Inhibited Psoas in FAI?

Daniel DePonte

I've been struggling with some hip problems for awhile that causes SI joint pain and some alignment issues everywhere from my knees to my thoracic spine. More or less, my hip doesn't internally rotate correctly and my physician(s) recommended hip artho to fix the FAI in that hip. However, I'm not 100% convinced that surgery is the answer...yet.

Most practitioners (along with myself) have stretched and released the living hell out of my psoas and I feel that may be made the problem worse... I was wondering if Kelly has any videos on here on how to active the psoas an strength the core.

Thanks!

Kaitlin Lyons

Have you addressed the soft tissue around the hip?
What is hip flexion and ankle dorsiflexion like?
A few episodes which address the psoas.
Episode 26: Hips and Seppuku: Psoas and Hip Soft Tissue Mob
Psoas Flossing and Biker Hips | Episode 301
Pro User Request Friday: Runners & Psoas Nastiness
Bubo Barbell Pec/Psoas Smash Quicky or What to Do With Those Bent Barbells
Jill Miller Smashes Your Guts! (and psoas, and tacked down viscera, and matted down abdominals…) Part 2

Daniel DePonte

Thanks, I'll look into these!

I've had some recent success with the high quad stuff and ankle flexion work. My concern is that iv'e stretched/released the heck out of the psoas on the side with the impingement, pulling the hip to the front of the socket when my goal was increase that posterior hip glide and increase my (limited) hip flexion.

thanks again.

Kaitlin Lyons

Have you checked out episodes on hip impingement?
Or episodes on hip flexion?
Episode 87: Hip Impingement 2: Band Variation
Episode 144: Ze Hip Flexion
Episode 234: Improve Your Proximal Hip Mobility and Nerve Tunnels

Glute/ham interface may be in impacting factor
Tuesday, October 25th, 2016

Dr. Tim Cummings, PT, DPT

Daniel,

Do you have imaging that confirmed you have FAI? If not, I'd check that box first.

If confirmed, I think you might do well to take a closer look at surgical intervention. The impingement caused by the acetabulum can cause a great deal of damage to the cartilage and the hip labrum. Though soft tissue mobility work and improving motor control can help, if there's a problem with the architecture of the joint, there's no exercise that will fix that.

Daniel DePonte

Thanks for getting back to me!

Tim - i had a hip arthogram at my local, academic medical center. I have a sizable CAM and pincer with some damage to the labrum.

I'm doing my best to improve my admittedly poor body mechanics and found Kelly's stuff helpful

Dr. Tim Cummings, PT, DPT

Daniel,

Good to hear the MWOD recommendations are helping. Hang in there, stick with that daily mobility practice, and make sure you're adding in a regular dose of hip strengthening work to minimize the aggravation in that hip joint!

Barefoot Rehabilitation Clinic

Try getting adhesion removed from the posterior hip capsule and adductor magnus. These two structures affect hip flexion most directly.

Daniel DePonte

Thanks everyone!

At this point, I have the mobility at my hip just not the stability. I still feel like it's a deep stabilizer issue - it just "turns off" sometime.

Kaitlin Lyons

Are you working on stability in the hip?
Lateral leg raises
Medial leg raises
bent leg lateral raises
single leg tuck
single leg over hold 20 sec

Daniel DePonte

I do some variation of these exercise regularly. The issue i face is - just like my core musculature - my glute (med) just turns off.

PS: You're the best Kaitlin!

Kaitlin Lyons

Thanks Daniel
Good to hear you are addressing the stabilization piece.
Many times cause of glutes shutting off is:
1. Pain
2. Position
3. Lack of use
Do you have pain?
Pain can cause the glutes to shut off which then causes greater instability which results in pain.

Position-- Glutes span pelvis to femur so..........alignment of the pelvis and femur, therefore, affects the position,
length and tension of your gluteal muscles. If these muscles are not in
an ideal posture, their function will be compromised--sometimes to the
point that the muscles are not able to contract.

Anterior pelvic tilt over stretches the glute. There is a connection between this posture and muscle function called the Lower
Crossed Syndrome.  The hip flexors and back extensors are
short and tight, while the abdominals and glutes are lengthened and
weak.
The glutes and hip flexors work in opposition. If the hip flexors are excessively tight, they may block the message from ever reaching the glutes leaving them inactive.
Thoughts?

Daniel DePonte

Pain? Yes. SI / Lower back pain on one side. I also get a fair amount of discomfort and clicking inside my hip. I've read all about the typical crossed / APT / "desk bound" syndromes online but I'm not sure that applies to me. I'm more of a PPT and rounded shoulders guy!

I've been to 3 different PTs who have offered only periods of relief. My local academic medical center says a "candidate" for a hip arthroscopy based on my images (MRI) and failures at PT, but I'm unconvinced - I feel that i have achieved periods in which my mechanics are improved, I just can't maintain them.

Generally, my bad hip does seem to internal rotate during my gate. I can mobilize-active my glutes and stretch my hip flexor all day, but this issue remains. This brings be back to my original post - could this be an issue with my psoas / deep hip flexors? If it's inhibited, the stability of my hip has to be affected...

Some other comments:

- I pass the thomas test, so theoreitically my hip flexors aren't tight?

- one leg isn't shorter than the other

- my hamstring tendon snaps around my knee during flexion

Kaitlin Lyons

It's a system of systems.
Where you see the issue may not be where it originates.

Are you seeing improvements with what you are doing to address SI/lower back?
Not following what PPT is.

What is your trunk organization like?
Have you addressed your gait?
Have you addressed your psoas and/or hip flexors?
Have you addressed your hamstring?

Pro Episode # 21 – Pro-User Request Friday: Not Seeing The Change? You Need a Systems Approach.

Daniel DePonte

ppt = posterior pelvic tilt

Kaitlin Lyons

Posterior pelvic tilt  disrupts the muscle balance in our body and can cause posture problems and back pain.
Are you correcting your gait?
Are you addressing your posture when sitting and standing?
These need to be corrected for lasting improvement.

Are you addressing your hamstring snapping around your knee?

There are several exercises and programs you can follow to strengthen the core. Using a variety of exercises is key to address different parts and the whole.

Gluteus Maximus is most likely tight.

Daniel DePonte

Thanks again Kaitlin!

The gait is the issue i struggle with most. Days when my back/hip hurt, Under load (walking) my hip extension and hip IR going to hell. I just can't pivot thru and drop my hip back. This causes my pelvis to tuck on that side and twisting me out of alignment. Maybe this is all from the FAI on that hip, who knows!

I'm lucky to have a mwod practitioner in town and hope to get an appointment with him the in next month before I reconsider surgery.

Kaitlin Lyons

Have you worked with anyone to begin correcting your gait, improving mobility etc.?
Need to get started to begin to get the situation under control.

Chris Lutz

Hi Daniel, were you able to resolve your issue, i know these posts were from a while ago, but I am having the same exact problems and would love to hear what you have done since. thanks!