Hip/Pelvis

Overcoming 6 Years of Hip Pain and Two Hip Surgeries..Now Back On The Golf Course Multiple Times A Week

Pat - Early 30’s, Ann Arbor

Injury: Chronic Hip Pain with arthroscopic surgery on both left and right for femoral acetabular impingement.

Dealing with hip pain can be an annoying thing that limits your daily lifestyle. In the case of Pat, it was impacting his ability to work as well as get out on the golf course as frequently as he would like.

He had dealt with various levels of hip pain for a while. Diagnosed with femoral acetabular impingement he eventually had arthroscopic surgery on both hips. Still after months of rehab after the surgery he was still experiencing discomfort that prevented him from golfing as well as continued to feel limited at work.

That was when he made the decision to come to On Track Physio and get next level care with a system in place to get at the root cause of the issue!

After 4 treatments in the span of 2 months he was feeling enough relief to start working out more frequently at the gym. With our continued guidance on a fitness program, and occasional follow up visits he is feeling much better!

A word from Pat: “You will get more from working with On Track Physio in 1 hour than you would at other places 2-3x per week.”

Today he is feeling much better at work, now golfing just about every weekend during the summer, and his gm workouts are feeling better than they have in years!


***If you would like to experience relief like Pat and receive next level care that actually gets to the root cause and fix problems as opposed to masking them then apply for a Free Discovery visit and see just how we can help do the same for you!

Snapping Hip

Recently I have had a string of clients present with a "snapping hip".

This isn't a medical diagnosis per say, but it is a symptom that many people deal with. The individual typically notices a random "popping", "clicking", or "snapping sound" from the front of their hip. It tends to feel different than cracking your knuckle, and it usually occurs when flexing the hip up. Or when they extend their hip back. 

Most people come to me and they say that they have tried a variety of different things before to help with it, but nothing seemed to make a difference. They have tried things such as stretching, strengthening, massage, dry needling, foam rolling, etc but no relief. 

No relief is noticed because using the above strategies did not address the problem.....So what is the problem?

I've treated many of these cases, and more times than not the individual will experience their symptoms in the following test:

The individual will notice a couple things...

1) The snapping either occurs as the thigh slowly lowers down...Or when the thigh is parallel to the ground and the individual flexes their hip back up toward the chest.

2) The individual will usually notice the thigh is able to get to a position that is parallel to the ground (so they have plenty of motion). But will have a tendency to want to move their leg out wider in this position or turn their foot outward because it feels more natural and comfortable.

So what's happening?

In my opinion this is a person who has put a lot of stress repetitively throughout the years to the front of their hip. As such, the individuals stabilization strategy is to compress at the front of the hip as opposed to utilizing their muscles properly to help keep the joint moving with proper congruence. 

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The picture above explains what Im talking about. You can see the joint roll across the muscle/tendon and that, in my opinion is what you are feeling. Some would say that this muscle is "tight". However, I would respectfully disagree....

Notice in the left picture how the joint faces us more. This is not optimal joint position. This is the strategy that you've most likely adopted to stabilize. Compressing and putting pressure on the front of the hip.

Now the fix for this is training a specific muscle called the glute med through full range of motion at the hip in all planes.

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Most people who have this feel a lot of quad and TFL activation with various exercises and even at rest. This is just more confirmation that you are front side biased in stabilizing the hip. They have a very hard time feeling the activation of a glute med muscle or musculature around that area when asked to perform certain hip strengthening activities.

Once the client learns how to feel this muscle, all of a sudden their symptoms tend to go away. Now this exercise is not just some simple squat or lunge. Trust me I wish it was....

Often times I spend 30 minutes to an hour just trying to teach someone how to feel this muscle work with a particular set of exercises.  But by the end of the session they notice a positive change in their symptoms and now they have homework to do.

If this sounds like you, or a friend, please share it with them. I'd love to set an appointment time up where we can talk about this in greater detail, and how On Track Physiotherapy can help. Just hit the discovery session button below to learn more.

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About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Why Stretching Your Hip Flexor Isn't Alleviating Your Hip Pain

Have pain or discomfort in the front of your hip?

Does it hurt when you run, jump, sit, or squat?

Have you tried stretching the front of you hip out but only got about 2 seconds of relief from doing so?

