Got Hip Pain ? Attention Runners and Athletes with Hip Pain.
Compensatory joint motions are quite often a source of a person’s pain. Shirley Sahrmann named her hip syndromes for the direction of the movement most consistently associated with pain. In a recent CME presentation we did for www.onlineCE.com we discussed the accessory movements found with the hip.
Lets look at the known normal biomechanical facts:
During hip flexion the accessory motion is posterior glide of the femoral head.
Hip extension: accessory motion is anterior glide of the femoral head.
Hip medial (internal) rotation: accessory motion is posterior glide of the femoral head.
Hip lateral (external) rotation: accessory motion is anterior glide of the femoral head.
Hip abduction: accessory motion is inferior glide of the femoral head.
Hip adduction: accessory motion is superior glide.
Impairment, either from joint/bony deformation (ie. torsions) or from functional muscular asymmetry, can lead to impairment of the accessory motions (compensation) that are necessary for clean joint function. This can lead to pain.
For you clinicians out there, knowing your hip torsions and versions will impact the amount/degree of these accessory motions. This is why we harp on knowing your fixed anatomic variants. (You can find discussions on these in our prior blog posts and on previous recorded www.onlineCE.com teleseminar presentations.) For example, reduced medial rotation at the hip (usually met with increased external rotation) is often seen in people with retrotorsion of the femur. Said another way, when your client has impaired medial or lateral hip rotation you must go beyond looking at the muscles at some point and consider whether they have a form of ante or retro torsion.
Hip extension is a critical part of normal human ambulation, whether you are walking or running. Normally the hip, when moving into extension during the final propulsive phase of ambulation, allows for the femoral head of the hip to glide anterior in the socket (acetabulum). This reduces labral RIM pinch (RIM Syndromes) and allows for greater safe extension range. If hip extension range is impaired then this accessory motion of anterior glide can be impaired and lead to compensation and pain.
Think about this:
What if the quadriceps are tight ?
What If the Glutes are weak ?
What if rotational muscles are short ?
What if ankle rocker (dorsiflexion) is impaired ?
What if there is neuro-inhibition from joint pain (ie. osteoarthritis or joint mal-centration etc) ?
What if there is imbalance and weaknesses about the hip ?
What if there are other faulty movement patterns ?
What if there is one of the femoral torsions present ?
Much of this is “chicken or the egg”, who came first ? These “what ifs” are what make practicing medicine difficult and a real challenge. Some of these issues can be found during functional movement assessments, but some of them will be missed if that is all you are doing. These issues may be what separates the good clinician, therapist, coach or trainer from the “not so good”. Knowing if a person has an impaired rolling pattern (see here http://youtu.be/dqnR0EcW2YY) is great to know, but knowing if the lower limb driver is off because the hip cannot internally rotate is even greater. Merely giving the person the homework of practicing and repeating the rolls on the impaired driver side without assessing all of the parts (for example some of the issues above) may cause you to miss the boat, or to engrain a new faulty motor pattern.
Knowledge is prince, application of knowledge is king.
Next week we will begin a blog post a week on the biomechanics of the hip. We hope you will join us.
Shawn and Ivo
Here are some of our prior blog posts to add and deepen this dialogue: