Sunday, July 19, 2009

HIPS Q & A

I recently sent out an email asking everyone if they had any questions about their hips as I was embarking on a deep study thereof.

Here are some of the questions and answers published for anyone who is interested.


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Q: Hi - I have had severe muscle spasms in my neck, shoulder back diagnosed as arthritis in my neck and narrowing of C6 vertebra

all related to aging - (inevitable)

I would like to strengthen my body - CORE - and these areas as well

As you know i am not very flexible and always have been this way.

What would be the best direction for me to go - Yoga? Pilates? Stretching? Strength Training (that's what started my problem)


A: Well, I have to mention that I know many people older than you who don’t have this problem and in truth, many people will never develop it. Your body responds to what you do with it. It's not that you reach a certain age and suddenly you have arthritis in your neck. You most likely have a simple physical habit or pattern that developed over time into this condition. For example, I was once told by a yoga teacher that I have a habit of extending my neck in forward bends and that if I didn’t correct that habit I would likely end up with arthritis in my neck.

To answer your question: You actually practically answered your own question. Based on your description, I would think flexibility should be your main concern. I would advise stretching and some yoga. You should also look into classes in the Alexander Technique. And if you’re not aware of how you can massage yourself, you should be working with a massage therapist who can help release those spasms.

You need to be careful, because while yoga is a great way to develop strength in your core, some yoga poses would be good for you while others definitely wouldn’t be. For example, I’d stay away from the Bridge, the Plough and the Shoulder Stand or any poses putting your body weight on your neck. But I’d think some gentle backbends like Cobra would be a nice place for you to start. And I’d also think Twist would be good for you. You should work with someone who can help you develop a short home practice.

I’d stay away from Pilates because it typically requires a lot of neck strength and stability. And unless I knew exactly what your neck situation was, I’d want to err on the side of caution. As far as strength training, I think strength training is essential for good health, but that doesn’t have to mean lifting weights. Most people can get good strength benefits using their own body weight. But I’d want you to get some specific coaching because you should be able to do it without causing pain or discomfort in your neck.

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Q: I do butterfly's and pigeon pose for my hips, but are there any more moves/stretches that I can perform on a daily basis in the morning to isolate the hips, that can improve my stiffness and open up my range of motion especially for the long walks in central park that I have been doing lately that span 6-7 miles are a time


A: First and most importantly, you will get the most out of your stretching if you do it when your body is warm. Since you said “in the morning” my first concern is that you aren’t sufficiently warm to effect the tissues much no matter what stretches you do. (Unless you are doing those stretches AFTER your long walks. Then you should be OK.)

The next thing I need to say is that you need to stretch correctly if you’re interested in improving your flexibility and opening up your range of motion. Do stretches that you can hold for a long time and relax into while you take deep breaths and consciously tell your body to relax. Then you need to wait and wait, breathe some more and wait and then feel your body start to give up and stretch. You may be surprised at how far you can eventually stretch using this technique. Just let your breath do it. You should hold these stretches, and breathe in this manner for 2 minutes eventually working up to holding them for up to 5 minutes. The most important thing is to be relaxed and to breathe deeply.


The butterfly stretch is a good one for your outer hips. Increase the fun by leaning forward or resting your arms on your knees. Don’t bounce your legs, it will excite the joint. Just press your feet together, scoot your butt as close to your feet as you can, fold your body over, place your hands on the floor in front of you, hang your head down and take 100 deep breaths; in through your nose and out through your mouth.


The pigeon is a complex pose and not many people can get into it deeply enough to relax in it. In the front leg, it’s most focused on those outer hip muscles again and sort of redundant with the butterfly. In the back leg you are getting a good psoas and quadriceps stretch.



But you can get a great psoas and quad stretch by doing a lunge stretch instead. You will probably find that since you can relax more, you will get deeper into this stretch and therefore get better results than in pigeon. In fact, you may find that after doing the lunge for a month, your pigeon gets much easier.


















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Q: my hips "pop" all the time. ok maybe not "all the time" but VERY often, more than any other joint on my body. is that something i should be worried about?


A: No. Unless it hurts, don’t worry. It is usually caused by one of two things. One, someone who at one time was very flexible and now aren’t as flexible as before may find that certain hip movements cause the pop. And two, if there is an imbalance of strength or flexibility in the hip joint, it could cause the joint to be pulled out of its prescribed path during certain movements.

The “pop” you hear and/or feel is either a tendon or ligament rolling over a bone, or a bone jutting up against another bone. By the way, when you hear your bones “crack” that is usually a release of gas from in between joints. Some people seem to be gassier than others and therefore have very noisy joints. It’s nothing to worry about.