Pain on the front side of the hip can be really annoying! It tends to start out at a low level discomfort that doesn't really impact you much...but it's just there! Then slowly and gradually you notice it impacting you more and more, eventually turning into an annoying toothache like symptoms in the front of your hip.

You've probably intuitively thought that this doesn't really feel like a muscle issue. It feels deeper than that. So you do what your high school gym teacher, trainer, coach, or even physical therapist told you to do.....stretch it out!

Only you notice about 2 seconds of relief.....Maybe 10 seconds if you hold the stretch for 10 seconds. But once you stop stretching the annoying toothache pain in the hip comes back.

Einstein said it best...."Insanity is doing the same thing over and over again, but expecting different results."

I see this all the time in the clinic, and have treated these cases successfully time after time. The first step is finding out if you shoulder STOP stretching the front of your hip. 

Watch this video to help you understand.

The first step in recovery is always to remove the provocative factors. Putting too much stress and pressure frequently throughout the day on the front side of the hip is quite frequently part of the problem. So we don't need to be feeding into it further by forcing the issue.

If you've been dealing with an issue similar to this, I'd like to invite you to schedule a free discovery session to dive more deeply into what SPECIFICALLY you need to be doing to get rid of the problem so that it doesn't turn into a bigger issue than what it's already become!

Real Solutions For Hip Pain| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

3 Reasons Why Your Still Feeling Low Back Pain, Stiffness, and Tightness

Chronic low back pain, stiffness, and tightness is one of the most common things I see and treat in the clinic on a daily basis. 

If you are currently experiencing low back pain, stiffness, or tightness that just doesn't seem to go away. You are not alone. In fact, millions of people deal with this issue unfortunately on a daily basis in the United States.

Many misconceptions about low back pain exist from individuals giving generalized recommendations. In today's article, I will discuss 3 common reasons why you're still experiencing pain, stiffness or tightness in the low back that not many people talk about.

If you have ever been to the Doctor and been given diagnosis such as: degenerative disc disease, spinal stenosis, etc. you'll want to be sure to read all the way through. Too many healthcare clinicians give out diagnosis but don't ever explain what's going on and why your experiencing the current issues in the first place. If your going to try to solve a problem, wouldn't it make sense to first understand what the problem is?......

Reason #1 ) Your body craves stability and control. If you are unable to provide it with enough control actively (using your muscles) then it will find a way to do it passively (bones, joints, ligaments, etc). Muscles have a much greater capacity to recover than passive structures, especially in the long term. 

Reason #2) Does it feel like you are constantly arching your back? Take a look at the picture above. See how the hips shift forward, the beltline points downward, and the ribs point upward. This is a position of extension and compression. Which in and of itself is not a bad thing. We just don't want to live there 24/7. 

Anyways, you will find people who frequently stand, sit, walk, etc. in this position. As you can see from the lines drawn, this puts a lot of compression on the low back structures and creates a lot of tightness in those low back muscles. Said another way, if you are in that position frequently, you are relying on passive structures to support your body frequently.

Reason #3) Let's look at this position a little more.... Below is a picture of a pelvis and low back model with the joints in "neutral". Neutral is a relative term, because when you move so does your joints. 

However if you are relying on passive support systems and compression to create control then your body defaults to that positional strategy. Which is the picture below. Notice how the hips flare further out to the side and the back hip bones start to approximate toward midline reducing space.

Hopefully these pictures provide some clarity for you. Holding a pelvis model in one hand and taking a picture in the other is not an easy task, but I think you get the point....

Frequent extension, compression, and passive support lead to feeling achy, sore, stiff, and tight. On Track Physiotherapy is your solution to finding an active way to provide relief and stop the daily annoying nuisance your back is currently experiencing. 

Not yet ready to come in for a visit, no worries. But please get started doing something....Click below to get your free report on Low Back and Hip Pain. 

Low Back Specialist Physiotherapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Sciatica, Back Pain, and Associated Leg Pain

Sciatica, back pain, and associated leg pain can be really annoying to deal with. It can make simple tasks like sitting, sleeping, or walking a nightmare. Fortunately, we’ve had a lot of great success with these folks so thought I’d share a couple examples.

Often these issues can be difficult to treat (especially if you have been dealing with them for an extended period of time) but we like a challenge!  Always being mindful of how the location of the pain extending down your leg can be a dead give away as far as what area to target in treatment.

