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Re: Hip Impingement Syndrome
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Re: Hip Impingement Syndrome - April 15, 2005 9:43:00 AM
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SJBird55
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From: Michigan
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Only thwapping someone or riding my horse are guaranteed to relieve my stress.
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Re: Hip Impingement Syndrome - April 15, 2005 12:17:00 PM
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srcase
Posts: 551
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From: Michigan
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Barrett,
Don't get discouraged, maybe you are just ahead of your time. I think the biggest obstacle against students learning Simple Contact is that it is contrary to everything we are taught in school, and does not fit in well with the model of health care that we have established in most clinics. That doesn't mean that things can't change, but I think it will take time.
When I think about my own personal struggles with your methods (and this just dawned on me today as I was driving home from an hour with my massage therapist...aahhh!), I believe it stems from bad experiences I have had in clinics where "alternative" treatments were used, and the stigma that goes along with it. Simple Contact shouldn't be considered alternative by any means, but because it isn't mainstream, it is therefore lumped into the other category.
One particular experience was the month I worked as an aide in a privately owned clinic, where the PT used mainly Feldenkrais. I never really knew what she did, because she would go into a room with the patients and close the door, but I intuitively new something was amiss (this was before I even got into PT school). Turns out she was brainwashing patients into believing they had been sexually abused, pushing herbal remedies on them, and other unethical practices (hence the reason I was only there a month). The whole place just creeped me out. I hadn't given Feldenkrais another thought until you mentioned it in your course. Now I am looking into it again.
Maybe other therapists have had similar experiences and there is some deep-seated aversion to anything resembling "alternative" therapy. I think you should make it a point in your classes to dismantle other so-called treatment such as cranioscaral and myofascial release, so that people really know where you are coming from. I don't know, just a thought.
As for golf, it is one of my favorite things to do, and part of the reason why I want to "fix" my hip problem....the weather is getting nicer and the golf "itch" is getting stronger! By the way, after the session with the massage therapist, my leg was lying completely externally rotated on the table. I don't know when was the last time I had been able to do that, but I know it is a good thing. (Still had cold hands and feet though).
Sarah
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Re: Hip Impingement Syndrome - April 17, 2005 10:32:00 AM
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jma
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From: NY
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Kendall has a new edition of her book out. Maybe things have changed. One might need to check it out. No longer the 50's
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Re: Hip Impingement Syndrome - April 17, 2005 12:57:00 PM
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Barrett
Posts: 967
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From: Cuyahoga Falls, Ohio
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Sarah,
Plenty of people can tell you how I feel about the sort of practice you describe-which, by the way, has nothing to do with what Feldenkrais did.
When asked I always make it clear that the craniosacral people need to answer some questions about that practice-questions they'd rather not have asked, as it turns out. The Barnes myofascial students have even more to answer for and it is no wonder both groups keep their heads down when near me, and I mean that literally. When I find them in class I note a complete silence. Unless someone asks I don't make it an issue, and in Detroit no one asked.
If I'm wrong, all they need to do is speak up publicly. This would be a good place to do it.
If silence is their only defense I will continue to wonder what they are ashamed of and conclude that cowardice is the reason they hide from debate.
_____________________________
Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Hip Impingement Syndrome - April 17, 2005 4:25:00 PM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
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I have returned from the course on Pelvic and Abdominal Dysfunction by Bruce LaBrecque, BS, RN, PT. Very intriguing area of the body that most PT's are not familiar with at all. This was my first foray into pelvic floor musculature examination and treatment (all external) and I learned quite a bit, about myself too. I don't know that I would feel comfortable using some of the techniques on patients, however (simply for lack of experience).
He did not give much research to back up his treatments, mostly anecdotal/experiencial evidence from many years of treating perinatal, postpartum, LBP, hip and pelvic pain patients. Treatments drew from myofascial release, muscle energy, positional release and core stabilization approaches mostly.
He touched on Pelvic Abdominal Dysfunction Syndrome which is probably more common than we think, and can include: pelvic floor tension myalgia, diastasis recti, sacral dysfunction, neuroligical inhibition of abdominals, and bowel/bladder changes among other things.
One interesting connection between pelvic floor and hip is the obturator internus muscle, which Janet Hulme has termed the "rotator cuff" of the pelvis. It's main function to "lift" the sides of the "bowl". I have to say that mine was "hot" and when released, my hip felt much better. I also had less ischial tuberosity pain when sitting on those hard chairs!
