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Self Care for Hip, Groin, and Back Pain

10/1/2014

25 Comments

 

Self Care Steps:

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This blog is for those of you who have hip pain, groin pain, hip impingement, sciatica, SI joint pain, or low back pain. And if you don't have any of these, then you are lucky and prevention is the best medicine!
Hip mobility is paramount for a healthy body and spine. During an evaluation I like to observe a static standing assessment, a functional movement assessment, and then perform a passive mobility assessment.  
People with back/hip/groin pain often have a postural position of "butt gripping" (read a great article about it here Diane Lee).  In this position, the pelvis is thrust forward and the deep hip rotators are contracted. When these muscles are overactive, they push the head of the femur into the front part (anterior) of the hip capsule which can interfere with hip motion: hip flexion (bringing the knee toward the chest) and internal rotation (turning the thigh inward).
On the functional exam I will see an inability to go into a deep squat, or the hips will shift to the opposite side during the squat.  On the passive motion test there will be a limitation in hip flexion, and they may express pain with a combination of movements: hip flexion, adduction and internal rotation.
Standing in alignment and learning how to let go of the grip in the rotator muscles is essential for healing, as well as reprograming the normal glide of the head of the femur.  In normal motion, as the knee moves toward the chest, the head of the femur should glide back and down.  Due to the tightness of the rotators, the back (posterior) hip capsule can be restricted.  Restoring the tissues and the hip motion can be achieved through simple self mobilizations.
Standing alignment for back and hip health
1. Standing Alignment: vertical leg, torso stacked over the legs.  Think about a plumbline going through the midpoints of the shoulder, hip, knee and front of the ankle bone.

2. Release Deep Hip Rotators:  Lie down on your back with your knees bent.  Place a tennis ball under your left butt cheek just to the side of your sacral bone.  Rock your knees to the side and return to start position 3 times.  Find a new spot and repeat.  Complete in 3-5 different areas and then switch sides.
Piriformis Release with tennis balls
3.  Hip Release and Hip Glides:  this is a video demonstrating how to do the self mobilizations to regain normal motion.
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.
25 Comments
Kathryn
10/2/2014 10:23:20 pm

Susan
This is so awesome! :)

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Susan
10/2/2014 11:27:34 pm

Thank you! Susan

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Annette link
10/3/2014 04:42:51 am

This is great and timely for me! Thanks so much!

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Susan
10/3/2014 05:03:08 am

Annette,

Excellent! Thank you for reading! Susan

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Sandra
10/3/2014 11:59:26 am

This looks great! So excited to try this!! :)

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kristin
10/4/2014 10:48:13 am

Thanks for the video! During this activity, where the hand is placed at the hip, are we supposed to keep that muscle or tendon (whatever it is) at the front of the hip to stay soft and not feel it tense as the leg pulls forward? Or is it something else we are trying to achieve?
Thankyou!

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Susan
10/5/2014 05:03:41 am

Kristin,
This is a great question. You want most of the work to come from pulling on the strap, so ideally you don't want to feel the muscle pop up into your hand. If you have a hard time not using your muscle, that is ok. Hope this helps, Susan

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Jo-Ann link
10/6/2014 02:07:42 pm

Thanks so much for all your videos - I pass them on to my clients and they love them as much as I do!

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Susan
10/7/2014 12:07:27 am

Jo-Ann,

Thank you for your feedback! I always hope to share valuable info that people can use and practice! Susan

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Sharon
11/7/2014 11:16:46 pm

A question. A chiropractor has been adjusting my back to correct misaligned vertebrae. But I now have problems walking. I feel as if my pelvis is uncontrolled and have difficulty moving my legs forward to take a step. The hamstrings seem way too tight. I feel some relief when I try to touch my toes then walk again. What exercises can you recommend to loosen things off. Pity I live so far away or I would make an appointment!

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Susan
11/8/2014 12:09:05 am

Sharon,
It sounds like you already found your answer: reaching down to touch your toes. Do that often throughout the day: every hour.
Where do you live? Susan

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Elise
2/24/2015 07:21:40 am

Hi Susan,
I'm reading your blog from Melbourne, Australia.
I have femoroacetabular impingement in both hips, particularly the left, and anterior pelvic tilt. I'm 21 years old. These exercises and stretches have been absolutely wonderful!
I don't suppose you do Skype consultations?
So grateful for your sharing of this information, you know exactly which areas to target -- finally, someone who "gets it".
Many thanks from Oz!

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Elise
2/24/2015 07:21:53 am

Hi Susan,
I'm reading your blog from Melbourne, Australia.
I have femoroacetabular impingement in both hips, particularly the left, and anterior pelvic tilt. I'm 21 years old. These exercises and stretches have been absolutely wonderful!
I don't suppose you do Skype consultations?
So grateful for your sharing of this information, you know exactly which areas to target -- finally, someone who "gets it".
Many thanks from Oz!

