his elbow was dysfunctional therefore causing an imbalance to the skeleton that took away joint spacing and therefore caused impingements. After completion of the interview, I was able to give him HOPE that this would be a short term relationship and he should have full use of his shoulder joints by the end of 2011.

I will keep everyone in suspense as to what I found for now, the point I want to make is that it is important for us as bodyworkers to give our clients HOPE. In many cases of allopathic medicine the answer is surgery, medication and/or you need to learn to live with it. In some cases this is true, but what I HOPE to give you as I write this blog is your own HOPE in how you are able to help individuals relieve their discomfort and reduce inner stress on the skeleton and internal organs so that a more comfortable lifestyle is attainable.

Okay, here is what I found for the individual that was diagnosed with bilateral rotator cuff syndrome. He had forward head posture caused by a bicycle incident where he concussed his skull and compressed his cervical spine. This process forced anterior rotation of the head of humerus in the glenoid-humeral joint and eccentrically contracted the rotator cuff group. His occupation is an accountant and spends many continous hours on the computer, therefore his hands are in a pronated position. When the hands are in a pronated position the head of the humerus needs to posteriorly rotate and allow the Scapula to retract to hold center posture. What was happening is the elbow joint was not permitting this process to take place. You were hear me talk about the turnbuckle effect of both the elbow and knee which permits the shoulder and hip joints to function unimpeded. Anyway what happens here is the carpal bones shift to compensate for this lack of movement to accomodate the brains desire to perform the movement necessary.

Treatment was provided that allowed the head to reposition itself on the shoulder girdle and the ligaments of the carpal bones were balanced. At completion of the first session we had his head on straight and he was able to completely move his shoulders and more importantly place pressure on the joints that would allow him to perform Yoga which he feels he needs for his mental as well as physical health. He now has HOPE that this will not be a lifelong ailment that would shut him down or even have corrective surgery that was not really called for.

It is my HOPE that I am able to give HOPE to not only bodyworkers but to the many clients who suffer or know someone who suffers from what is sometimes unknown pain. As we go through this we will be referring to Muscle Release Therapy, MRTh® and Fundamental Movement Therapy(SM) which are theories and protocols that I have developed over the past 25 years. I will be adding to the blog on Tuesdays and Thursdays and look forward to your comments. Any questions please feel free to contact me at [email protected].

Thank you and have a day filled with HOPE and many blessings.

Dennis Gibbons