Like I said, Women's Health is not necessarily an area that I am drawn to as an orthopedic PT, but I can't deny the influence of the pelvic floor in those hard-to-treat patients (many of which came to mind during the course) of all types: young, old, male, female, athletes and non-athletes that just don't respond to our typical back pain/SI joint treatments.
I think I am going to have to buy more books......imagine that!
Sarah
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Re: Hip Impingement Syndrome - April 18, 2005 1:51:00 PM
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srcase
Posts: 551
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From: Michigan
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Back to an earlier discussion on postural exercises, aka Kendall and Sahrmann, Barrett stated he didn't believe these worked because so many therapists have pain even though they know about these exercises. I just want to point out that I know about these exercises, but don't DO them. From my experience, PT's are the worst "patients" for that reason, they aren't compliant with HEP. Anyway, just an observation.
So, let me ask this....I went to a massage therapist who is craniosacral and myofascially trained (among other things), and my hip has felt so much better since going to her that it makes me wonder how you would explain this. Is it just that she was touching my skin and I was self-correcting? (I didn't move). I am going to assume the answer to that is yes. I told you how my leg was relaxed, foot pointed out to the side afterward.
Also, I was walking home from the auto-mechanic (car trouble) and tried to shift my hips backward (as Jason suggested) and my gait significantly changed...longer stride length, more equal stride, and more saggital plane arm swing...plus less back and hip pain. So obviously I was decreasing some sort of mechanical deformation. This lead me to another question: if we address the musculoskeletal system in a way to allow for more "normal" movement (assuming that this leads to less mechanical deformation), using neuromuscular reeducation and motor control/motor learning strategies, ala Shirley Sahrmann...isn't this just as viable a treatment strategy as Simple Contact?? (I am using myself as an example because I learn more from my own body than from anyone else's).
Also, Barrett, how do you feel about trigger point release and why that works??? Ok enough questions for now.
Sarah
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Re: Hip Impingement Syndrome - April 18, 2005 2:37:00 PM
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Barrett
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From: Cuyahoga Falls, Ohio
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Simple Contact promotes movement that enhances adaptive potential, it doesn't alter consciously controlled use. I prefer to let Sahrmann explain her work (should she ever show up here) and I don't see it comparable to my own, just based upon a different strategy for reducing mechanical deformation. Obviously, I prefer the use of instinctive movement. I'm fairly certain Sahrmann doesn't know much about that. My work begins without judgement and gives permission. Hers begins with judgement and proceeds to choreographed "correction." Take your pick.
Perhaps your massage therapist enhanced your tendency to self-correct, I don't know. Maybe you should ask her. In any case, she got your hip where I'd prefer to see it. How are you going to keep it there? Are you going to have to constantly attend to the way you move? Can't you create a system with enough give in it to walk naturally (for you) and not strive perpetually for something you call "normal"?
My opinion about trigger point treatment is much too long an issue for this thread.
Isn't there anybody else out there?
_____________________________
Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Hip Impingement Syndrome - April 18, 2005 2:45:00 PM
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coreconcepts
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From: Vancouver, BC
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Hi sarah,
Just breezed through these threads and I caught this question;
"Doesn't the clamshell exercise bias the movement more toward TFL and less gluteus medius (because of the hip flexion + abduction)??"
Didn't see an answer but could have missed it. In side-lying, if you rotate the ASIS downwards (as an example if you are on your left side, bring the right ASIS closer to the ground) this takes out the dominating TFL - despite losing considerable ROM.
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Re: Hip Impingement Syndrome - April 18, 2005 4:34:00 PM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
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coreconcepts,
Thanks. That question was not answered, but your suggestion makes sense. I tried it and I definitely feel gluteus medius working more than TFL, but it is not very comfortable in the hip joint. I usually work the gluteus medius in closed chain anyway, but I was just wondering if anyone had any other ways of strengthening it.
Sarah
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Re: Hip Impingement Syndrome - April 18, 2005 4:48:00 PM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
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Barrett,
If I asked my massage therapist, she would say that she released the fascia or improved the flow of cerebral spinal fluid or something like that. We all know that this is bunk, but what I am trying to understand is how did it work?? The only viable theory that I've heard to explain it is yours.
