Hip Pain

SI Joint Dysfunction. Nothing FUN about it.

~ Dr. Robert Speirs DC ~ Leave a comment

Your sacroiliac joint is the mechanical link on each side of your hip that connects your legs to the rest of your body. The joint has a limited but very important degree of mobility. Symptoms develop when one or both of the joints loses normal motion. When a joint becomes “restricted”, a self-perpetuating cycle of discomfort follows. Restriction causes the muscles to become overworked, leading to tightness, compression, inflammation, pain and more restriction.
Sacroiliac problems can happen as a result of repetitive strenuous activity or trauma- like a fall onto the buttocks. Other causes of sacroiliac joint problems include, poor posture, having one leg slightly longer than another, having an altered gait, having flat feet or scoliosis, or having pain somewhere else in your legs. Pregnancy is a common trigger for sacroiliac joint problems due to weight gain, gait changes and postural stress.

Sacroiliac joint problems often begin as a focal discomfort in your back just below the belt line, slightly to one side of center. Your pain can travel into your buttock or thigh. Symptoms are often worse by standing on the affected side. The pain may become more apparent when you change positions- like exiting a chair, car or bed, or during long car rides. The pain is often relieved by lying down.

To assist with your recovery, you should avoid any activity that provokes pain, like standing on the affected leg or prolonged sitting.

My ankle hurts…….

~ Dr. Robert Speirs DC ~ 1 Comment

The posterior tibialis muscle begins deep in your calf. The muscle is connected to the arch of your foot by a tendon that runs along the inside of your ankle, just behind the large bump called the medial malleolus. When you walk, the posterior tibialis muscle lifts the arch of your foot.
Posterior tibial tendon dysfunction is one of the most common foot and ankle problems. The tendon may be damaged from an acute injury, like an accident or fall. More commonly, problems arise from overuse or repeated strain. Ongoing irritation slowly damages the tendon’s fibers and eventually leads to weakening and degeneration. This decreases the tendon’s ability to support your foot when you walk. As the tendon becomes less effective, the arch of your foot is allowed to collapse, which further increases the strain on the muscle and tendon.

The condition is often triggered from overuse and/or training on excessively hard surfaces. Other factors that can contribute to posterior tibial tendon dysfunction include: obesity, diabetes, hypertension, prior surgery or steroid injections.

Symptoms include pain or swelling along the course of the tendon, particularly behind your inner ankle bone. Symptoms often begin following an increase in training intensity or duration. Standing, walking, or running will likely increase your discomfort. Your pain may be aggravated by spending prolonged periods of time on your feet, especially, when standing tiptoe and walking stairs or uneven surfaces.

Early diagnosis and treatment is important to slow progression of the disorder. You may need to temporarily limit weight-bearing activity to allow your tendon to heal. Using a stationary cycle, elliptical machine, or swimming can be good alternatives to walking and running. Your doctor will likely prescribe arch supports or orthotics to help support your foot. You will be given exercises to strengthen the posterior tibialis muscle. These exercises should be performed while wearing shoes with good arch supports. In certain instances, a walking cast or boot may be needed to temporarily protect your foot.

Hip Abductor Weakness

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One very important job of your hip muscles is to maintain the alignment of your leg when you move. One of the primary hip muscles, the gluteus medius, plays an especially important stabilizing role when you walk, run, or squat. The gluteus medius attaches your thigh bone to the crest of your hip. When you lift your left leg, your right gluteus medius must contract in order to keep your body from tipping toward the left. And when you are standing on a bent leg, your gluteus medius prevents that knee from diving into a “knock knee” or “valgus” position.

Weakness of the gluteus medius allows your pelvis to drop and your knee to dive inward when you walk or run. This places tremendous strain on your hip and knee and may cause other problems too. When your knee dives inward, your kneecap is forced outward, causing it to rub harder against your thigh bone- creating a painful irritation and eventually arthritis. Walking and running with a relative “knock knee” position places tremendous stress on the ligaments around your knee and is a known cause of “sprains”. Downstream, a “knock knee” position puts additional stress on the arch of your foot, leading to other painful problems, like plantar fasciitis. Upstream, weak hips allow your pelvis to roll forward which forces your spine into a “sway back” posture. This is a known cause of lower back pain. Hip muscle weakness seems to be more common in females, especially athletes.

You should avoid activities that cause prolonged stretching of the hip abductors, like “hanging on one hip” while standing, sitting crossed legged, and sleeping in a side-lying position with your top knee flexed and touching the bed. Patients with fallen arches may benefit from arch supports or orthotics. Obesity causes more stress to the hip muscles, so overweight patients may benefit from a diet and exercise program. The most important treatment for hip abductor weakness is strength training. Hip strengthening is directly linked to symptom improvement. Moreover, people with stronger hip muscles are less likely to become injured in the first place.

Pathophysiology of trigger points.

~ bryancobb ~ Leave a comment

A large number of factors have been identified as causes of trigger point activation. These include acute or chronic overload of muscle tissue, disease, psychological distress, systemic inflammation, homeostatic imbalances, direct trauma, radiculopathy, infections, and lifestyle choices such as smoking. Trigger points form as a local contraction of muscle fibres in a muscle or bundle of muscle fibres. These can pull on ligaments and tendons associated with the muscle which can cause pain to be felt deep inside a joint. It is theorized that trigger points form from excessive release of acetylcholine causing sustained depolarization of muscle fibres. Trigger points present an abnormal biochemical composition with elevated levels of acetylcholine, noradrenaline and serotonin and a lower ph. The contracted fibres in a trigger point constricts blood supply to the area creating an energy crisis in the tissue that results in the production of sensitizing substances that interact with pain receptors producing pain. When trigger points are present in a muscle there is often pain and weakness in the associated structures. These pain patterns follow specific nerve pathways that have been well mapped to allow for accurate diagnosis or the causative pain factor.

