Question
Dr. Shawn,

I am almost 51, andfor a number of years my hips would often pop and jump rather starkly when spreading my legs apart or during similar motions.  While the movement did not cause pain, the joint would be sore during certain motions, especially when the popping is frequent.

Since I have been studying Tae Kwon Do for 1.5 years, I am more acutely aware of the problem as I have been attempting to gain more flexibility.  While doing butterfly stretches, I cannot get my thighs even close to the floor; the best I can do is perhaps a 45 degree angle even though I have been religiously stretching (moderate static and isometric) for at least a year.  If I over do it, the joint is sore during certain motions.

My two related questions are as follows: how can I gain flexibility in my adductors and/or does it appear likely that I may have ligament damage?

Answer
Dear Al,

Popping of the joints can be the result of a few different circumstances.  First: when a joint is restricted in motion, gas such as carbon dioxide and nitrogen can build up inside the capsule that surrounds the joint.  When the fixation is finally releases, or the capsule stretches enough, the gas can shoot out and create a popping sound (this will not repeat for a minimum of 20 minutes).  

Second:  joint popping can be the effect of tendinous bands that have some laxity and that move with joint motion.  As the hip joint moves, the lax tendon can actually pop back and forth creating a repetitive popping sound.  This is a common problem in the outside of the hip joint over a bony prominence called the greater trochanter, and is called slapping hip syndrome.

Third:  Ligament damage/laxity/tearing can create an unstable joint which allows for popping as well.  This a less common scenario and more severe.  The hip joint however is a very strong joint and you would need some significant damage to the ligamentous complex for this to occur.  Moreover, this would lead to repeated dislocations and these are quite painful....I do not think that this is your problem.  Now, lower level laxity can still allow for abnormal joint motion and this could create popping as well, but this shouldn't be a primary concern...normally sub-clinical.

Fourth:  It is possible that you have a mild form of hip dysplasia due to the fact that you seem to have bilateral concerns.  Hip dysplasia is where the head of the femur develops in an abnormal configuration. This can happen in utero or in child development.  What occurs is that the arrangement/alignement of the hip joint is imperfect and this can either limit motion or increase it.  If this is the case with your hip joints, then the lack of flexibility may be due to the lack of normal internal joint motion. (may be normal for you.  The only way to verify this is with a standing pelvis x-ray to look at the top of the femur and how it inserts into the acetabulum of the pelvis (hip joint articulations).

How, if this is a true loss of flexibility issue, due to contracted musculature, then stretching will help to alleviate it, but stretching needs to be performed in a correct manner.  All stretches need to be help for a minimum of 15 seconds and repeated.  This is because there are two distinct muscle phases; the plastic phase and the elastic phase. The elastic phase is takes about 10 seconds to overcome to get into the plastic phase.  Elastic means the muscle will just go back to its original length, while plastic means that the muscle will retain some of the stretched length.  You have to stretch for more than 15 seconds to get into the plastic phase and create increased flexibility.  To increase the effectiveness of stretching you can utilize a technique called PNF.So what is PNF Stretching?

Proprioceptive Neuromuscular Facilitation (PNF) is a more advanced form of flexibility training that involves both the stretching and contraction of the muscle group being targeted. PNF stretching was originally developed as a form of rehabilitation, and to that effect it is very effective. It is also excellent for targeting specific muscle groups, and as well as increasing flexibility, (and range of movement) it also improves muscular strength.

The process of performing a PNF stretch involves the following. The muscle group to be stretched is positioned so that the muscles are stretched and under tension. The individual then contracts the stretched muscle group for 5 - 6 seconds while a partner, or immovable object, applies sufficient resistance to inhibit movement. Please note; the effort of contraction should be relevant to the level of conditioning. The contracted muscle group is then relaxed and a controlled stretch is applied for about 30 seconds. The muscle group is then allowed 30 seconds to recover and the process is repeated 2 - 4 times.

Below you will find two stretches that I utilize that are different from the traditional seated butterfly stretch.  Incorporate these into your program and it should help you to gain some flexibility.

Position: Begin standing tall with your back straight, place your feet approximately twice shoulder width apart.

Action:  Gently lunge to your right side, keeping your left knee straight, until you feel a stretch in the groin. Hold for 15 seconds, 5 times at a mild to moderate stretch pain-free on each side.

Position: Lying flat on your back, place your legs up on a wall...heels on the wall, legs straight. Have buttocks as close to the wall as possible. Keep back in a neutral position and try not to arch.  For more pressure

Action: Slowly separate legs on the wall so that gravity can help with the stretch. Breath regularly. Hold this stretch for 15 seconds.  Repeat 5 times per stretching session. (you can add ankle weights to increase the gravitational effect)

Lastly, the following link has some good information, so I include it for your review:

http://www.maxpreps.com/news/article.aspx?articleid=72284284-9a61-4e7d-955e-100f...

Hope this helps Al...feel free to write back if you need further help.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net