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Pain in the hip, and what to do about it

1/2/2013

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Tensor Fascia Lata (TFL) attaches to the iliac crest/ASIS and into the fascia lata that terminates at the lateral knee.  The primary functional movement of this muscle is to stabilize the pelvis and the knee.  Its action is hip abduction, flexion and medial rotation. Trigger points related to the TFL refer to the outside of the thigh.
Iliacus & Psoas = Iliopsoas The Iliacus attaches to the iliac fossa and the Psoas attaches to the transverse processes of L1-L5 and the lateral aspect of T12-L5.  They share a common attachment point on the lesser trochanter of the femur.  The iliopsoas flexes the hip and trunk.  
Trigger points in the iliopsoas refer to the anterior thigh and low back.
Sartorious attaches to the ASIS on the pelvic crest and to the medial aspect of the tibia. Its action is hip flexion, external rotation, abduction and knee flexion. Trigger points in the sartorious refer to the anterior and medial thigh.
Trigger points in a muscle can be the culprit in many pain disorders.  In this post, I provide a self care technique to assist with these potentially troublesome trigger points. The muscles that can refer pain into the hip area are the tensor fascia lata, iliacus, psoas and sartorious.  If you are interested in learning more about what causes trigger points and how to treat them, I have listed some websites dedicated to trigger points and myofascial pain syndromes at the end of the blog.   Click on the pictures below to enlarge the picture and to link you to triggerpoints.net, an amazing resource for trigger points and referred pain.

If you are experiencing any of these pain patterns , try this:

How to release the psoas
Release tension in the psoas,  and the surrounding hip musculature by performing a constructive rest position with a bolster.  Allow yourself to breathe and relax for 5 minutes.  For instructions on how to do this click here.

How to release tight hip flexors with a ball
Perform a release technique utilizing myofascial release balls such as Yoga Tune Up Therapy Balls for Self Massage (that's what I have and I love them),  Melt Method Products, or good old tennis balls.  There are a lot of different ways to get into the muscles.  For this technique you will take two balls held together in a sock or bag.  My finger is pointing to my ASIS on the iliac crest.  Place the balls horizontally just below the ASIS.

Femoral Triangle
You will be working near a tender area due to the superficial exposure of the femoral vein, artery and nerve at the femoral triangle.  If you start to feel tingling and nerve sensations, move to a different area.  Just underneath the vessels and nerve lies the iliopsoas.  The next muscle laterally (to the right in this pic) is the sartorious, and the muscle in red is the tensor fascia lata.  Sandwiched in between the two is one of the quadricep muscles, the rectus femoris.  This will get released as well.

myofascial release to hip flexors with tennis balls
The balls are placed as above on the left side here.  With the right leg you can adjust how much body weight you put down into the balls.  If it is more comfortable, you can prop up onto your elbows.  If you are not able to get down onto the floor, you can place the balls at your hip, and lean into the wall or a door jam. Try to allow your muscles to relax and mold over the balls.  If you find that the balls are too intense to start with, place a folded hand towel over them to disperse the pressure.  If you are holding your breath and tensing your muscles to deal with the pain, this defeats the purpose.  You should be able to feel the sensation and breathe into the area as the muscles release.   Once you feel that the muscle has let go, move the balls into a new area.  Spend 5 minutes on each side.  Enjoy how you feel when you get up to walk.  Feel the freedom in your hips!


Resources:
 http://www.triggerpoints.net/, http://saveyourself.ca/tutorials/trigger-points.php, http://www.myofascialtherapy.org/
Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.
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    Susan McLaughlin,
    Physical Therapist

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Contact:  Susan McLaughlin, PT 801.859.4142
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