I know I ask a lot of questions, but I do value your insights and I appreciate that you humor me with an answer at times. :)
You must understand where I am coming from...I graduated less than three years ago, have seen everything from the crazy Feldenkrais practitioner to Olaf Evenjth himself, to Shirley Sahrmann. My learning style is to assimilate everything into a cohesive picture, that's just my nature. The point of contention is usually that no one has a deep model to explain why their practices work, but yet they do work. No sane person would go through all the effort of writing books and teaching students without getting results. Which leads me to believe that something we haven't yet discovered is to be attributed here. Hence, the questions.
I still would like to hear your theory on trigger point release. I guess no one else wants to jump in here.....
Sarah
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Re: Hip Impingement Syndrome - April 18, 2005 5:57:00 PM
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Jon Newman
Posts: 1709
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From: Amherst, WI
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Hi Sara,
I'll add my own thoughts on what I've read thus far. I don't know if it will help or further confuse things (or simply not further the discussion at all).
Your current situation is quite common (in terms of how thing unfold). Allow me to summarize things thus far. Feel free to correct if I've misunderstood.
You have pain without apparent reason
You try to diagnose the pain--give it a name, make the unknown, known and if you fix this now named entity, you'll be better
Unfortunately the process above is turning out to be harder than you hoped and the meaning of this pain is the you are:
too tight someplace
too weak someplace
moving wrong somehow
A and B
A and C
all of the above
Gotta love those k-type questions
No matter what, you begin to pay attention to the area and try to behave differently. You try to purposely use certain muscles. You try to purposely move a certain way. You see a massage therapist and you feel better. You claim not to have moved except that your legs rest differently afterward than before. How did that happen without moving? What quality of movement did you have when moving prone to supine or on versus off the table?
I'm guessing there is a common reason people are willing to pay so much for a massage and hesitate to do the same for a PT. I think it's because they know they're going to feel good after the massage while all bets are off after the PT. Anyone use ice after PT? How about massage therapists; do you need ice after your treatments? The problem is that it's not as nice or effective to massage oneself.
I think that if you moved differently or used specific muscles, etc and it made you feel better, great. But since you own the sensations, and the internal mileu from where the pain arose and since you're natural "learning style is to assimilate everything into a cohesive picture", I have no doubt that you'll learn something from this.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Hip Impingement Syndrome - April 19, 2005 2:30:00 PM
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birongirl
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From: NY, USA
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OMG!!! I just spent 30 minutes posting a reply and my pop-up blocker refreshed the page - I lost EVERYTHING!!! ARRGGGGHHHHHH.
I'll just add my two cents in response to Yogi since I don't have the patience to type it all once again...
Just be careful you don't get so caught up in whacking the ball that you lose sight of the target.... it can cause things to occasionally backfire ;)
(Heh... didn't lose it this time. EViL Microsoft)
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Re: Hip Impingement Syndrome - April 19, 2005 2:59:00 PM
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birongirl
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From: NY, USA
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OK... hmmmm. I seemed to have missed a whole page of intriguing responses. I frequently read literature and try to regularly use practices backed up by sound clinical evidence. At the same time, I firmly believe that it is silly to completely discard a tool that people with many years of experience have found successful just because the research has yet to be done. Recognize that I use the word 'tool' instead of 'methodology' and 'yet to be done' not 'disproven' ;) . Of course, if a particular tool is not successful for me I won't continue using it...
I also prefer closed chain activities for those muscles which are primary to closed chain movements in normal function. I've found attention to posture while performing the movements + using functional movements/positions to strengthen to be very successful. I especially like exercises in standing that incorporate strength, balance (dynamic and static) and stability for the glutMedius as long as I can feel the approp mm firing. I find dynamic movement in single-limb stance especially useful (with minimal involvement of another extremity if insufficient strength/balance/stability etc). And I really like S. Sahrmann's book.
Anyways.... Good luck!!
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Re: Hip Impingement Syndrome - April 19, 2005 6:03:00 PM
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eam
Posts: 292
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From: New York, NY 10028
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Hi Sarah-
I will try and add something here as I have entered this thread late-been away on vacation. I read your history and thought I was reading a description of my hip problem, literally. I have had it for years and I mean years. Actually, it was one of the reasons why I became a PT. I have had it worked on, looked at, ultrasounded, mobilized, massaged, stretched, strengthened you name it. Even acupuncture. What finally worked for me (may not for you but I figured I would throw it in anyway!) was a combo of joint mobs with the belt ( I attach the belt to a table leg and the other to my leg and do a self lateral and inferior glide-quite riotous in a small apt in NYC-I have to say), some of Sahrmann's single leg atance work, end range (not full range) strengthening of my PGMEd., her quadruped exercise, some prone figure 4 glut work as well as unilateral bridging. The iliopsoas exercise that Jason mentions, I am working into as it really pinches in my groin when I do this. I would say I am 85% better from my worst days, Yes I still get the hip pain, and I am not as diligent as some of my patients in their HEP I have to admit.
