Question
QUESTION: now 40 year old male. i do have alot of back problems. i do know about lower
crossed syndrome which may or may not be my case. but my right QL muslce has
deep trigger points and is always quite tight. now the left hip bothers me alot.

so maybe that is somewhat from the lower crossed syndrome.
but for today i want to just focus on the hip and take it as a separate problem.

that left leg is 5 mm shorter than the right leg a chiro before
did measure off an xray. i know that is not so accurate as it
all depends on everything being square when the xray was taken.

but i do believe that to be the case. i do use a foot raise of about the same
6mm in my shoe. but it does not seem to help that much. i did have an external
snapping hip but is a bit less now that ive done tons of self myofascial release
and stretching of the it band and TFL.

i can not bend at the left side without pain in the muscles of that hip. i think
its TFL or muscles close by to this.
also sometimes i seem to have pain in the hip joint. i can sort
of tell where the pain is coming from cause of the type of pain. ie. aching,
sharp, zingie, etc.


now ive tried to activate and increase endurance and strenghten the gluteus
medius with very excersize and also tried to increase strength of the gluteus
max and minimus. also i work on hip mobility exercises daily. maybe i should not
being doing hip mobility excersizes as im almost thinking that hip is too mobile
or has no stability. when i do an excersize called the fire hydrant that one
seems to get the muscles of the hip around TFL hurting. when i do reverse lunges
the right leg forward is fine but the left when i do that one forward is quite
unstable.

just what kind of treatment could be done or just what possibly could be
happening?

and just what excersizes would be of help on strenghen the muscles of the hip?
and just what kind of hip mobility excersizes should i be doing or perhaps
stoping them.

prolotheraphy do you recommend it?

what about some kind of brace for the hip?

you dont need to answer every question i asked. but please direct me to the best path.

thanking you in advance.
ANSWER: Hi jii,
I am not sure you are under the care of a qualified physician, you may be developing a muscle imbalance by exercising target areas causing asymmetrical stress on the (concentric) opposite muscle.
Prolotherapy is great for chronic tendenosis and only a D.O. should evaluate you for that option.


Here is some good advice,

Since all your diagnostic tests are unremarkable and standard physical therapy and rehabilitation protocols have helped minimally what do you do? Look a little deeper into the likelihood of a muscular imbalance condition known as the lower crossed syndrome (LCS), which you have done.

These imbalances contribute to habitual overuse in isolated joints and faulty movement patterns, creating repetitive microtrauma, dysfunction and chronic injury.

The primary muscles involved in LCS are as follows (see list below). Muscle imbalances can be caused by postural stress, pattern overload, repetitive movement, lack of core strength, lack of neuromuscular control, immobilization, and decreased tissue recoverability following activity. These muscle imbalances result in reciprocal inhibition, synergistic dominance and arthrokinetic (joint) dysfunction.

Reciprocal inhibition is the neuromuscular condition that occurs when increased neural drive in a specific muscle causes decreased neural drive to that muscles functional antagonist. For example, if an individual has increased neural drive or tightness in the iliopsoas (very common), then the functional antagonist (gluteus maximus) can have decreased neural drive, resulting in muscular inhibition, weakness and synergistic dominance.

Typically Tighten and Shorten
Iliopsoas
Rectus femoris
Erector spinae group:
thoracolumbar
lumbosacral L5-S1
Quadratus lumborum
TFL/iliotibial band
Short adductors
Hamstrings
Piriformis
Gastrocnemius
Typically Weaken
Abdominal group
Gluteus medius
Gluteus maximus
VMO
Tibialis anterior
Plantar fascia

Synergistic dominance occurs when synergists take over function for weak or inhibited prime movers, causing faulty movement patterns and tissue overload. In the above example, if the gluteus maximus has decreased neural drive, synergist (hamstrings), stabilizers (erector spinae), and neutralizers (piriformis) substitute and become overactive. This leads to altered force-couple relationships, joint dysfunction and chronic subluxations.

Having tightness or hyperactivity in the iliopsoas can cause knee pain. The gluteus maximus (GM) is primarily responsible for eccentric deceleration of hip flexion, internal rotation and adduction. Weakness or inhibition of the GM increases sacral rotation and stresses the tibiofemoral joint, leading to patellar tendonitis. This alters the length-tense relationship of several muscles. The gluteus medius is weakened, taking away its ability to perform hip abduction. The TFL and iliotibial band begin to compensate, and this overactivity inhibits the vastus medialis oblique (VMO), increasing femoral flexion, internal rotation and adduction. This increases stress to the tibiofemoral joint and the patellofemoral joint. And to think, all of this resulted from weak and overactive muscles.