There are other ways to narrow down the location of the problem as well:

  • The muscles will be painful to palpation at a specific vertebral segment and may even refer pain down the leg when palpated with deeper pressure.
  • Reflexes may be diminished.  A slow or non-existent patellar tendon reflex corresponds with lumbar spinal nerve L4.
  • Muscles may test weaker on the affected side which may indicate an injury to a particular spinal level or nerve.  An example of this would be weakness in the calf muscles (can’t lift up on to the toes) which are controlled by the first two sacral nerves (S1 and S2 on the chart).

So below are a couple great examples of a number of these factors all lining up and how quickly the pain and loss of function can be addressed.

Case Study #1

The patient in this case had left sided low back pain and pain running down through the back of her hip and leg to the mid-calf.  She felt a ‘pop’ in her back and immediate leg pain as a result of pushing and twisting trying to put a heavy object in the back of her truck.  She is an avid runner but even standing and walking significantly increase her pain after 10 minutes.

Exam

So here is what I found:

  • Symptoms following the S1 and 2 dermatomes down the back of the left leg
  • Increased muscle tone/spasm at the S1 and S2 levels of the spine, and these muscles are tender to palpation.
  • ‘Springing’  or pushing down on the S1/S2 vertebrae reproduced the symptoms into the back of her hip/upper thigh.
  • She could do only 12 calf raises on her left leg while doing 25 on the right side (this muscle corresponds with S1 and S2 nerves).
  • Achilles reflexes normal (S1 reflex)

It’s nice when everything points back to a specific level or two like that.  Doesn’t always work that way but when it does it makes me much more confident that we can knock this out quickly.

Treatment

In this case I chose to use dry needling to address the muscles at the S1 and S2 spinal levels on both sides of the spine.  Once the needles were placed I attached an electrical stimulation unit and she just relaxed for 10 minutes.  Dry needling in conjunction with e-stim are shown in the research to decrease tone within the muscles as well as alleviate pain through a number of local and global factors.

The patient was instructed in two exercises that had multiple purposes:

  • decrease pain through relaxation of the over worked muscles of the back and anterior hip
  • facilitate improved stability through the lumbar spine and pelvis

Results

The patient had near full resolution of symptoms for two days after the first session.  Her exercises relieved her pain at home and she could walk as much as she wanted.  She tried to run on the third day but was unable due to pain.

We repeated the same dry needling + e-stim treatment during the second visit and followed it up by progressing her exercise program.

The patient cancelled her appointment the next week as she reported being completely pain free and back to running.

Case Study #2

The patient in this case presented to our clinic with pain shooting into the front of his hip and groin as well as down the front and side of his thigh.  He also reported minor back pain but it was nothing compared to the pain in his leg.  The patient reported having this pain on and off over the past couple years especially when exercising but recently it was much more constant and severe.  In the past he had been diagnosed with IT Band syndrome (pain laterally in the hip and thigh might make you think that), and more recently with a hip flexor strain (could also make sense now that he was having more pain into the front of the hip and groin).

Exam

  • Minimal tenderness to the ‘hip flexor’ muscles anteriorly, slight weakness with manual muscle testing but no pain (probably not a hip flexor strain).
  • Moderate tenderness and active trigger points in the lateral hip musculature that referred pain down the lateral thigh to the knee (could be part of IT Band syndrome).
  • Springing of the lumbar vertebrae at L2 and L3 reproduced the typical symptoms  he felt into his anterior hip/groin as well as lateral thigh (Bingo!)

Treatment

Dry needling was performed at the levels of L2 and L3 along with electric stimulation for 10 minutes, and followed up with IASTM to decrease tone and improve mobility of the superficial fascia and muscles of the mid and lower back.

A couple exercises were given to maintain, and hopefully even improve, the mobility gained through the spine and hips as a result of the dry needling and IASTM.

Results

The patient reported a significant decrease in the anterior hip and groin symptoms as well as a moderate improvement in lateral hip and thigh symptoms.

During the second treatment session I decided to treat the muscles of the lateral hip as well since they also referred pain into the lateral thigh.  This was done with by dry needling + e-stim just like we had done in the low back.

By the third treatment session a few days later the patient was reporting a significant reduction in lateral hip and thigh symptoms as well.

