Happy New Year - truly a Reason to HOPE!
In recent writings I have talked about hip pain and from the response I received there seems to be an epidemic of this problem. In the last article I wrote about the necessity of the ankle joint and its use to reduce pressure on the hip region. I have talked how the knee joint acts as the turnbuckle joint. That allows the ankle to accomodate any oddities that the foot encounters and minimizes stress to the hip joint. One area that is often overlooked but is critical in the assessment for Muscle Release Therapy, MRTh® is the lower thoracic and lumbar paraspinals. The lower thoracic is directly related to the Gluteus Medius, while the lumbar paraspinals to the short head of the Biceps Femoris of the Hamstring muscle group. This interaction of the tensegrity of the skeleton is crtical to resolving issues of the hip joint and also to help reverse some of the unnatural tension on the lower veretbrae.

The verebral column consists of the most articulations in the skeleton, therefore it has the most range of motion of any portion of the skelton. This fact is often overlooked when someone has a complaint such as hip or knee pain, plantar fascitis, or a penchant for turning their ankle. When the interconnection of the vertebral column and the lower extremity is in an unnatural tension there is an adaptive quality that needs to happen to allow movement to take place. It is important to remember that the brain will do what is necessary to protect the integrity of its lifeline, the spine. This is the most intrical part of the anatomy as it carries the nerve energy needed to move.

So how does the spine play into hip joint pain? I wish the answer was an easy explanation but I will do my best to simplfy it for all of us. This picture show the movement of the spine during inspiration and expiration.

This movement needs to happen each and every time we breath or an uneven pull to the bony structure develops. When the lower thoracic vertebrae (at the base of the rib cage) becomes constricted it does not allow the vertebrae to move. What will follow is an adaptative movement lower that will move the pelvis up and down. This movement will create an uneven pull to the rib cage and does not permit the proper expansion and contraction of the ribs when breathing. That is one of the primary reasons it is important to breath properly when exercising. If you are working out faster than your body's musculature system can keep up to your breathing, injury of some form normally happens. 

The above action will now force the lumbar spine to over compensate for the reduced movement of the verebrae above it. This will alter the Sacrum (large tailbone) and will cause many issues with that joint and one of the side effects is Sciatic nerve discomfort. That is how the short head of the Hamstring muscle becomes involved.

This sets up trigger points in the muscles and forces fibers to move in different formats to avoid discomfort. These trigger points, often thought of as acupressure points, will interfere with the normal nerve transmissions and interrupt proper sensory to motor movement. When trigger points are imbedded in the muscle fiber the fiber's ability to function is inhibited and normally this is when the action potential, or the fibers ability to fully contract, is limited. Muscle Release Therapy, MRTh® premise is to locate these areas, assist the brain in relieving and balancing the proper tension to bring about a natural tension to the skeleton.

Fundamental Movement Therapy(SM) helps the brain re-program proper movement and helps to re-inforce the neurological activity between the ligaments, tendons, and muscles.

In my next blog, I will continue to investigate the movement of the spine in relationship to lower leg, hip, knee and ankle discomfort and dysfunction. So, next time you have hip pain make sure the interconnection of the movement in the spine is balanced to the tension of the lower extremity skeleton.

If you have questions, or would like a free consultation, please call 216-364-0152 or email us at [email protected]. One of our therapists or instructors will be glad to discuss how we might be able to help.

Happy 2012 and there is...a Reason to HOPE!

Dennis

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]