So, how do you fix it? Good question. The following protocols have proven to be very effective in helping to reverse this syndrome.

Muscular adhesions and active/latent trigger points must be removed before attempting any stretching or strengthening program. Failure to do so will result in further muscular inhibition. Perform myofascial release (MFR) and trigger-point massage (TP) to muscles in the LCS chart above. Pay special attention to the gluteus muscles, iliopsoas and TFL. Be sure to check the soleus muscles, too. An overactive soleus can result in decreased toe-off motion of the foot during the gait cycle, causing faulty lower back mechanics. Have your Chiropractor
ultrasound you for 5 minutes (1.5 W.c2 constant) on the gluteus medius and/or TFL, or you may substitute laser therapy, 150 joules per point. The sacrotuberous ligament also may require attention.
Self-myofascial release with biofoam roller massage on all muscles listed in the chart.
Chiropractic adjustments to the hypomobile sacroiliac joint and lumbar spine. Make sure the Chiropractor does not adjust the hypermobile sacroiliac side. Hypermobility can result from lack of muscular support due to the reciprocal inhibition, thus mimicking a subluxated joint.
Wobble and/or BAPS board for five minutes, two to three times per week. Start with both legs and then progress to single-leg stance. Progress this procedure by performing the routine with your eyes closed.
You should be instructed on core stabilization exercises for the transverse abdominus muscle (TA) and lumbar multifidus. Perform the 揹raw-in?maneuver daily for five minutes by alternating 30-second intervals while breathing normally.
Yoga poses: warrior #1 and #2. You must actively contract the gluteus maximus during these maneuvers to inhibit the iliopsoas, allowing for a more effective stretch. Progress to isometric frontal and side plank maneuvers for the TA.
To stay on the cutting edge of your care, you need to follow a comprehensive, systematic and integrated functional approach to kinetic-chain diagnosis. A comprehensive LCS rehabilitation program improves dynamic postural control, ensures appropriate muscular balance and improves neuromuscular efficiency throughout the entire kinetic chain.

I know this is complicated stuff, but you seem to have a good grasp on the intricacies of your problem. You should still have this supervised by your Chiropractor until you can do it on your own.

Hope this helps!
Dr. Timothy Durnin
drs.chiroweb.com


---------- FOLLOW-UP ----------

QUESTION: thanks very much for the great answer. very nice of you to spend so much time.

i do know very well what hypotonic and hypertonic muscles usually are. the list you have i do agree with.

this Reciprocal inhibition i do know very well about. i do realise that the body does not work in isolation. that is if one area is out then changes are that many areas are out as well. the body want to find a balance. i have attacked all areas like exaggerated lumbar lordosis and the exaggerated thoriac khyosis and the forward head posture and then the anterior pelvic tilt and then contining on down the leg.

while it is true that it does appear that my whole left leg muscles are tight. i daily do foam rolling on all the muscles that you listed. but mostly focus on the tight group. at first about 2 years ago when i started it was a bit painful. but now there is litlle pain. in almost like i cant get any further out of it. i even built up to using a pvc plastic pipe instead of the soft foam. but being very careful to stay away from the bones.

anyways do you really think that as i have pain in just this left side and not the right that it solely caused from the major lumbar problems that i do have which i do have spina bifida occulta in l4 (the more i read on that im thinking that in the minority of people it really could be a cause as i do have scolosis a tiny bit and also have hip problems) and l4-l5 disc is bulging and a very tight right ql? i did not want to mention this stuff before as i have tried an awful lot to stretch out and self myofascial release which i have made progress.
but the problem of the hip has not went away. perhaps i did not do as good as job as possible on correcting the stuff.

BUT was almost thinking that it may be separate problem and tackle it like that and see what happened.

so if you still quite convinced of what and why its most likely happening all just take your great advice.

thanking you in advance.

Answer
I was unaware of the concaminate HNP at L5, this is easily treated with Flexion/Distraction or spinal decompression, both non-surgical.
This could very well be the cause of a referred pain syndrome into the hip. The only way to find out is get the treatment, the results are astounding and immediate.
Find a doctor that has this equipment and schedule a few visits and you wont look back.
You can research this proven therapy online and find local doc's that do this.
I think it will be the last piece of the puzzle to achieve total health and pre-injury status.

You will be pleasantly surprised, if you have difficulty finding a local D.C. that performs this, I will set up a referral for your area.

Please don't forget to rate my answer, it would be equally appreciated, thank you!

Hope this helps,
Dr, Tim Durnin
drs.chiroweb.com