I am a runner and I found that changing the way I run a little bit-tough to explain here- has also helped. Sometimes it is tough as a PT to objectively analyze your movement patterns b/c you don't see yourself move. Having someone watch you is clearly better. Good luck!
Erica
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Re: Hip Impingement Syndrome - April 19, 2005 6:20:00 PM
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srcase
Posts: 551
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From: Michigan
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Hello all,
Jon -- I sort of understand what you are getting at, but frankly, you lost me about half-way through. I know I have learned something (what doens't work) and I agree that it is not just something being tight or weak, but may actually be more simple (adverse neural tension as Barrett would suggest).
Erica -- your suggestions are very much appreciated, as I have gotten the idea from other therapists that I must be an alien because they don't understand the "pattern" of my hip problem...nice to know someone else has experienced this. Needless to say, I "fired" my PT, and I am going back to my massage therapist in 2 weeks. Meanwhile, I will be self-correcting and practicing my Sahrmann exercises....that's all I've assimilated so far.
Thanks to everyone for your thoughtful and thought-provoking replies.
Sarah
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Re: Hip Impingement Syndrome - April 19, 2005 6:50:00 PM
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nari
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From: Australia
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Barrett
Back to the 14th April post..
how long have you been teaching?
Sahrmann has great difficulty finding evidence yet keeps trying,...you have great difficulty finding PTs who will listen and even acknowledge the brain exists..
Yet you are still trying.......
What is that saying?
Nari
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Re: Hip Impingement Syndrome - April 20, 2005 11:54:00 AM
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Yogi
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From: San Antonio, Tx., USA
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Birongirl, since I was doing hard labor work on a golf course at the time, the satisfaction came from whacking the balls into a lake, which was kind of hard to miss as long as I faced it. Not sure what your point is.
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Re: Hip Impingement Syndrome - April 20, 2005 9:25:00 PM
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Timothy
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From: Australia
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Here's two cents worth from Perth, Australia.
I would take issue with the "correct function" instead of making a diagnosis school of thought, because "motor control" changes can be adaptive or maladaptive. For example, I imagine there's a number of changes to muscle function in the low back when someone prolapses/tears a disc and presumably attempting or even succeeding to change muscle dysfunction will have little effect on the pain generator. When the muscle changes are maladaptive, ie. injured tissues have healed/no longer generating pain, by all means they should be addressed. This is very simplistic, but I think the "normalise function/normalise pain" school of thought has some serious flaws. As for hip impingement, if it were me I'd want to know that there was nothing detectable on the best imaging I could get before I started chasing my tail with all sorts of regimes/therapies. Of course, it's worth remebering that radiographic changes are present in the pain-free population but I would argue that this is even more true of "muscle imbalances", poor posture, weakness, tightness etc...
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Re: Hip Impingement Syndrome - April 21, 2005 3:42:00 AM
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JLS_PT_OCS
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Tim-
I would agree that both imaging findings and any possible assymetry in function or position can be associated with normal population and asymptomatic people, and may not be relevant.
If that's the case, why you do choose "the best imaging I could get" over looking at the hip from a muscle function and motor control standpoint as some suggest? If they both can lead us nowhere, why the preference for one over the other? Especially, why the preference for a diagnostic model (through imaging) that has not shown to be of benefit in so many cases?
I choose to treat the way I describe because it is a lot cheaper than an MRI, and involves the therapist early on to try to acheive what relief may be wrought. Nobody ever was cured by an MRI. But many people become convinced they need or don't need certain things based on what is or isn't seen there. Know what I mean?
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Hip Impingement Syndrome - April 21, 2005 8:48:00 AM
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Alex Brenner PT MPT OCS
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I agree. Tim, What would you be looking for with the "best imaging possible" and how would this change the way you treat her?
_____________________________
Alex Brenner, PT, MPT, OCS
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