Final Thoughts

It took a few more treatments to completely resolve this patient’s symptoms but it’s nice to see an immediate decrease in symptoms to know that you are treating the right areas.  With a thorough evaluation process it wasn’t hard to figure out that the patient’s symptoms were primarily coming from his spine which was quite a different diagnosis than what was previously thought.

If this sounds similar to you or would like some assistance in your recovery, then click the link below to receive a FREE discovery session.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi.

Follow On Track PT and Performance on Facebook.

Dry Needling For Hip and Knee Pain

Ann Arbor, Mi - At On Track Physical Therapy and Sports Performance we strive to find new and innovative ways to treat pain and get you moving again.  Dry needling is one of those treatments and can potentially works wonders for hip and knee pain.

The Vastus Lateralis (VL) is one of the four muscles that make up your quadricep and is the most lateral.  Trigger points in this muscle will often refer pain to the lateral knee.  Check out the photo below of the VL and corresponding trigger point referral patterns.

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Even without active trigger points, the VL is often in a state of high tone which can significantly limit hip mobility in certain directions.  With it’s attachment all along the IT band, it can also create greater stress on the knee joint through that IT band.

In the video you’ll see the limitations in our patients hip adduction (her knee should hit the table when I try to lower the leg across midline).  Her right hip does this easily.  This is a fairly standard PT test, known as the Ober test in most circles.  In the video you’ll see how dramatically dry needling the Vastus Lateralis with a few minutes of muscle stimulation can change her hip mobility.

Just a quick note on the video.  This was originally created by my mentor Joe Heiler at Elite Physical Therapy in Traverse City for the website Sports Rehab Expert which is read by other PT’s, Athletic Trainers, Chiropractors, etc.  Sorry for all the medical talk but you’ll get the idea with the huge change in range of motion following the dry needling treatment.

Here are some of the common diagnoses you’ll hear from your doctor that will respond well to dry needling:

  • IT Band Syndrome
  • Runner’s Knee (distal IT band syndrome)
  • Patello-Femoral Pain Syndrome/Patellar Mal-Tracking
  • Hip Bursitis

There are many other ‘diagnoses’ that can benefit from improved hip mobility but those above are what we would see most frequently.  For those that are needle-phobic, we can get similar results using IASTM and other manual therapy techniques, it’s just often not quite as dramatic.

There are also a number of specialized motor control and strengthening exercises that need to be used following this treatment to maintain this new mobility.  Just because she can move her hip now on the table doesn’t necessarily mean its going to move that well when she is standing, walking, or running.  Strength must also be established in that new range.

Hope that was helpful to see plus you get a bit of a glimpse at what we do here at On Track Physical Therapy and Sports Performance.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Adductor Pullback

The adductor pullback is a exercise designed by the postural restoration institute (PRI). The exercise is designed to get the client to shift into their left hip mimicking the qualities of left stance. Left stance is important due to the body's natural asymmetry that is present which creates a predictable set of compensation patterns. Often times you will find individuals with low back or hip pain who demonstrate lack of hip internal rotation on the left leg as opposed to the right leg. This exercise is one of the potential steps one could take to improve hip internal rotation specific to the left leg. 

Core Stabalization Progression

The Wall Press Abs exercise is an excellent way to learn how to create protective stiffness in the spine. When performed correctly it will help create stability through your low back and aid in creating increased mobility through your hips. Being able to dissociate between the low back and hips/pelvis is a region where many people with hip or back pain struggle. 

By pressing your arms into the wall you will help engage your abs. Holding this position, then taking a breath in then exhaling and allowing your ribs to drop down will activate you oblique muscles further. Then maintaining this position of ribs down inhaling and exhaling will incorporate your diaphragm which is a muscle and spinal stabilizer as well.

Finally you will begin to move or extend your legs out which will continue to challenge core control while you work hip mobility. Below are the progressions from easiest to most advanced.

Anterior Plank - Not just an exercise for your abs

The Plank is often thought to be a core exercise. However, I'm here to tell you that there are other unforeseen benefits of the plank that you may not have considered before.

First we need to talk about what a good plank looks like. A good plank will show a nice straight line from your head to your tailbone. This line should be parallel with the floor. You should be actively reaching through both elbows pushing your chest away from the ground. Hold this position as you take a breath in through your nose and out through your mouth. When you breathe in through the nose your should feel your upper back expand. When you exhale, you should feel your abs turn on.