Diagnosis of trigger points.

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Diagnosis of trigger points typically takes into account symptoms, pain patterns, and manual palpation. When palpating the therapist will feel for a taut band of muscle with a hard nodule within it. Often a local twitch response will be elicited by running a finger perpendicular to the muscle fibres direction. Pressure applied to the trigger point will often reproduce the pain complaint of the patient and the referral pattern of the trigger point. Often there is a heat differential in the local area of the trigger point.

What is a trigger point

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Dr Janet travel coined the term trigger point in 1942 to describe clinical findings with characteristics of pain related a discrete irritable point in muscle or fascia that was not caused by acute trauma, inflammation, degeneration, neoplasm or infection. The painful point can be palpated as a nodule or tight band in the muscle that can produce a local twitch response when stimulated. Palpation of the trigger point reproduces the pain and symptoms of the patient and the pain radiates in a predictable referral pattern specific to the muscle harbouring the trigger point.

Snapping Hip. Not as horrific as it sounds.

~ Dr. Robert Speirs DC ~ Leave a comment

The muscle responsible for flexing your hip toward your trunk, is called the Psoas. This muscle begins on your lower spine and passes through your pelvis to attach onto the top of your femur (thigh bone). Along this course, the muscle travels across the front of your hip socket and over several bony prominences. If the muscle is too tight, its tendon may rub over these “bumps”. This occasionally produces an audible snapping sound, hence the moniker, “snapping hip”, aka “psoas tendinopathy”.
The tendon can be irritated by an acute injury, but more commonly from overuse- particularly repeatedly flexing your hip toward your trunk. The condition is also known as “dancer’s hip” or “jumper’s hip”, as movements associated with these activities are known culprits. Likewise, the condition is frequently seen in athletes who participate in rowing, track and field, hurdling, running (especially uphill), soccer, and gymnastics.

Your symptoms may include a “snapping” sound or sensation when you flex and extend your hip- although many cases are silent. Repeated rubbing causes inflammation and subsequent deep groin pain that can radiate to the front of your hip or thigh. Long-standing problems can trigger weakness or even limping.

The diagnosis of snapping hip is frequently overlooked. In fact, some studies show that identification is often delayed more than two years, while other potential causes are pursued. Fortunately, your problem has been recognized, and our office has several treatments to help you recover.

Psoas problems often start when one group of muscles is too tight, while another is too loose. Your home exercises will help to correct this problem. Depending upon the severity of your condition, you may need to avoid certain activities for a while. You should especially avoid repetitive hip flexion. Prolonged seated positions can encourage shortening of your hip flexors so be sure to take frequent breaks. Patients with fallen arches may benefit from arch supports.

What to expect with a trigger point massage.

~ bryancobb ~ Leave a comment

A treatment with Bryan is very user friendly. And, no, you don’t have to remove any clothing. However, bringing a t-shirt and a pair of shorts or sweats is recommended.

The first time you come for a treatment you will be asked to fill out a Client History form. Bryan will go over the information you provide, asking for more detail and discussing the type of pain you are having and its location.

The treatment itself involves locating the Trigger Points in the muscle or soft tissue and applying a deep focused pressure to the Point. This will reproduce the pain and the referral pattern that is characteristic of that pain.

The treatment will be uncomfortable at first, but as the Trigger Points release, the pain will decrease. The pressure will always be adjusted to your tolerance level. If, at any time, you feel too uncomfortable you can ask Bryan to ease off a bit.

Depending on your specific problem, Bryan may also use some stretching and / or range-of-motion techniques, as needed.

After treatment, it is usually recommended that the client apply moist heat to the area treated.

The Bird Dog

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Bird Dog

Today we are going to look at one of the most effective exercises to protect your lumbar spine from discogenic injury, the bird dog. A great way to work on both posterior chain and rotational stability, the bird dog is safe, effective and simple.

  • Get on your hands and knees (four point position) with your knees and hands, hip and shoulders width apart.
  • Your back is in neutral position (slightly arched) and your chin must be tucked in.
  • Activate your lower abdominals (transversus abdomini) by bringing your belly button inward and by activating your pelvic floor muscles 20 to 30% of maximal contraction.
  • Maintain a steady abdominal breathing while you simultaneously lift one leg backwards and the opposite arm overhead keeping your back in neutral position.
  • Return to the initial position and repeat with the other leg and arm.

2 sets of 10 reps as part of your regular core/stability routine will have you well on your way to a life-proof low back!

Image and instructions from physiotec.ca 

Lumbar Spine Stabilization

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L Spine Stabilization

This is a great way to increase the stability of your lower back.

  1. Lie with your stomach over a therapeutic ball while stabilizing yourself with your feet and arms and keep your head in line with your body.
  2. Tighten your abdominal muscles to flatten the spine by pulling your belly button towards your back and hold the contraction throughout the exercise.
  3. Bend one knee and lift it up towards the ceiling.
  4. Lower the leg and repeat on the other side.