Reply
Susan
2/25/2015 12:57:46 am

Elise,

Yes, I do skype sessions. Email me at [email protected]

Thank you for your feedback! I am so happy to hear that you have received benefit!

Susan

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Cynthia Zenner
10/8/2015 01:19:43 pm

Hello Susan,

Wow is all I can say! I've been getting excellent PT care for a fai (femoral acetabular impingement) diagnosis of 2+ years ago, making steady progress. A week or so ago I stumbled upon your post and got the gentle message to "just go try that" so I did. And I successfully "put my femur back into place" following your great video! This one maneuver has drastically improved my left leg balance in a way I've not achieved for many, many years. I'm very grateful - thank you for your knowledge, caring, and excellent clear instruction! I found it especially helpful to really push down hard with my left thumb but not engage my hip muscles as I pulled up strongly with the strap, going slowly and steadily. Hope this helps others!!

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Susan
10/8/2015 02:08:22 pm

Cynthia,
Thank you so much for sharing your results. It made my day to hear about your progress.

Best to you, Susan

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Connie van Hoesel
3/3/2016 09:16:17 pm

This has been so helpful to me. I have only done it once but noticed a release in my right hip that always seems to be tight on the front side. So I also have been reading Katy's books and trying to incorporate her stance points, but have the following question: if we are supposed to use our deep lateral hip rotators to keep our knee pits neutral while standing, how can we keep from gripping our glutes?? Maybe my misunderstanding of this has been causing my hip problems.

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Susan
3/4/2016 09:51:41 am

Connie,

This is a great question. It is possible to use more of the deep lateral rotators to externally rotate the femurs to bring the thigh to neutral. We are so used to squeezing the glute max that it will come along for the ride. I find it helpful to "find" the rotators unloaded with one leg first: Lie on your side. Bottom leg stays straight. Let your top leg move 45 degrees to 70 from start (depending on how tight your hamstrings are). Keep the top leg straight as the inside of your foot stays firm on the floor. Keeping the knee straight, practice externally rotating your femur.
Because neutral femurs require muscle activation to get there, I personally don't advocate standing this way all of the time. I encourage people to do this more of an awareness practice and to free up the other areas that may allow for more ease in standing.

Thank you for your comment, Susan

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Connie
3/17/2016 08:29:58 pm

This was so helpful, Susan. Was able to find the rotators easily with this instruction. I have been finding it difficult to keep quads/glutes relaxed while I try to get neutral femurs, but it has been getting easier to achieve. Perhaps it is one of those layered things, almost like achieving the vertical shin squat. Good to try to get there even if you can't quite yet.

Susan
3/18/2016 08:17:11 am

Connie,

Yay! Thank you for sharing your progress! Susan

Connie
3/21/2016 10:12:24 am

One step forward, one step back...a few months ago because of trying to keep neutral knee pits I got weird soft tissue problems in my right outer lower leg -- it is off/on ever-so tingly and the tissue feels very tender (peroneals?). It got better after I stopped the neutral knee pit rotation of my leg and put on a compression sleeve in the area. Now it is about 3 months later and after resuming the neutral knee pit thing it seems to be coming back. Is this a sign to definitely back off the neutral knee pit thing? I guess I just need permission to hear that stance is OK without this because Katy promotes it so big in her DR book and Dont Just Sit there. I think MYDNA might have it in there, too.

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Connie
3/21/2016 10:24:50 am

One more comment about this...I think that it is also beneficial to REALLY focus on keeping kneecaps released and glutes relaxed while at my standing work station, even if I can't get the external rotation of the thighs thing going without messing up my lower legs. At least until they are not showing any more symptoms... Do you agree?

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Robin ROTH
8/16/2017 01:55:51 am

I have pretty severe facet joint disease. Past cervical diskectomy. RN 34 years pushing beds. in have noted that I need to push my pelvis and belly out tighten but both cheeks to get pain relief lower back. This will in turn aggregate osteophytes in thoracic disc. PAIN unreal. HELP. see specialist ,but still hard mobility. I am scared. Robin

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Susan
8/20/2017 07:51:44 pm

Hi Robin,

Yes, pain is scary and uncomfortable. It sounds like you might benefit from unraveling some of that tension. Do you have someone that you can work with in your area? Susan

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Claudia Beck
3/20/2018 05:29:48 am

Hi Susan,

Great article I'm reading this from Perth, Australia, I used to suffer from very back hip and back pain. after reading the article and watching the video I started working out the same and found my pain slowly reducing and feeling better thanks for your tips. There was another article that helped me a lot thought of sharing the good to you, https://www.bodygenius.com.au/functional-hip-and-groin-movement/

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