When performed in this fashion, here are some added benefits and applications you may have never considered before.

Shoulder - Reaching through your arms (elbows in this case) stimulates the serratus anterior which is needed for shoulder health. Reaching + Breathing creates an optimal relationship between the scapula and rib cage. All the while your rotator cuff muscle are firing in an isometric fashion.

Shoulder Rehab - this is an excellent way to start introducing closed chain activity for the upper extremity at a lower level to work scapula thoracic relationship.

Youth Sports Training - Obviously its a good exercise to gain core control, we know that. But many youth athletes struggle mightily with a pushup. 1) Due to lack of core strength/endurance to maintain a neutral spine position. 2) Lack of shoulder strength/stability. Performing a plank correctly can stimulate both of these components as you simultaneously work relative strength with a dumbell floor press.

Plank Exercise Progressions

A lot of people will perform planks as part of their exercise routine.  The front and side plank get a lot of love, and for good reason! For a lot of people these exercises are challenging enough. However, once you've mastered the basics, you may need to step it up a notch. Here are some challenging progressions that I feel really carry over to athletics and can get you closer to your training goals. Each of the following plank progressions add hip motion to the equation so you will be supported on one limb for a period of time.  It’s the support leg that is most important for stability and will be working the hardest.  With all of these exercises, you must maintain a stable core.  So in other words, when you lift a leg your trunk should remain motionless.  If you have to lift your butt up or it sags down then either it is too much for you or you are getting fatigued and need a break.  Perfect reps, nothing less.

The other great thing about these exercises is that they give you a chance to look at symmetry.  By this I mean how does your right leg compare to your left leg when doing a front plank, or how about right and left sides when performing a side plank?  It should be just as easy or difficult on both sides.  Right-Left asymmetries are a huge predictor of injury so work to limit these.  Typically I will have patients or athletes perform an extra set on the weaker side to bring that side up to par.

Alright, done with the lecture.  Check out the plank progressions below.

Prone Plank with Hip Extension -alternate lifting legs about 4-6 inches off the floor.  Nothing moves but the hips.  Shoot for 10 solid reps each leg without losing form.  And if you’ve been paying attention in previous posts, hold the leg up long enough to cycle a breath, then set it back down.  That will be the true test of your inner and outer core working together.

Side Plank with Hip Abduction – I really like the side planks as they test your entire lateral kinetic chain for stability.  Post up through the forearm by pressing it ‘through the floor’.  Now lift the top leg keeping the hips high.  Shoot for 10 quality reps with proper diaphragmatic (belly) breathing throughout.  When you can achieve that, now hold the leg at the top and cycle a breath before bringing it back down. 

Side Plank with Hip Adduction –this is another great variation that I think gets overlooked.  The bottom leg will be off the ground in this case so the adductors (inner thigh muscles) of the top leg will be carrying more of the load.  Breathing is crucial again so get it right.  Start with 10 second intervals if necessary shooting for 30 second holds ultimately.  If you’ve achieved that, then progress the exercise by moving that bottom leg back and forth.  It should look like a running stride – flex the hip up and then extend it back.  Adding the front to back movement will make your core have to work that much harder to remain stable.  I’ll shoot for 10 reps here again as well.

Three great ways to challenge yourself!  Remember to play close attention to those side-to-side differences.  Cleaning those up will bring the greatest benefits.

Low Back Pain - Ann Arbor, Mi

Ann Arbor Physical Therapy Low back pain is one of the most common ailments in the United States. A number of contributing factors can play a role in this type of dysfunction. One of the most common reasons that your back may hurt is due to your hips. More specifically the lack of range of motion in your hips. In a study published by the Institutional Journal of Sports Medicine titled Passive hip range of motion is reduced in active subjects with chronic low back pain compared to controls. The authors found that typical range of motion in the hip lacked -4 degrees of extension from a neutral position. In those subjects without low back pain, they had 6 degrees of hip extension available beyond neutral. All totaled, this is a 10 degree difference in hip ROM. These findings are common in individuals for a number of reasons. One in particular is the tendency for people to sit for long periods at work, school, or home which puts your hips in a flexed position (opposite of extended). This is a video of one technique we use at On Track PT and Performance to help improve hip extension through neurological inhibition.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.