I would avoid doing any activity that has a repetitive action in which you pop every time. For example, if you popped with every rotation of a bike pedal, I would advise you to stay off the bike for fear of the constant rubbing of tissue together developing into tendonitis.

You can correct muscle imbalances with a well rounded yoga practice. In the course of undertaking the variety of positions, you will notice some movements are easy and some are very difficult. Those are imbalances coming to light. You need to work on those ones you don’t like. Those poses are difficult for you because of your imbalance.

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Q: Last week, on the day I was returning home from vaca, something happened to me that never happened before. I merely bent over to look at something on the ground & when I stood up - wham! I guess it was a muscle spasm in my left hip/lower back area. It was debilitating, limited range of motion, etc. Most importantly to me, I have not been able to go back to the gym!

I have had 4 chiro Rxs since then - w/electric stim & hot packs in between. It is better but there is residual pain. I am able to walk better, a bit faster but boy, has this cramped my active style! I believe it is a result of my fascia problems returning about a month ago, on BALL of left foot this time (last time it was the heel). I have been wearing foot brace in Nia classes but decided to wait til after vaca to see my podiatrist - but I guess my body had other ideas. I believe compensating for the tenderness in left foot,caused my alignment to be off, which made my whole left side vulnerable, causing the hip spasm during an inocuous activity.


A: You are exactly right when you say that your foot problems are the main culprit.

Have you been doing your foot exercises and stretches?

Do you have a set of therapy balls that you can use to constantly treat yourself? If you don’t you should get some immediately. Can you interlace your fingers between your toes? You should do that every day. I do it as part of my daily morning routine in the shower as I’m washing my feet.

In addition to taking care of yourself, you can practice some prevention. You need to take a hard look at what you might be doing to cause this irritation in your foot. Common places to look are in what kinds of shoes you wear or how you use your feet when walking or doing your activities. See if you catch yourself walking with clenched feet. Tension in your toes? Also, do you spend much time barefoot? Your feet are muscular and have lots of bones and joints and they need to move to be healthy.

Wearing a foot brace during Nia class is also very likely to cause the type of imbalance that would result in a spasm. I assume the brace held your foot and prevented it from doing what its supposed to do, which is to change shape, absorb the shock from the ground and distribute it comfortably up to your body through your legs and hips. If the foot doesn’t have it’s movement, there is nothing protecting your hips and lower back from the hardness of the floor. All of that shock goes into the joints unfiltered. You could also have developed knee problems or shoulder or neck problems, but maybe for whatever reason your hip/back was the weakest link.

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Q: Jason, There are two "sacs" at one's side, just where the leg and hip join. My Rheumatologist pressed these, during a visit to check for arthritis, and low and behold, they felt tender. I asked him what that meant, and in the tradition of western medicine, he answered, "I don't know." Can you imagine, he didn't even know why he was checking them! He did say it was not about a problem in the hip socket. I'm hoping your physical therapist has a better answer than that.

Could you share this person's name and number? I would like to consult with them on this and another problem I'm having, pain in the pads of my thumbs which turns out not to be arthritis.


A: What you describe sounds like bursitis. Bursas are sacs that are meant to cushion tendons that would, without the bursa, rub against the bone and become irritated. But if there is excess tension, usually the result of muscular imbalances or lack of flexibility, the pressure can become so great on the bursa that it responds by swelling up and taking up more room that was originally allotted for it. All of that pressure is painful.

Your doctor was right. It’s not in the hip socket, but it is still part of the hip joint, which is more than just a socket. In the photo you can see the acetabulum on the far hip which is covered by the labrum in the near hip. That is the hip ball and socket joint. The bursa is way over on the other side of the femur bone (the blue thing on the far left in the picture). Many muscles and tendons run over this bursa and a tightness in any one of them could cause the pain.


Sometimes cortisone will be a good, quick temporary solution, but I stress that it is temporary and I caution you that it is caustic. It causes damage, and could lead to worse conditions if abused. Many people with hip bursitis eventually find relief through weight loss, stretching programs and/or physical therapy.


I will happily give you the information for a therapist who I cannot recommend any higher. His name is Shmuel and his website is www.bodytuning.us. He is very intuitive and has a way of knowing exactly what your problem is just by holding your hands and looking into your eyes.


If you do contact him, tell him I referred you. He tends to be very busy but he gives priority to referrals from current clients. Let me know what your experience is with him, I’d love to hear all about it.

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So, thanks to everyone who sent in questions. I had a good time researching and pondering them all. If anyone has any other questions that I can answer, please don’t hesitate to ask. Most of the techniques I described above are things that I teach in classes or that I can teach in personal training sessions. Please contact me if you're interested in private coaching or classes.


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