Question
thanks very much. great detailed answer. just what i like.

ive already do the bird dog regularly. i learned about it from the the ultimate back fitness book by stuart mcgil. a leading edge source of info. the patrick test ive had done to me before when i went to a doctor and told him i had si joint pain. there was no pain really.

from reading what you answered the part out in the muscles that will give you the clue. now this just needs a simlple yes or no for my clarification. now im almost sure that i all i have is pain in the muscles on this left hip from this excersize. so if i only have pain in the muscles and not the joint or lamrum from doing this fire hydrant could i say that it was the muscles of the hip that needed work and that the joint and labrum are fine? and well this might be asking the impossible but maybe you could answer. in my case is my left hip problem caused by a problem of the hip or could it really by caused by the right ql muscle? is my case a case of lower crossed syndrome? im intesting in the tons of people your seen as to if that was common to have both problems in the same paitent. or maybe i have 2 independant problems?

thanking you ina advance.
-------------------------------------------
The text above is a follow-up to ...

-----Question-----
Before i did ask you about tigger points, right SI Joint and then this question may be geared about the lower crossed syndrome. Thanks very much for that. I really do read over your answers over and over. Please if you dont mind even if its brief points me in the right direction.

When i do a mobility excersize for the hips called the fire hydrant. The name describes it all. What a dog does with its back leg when it gets to a fire hydrant.
Now on all 4 im pushing with the heel and rotating slowly. With the right leg there is pain after. Perhaps the maybe medius is fatigued but it does seem a good excersize. BUT the left hip which i alot of the time have pain somewhere around the TFL when i walk or even lie down. But not for sure but sort of often. Now when i do the excersize for the left hip afterwards i get sort of sharp pains in the muscles of the hip i guess around TFL. It seems to last for say 10 minutes. Any ideas what this could be? Im guessing maybe one of my ligamnets could be partially stretched. This is an ongoing problem. I was thinking that it was caused from the rigtht QL the lower crossed syndrome. but i dont know? Would there be any value in getting an expensive MRI for the hip and then even the lumbar as well? All the doctors that ive been to and even the chiro have not at all reduced my pain. So i just dont know where to turn?




Also before a chiro had me doing the Mckenzie back Extensions. He did not tell me the name but he had wanted me to do them 5 times a day with say 8-10 reps of iso holds at the top for say 10 seconds. He said that this excersize is what has helped so many people get rid of back pain. Well i did do them but im not really sure if they even did do anything. Now from reading up about them i figuring they would only be helpful if it was disc bulge that was the cause of pain. And that these over time would push the disc back. But ive also read that i think the facet joints were the problem that this would be the worst thing to do. And it is possible to have both problems. Well i do have a disc bulge at l4-l5 and im not sure if i have a facet joint problem as well. Anyways do you recommed this excersize to your paitents? And is there any benefit for me to be doing this regularly?

Thanking you in advance.
-----Answer-----
Dear Jii,

McKenzie exercises are good for overall back stability increases, but you are correct in your notion that if you have some form of facet inflammation or imbrication (jamming of the joint space), then extension exercises such as the Mckenzie will aggravate it. You can also make the holes in the spine (intervertebral foramen) smaller during the course of the exercise which may further inflame the nerve roots.

When I have my patients due extension types of exercises, they are always instructed on keeping their form tight (not going into hyper-extension), and focusing on contraction of the transverse abdominus muscle before they perform the extension movement.  What this effectively does is stabilizes the core and initiate proper muscle firing sequences to create normal firing patterns of the muscles.  You are really trying to specifically focus on training the multifidus muscle in the lumbar spine.  This muscle has been shown to attach to the disc and the facet joints of the back, thereby creating more stability.  One of the best exercises I have used with patients is the BIRD DOG exercise which does not hyper-extend the back.  An illustration of the exercise can be found at the below link:

http://www.acefitness.org/getfit/exercise_display.aspx?pageID=687

Now, concerning the fire hydrant exercises, these are good exercises for abductor and the external rotators of the hip, I used them frequently when I was a personal trainer...but you could easily flare up the TFL or Glute Medius with this exercise if the muscles are not sufficiently stretched.  It is also possible to have an anatomical problem within the confines of the hip joint.  Your symptoms should give you a clue:  pain deep in the joint, or superficial...out in the muscles.  Obviously if the muscular system is the problem, functional stretching and myofascial work are the keys to eliminate the problem.

Suspected internal problems of the hip may include arthritic changes that can be flared up with rotation of the joint, as well as  a labral tear.  The labrum is the cartilage that lines the hip socket (acetabulum) in which the ball of the hipbone (femur) sits. This cartilage provides stability and cushioning for the hip joint. A tear in the labral cartilage can result from injury or degeneration, such as above mentioned osteoarthritis.  You can actually test this with the Patrick's test (Faberes test).  Explanation: With the patient supine, the thigh and knee are flexed and the external malleolus is placed over the patella of the opposite leg; the knee is depressed, and if pain is produced thereby, arthritis of the hip or internal pathology is indicated. Patrick calls this test fabere sign, from the initial letters of movements that are necessary to elicit it, namely, flexion, abduction, external rotation, extension. (this is for screening, and does not necessarily prove diagnosis).

Labral tear symptoms:  A locking or catching sensation in the hip joint. Pain, usually in the hip or groin, and yeas an MRI would confirm this if present, but many labral tears don't even require treatment other than a possible steroid injection for inflammation and pain.  

Hope this answers your question JII...and by the way, Merry Christmas.

Respectfully,
Dr. J. Shawn Leatherman  

Answer
Dear Jii,

I think that you probably do have a combination of both low back muscular dysfunction as well as hip dysfunction...obviously the structures are closely related.

Concerning the lower crossed syndrome (LCS), yes this is very possible, and I see this frequently in patients as well as the general public.  I am sure you have read about this, since you brought it up, remember that the key to rehabilitation concerning LCS, is to strengthen the abdominals and glute max while stretching the erector spinae and the illiospoas muscles.  SO again hyper-extension exercises are not good for LCS rehab.

If you really suspect LCS, then these are the clinical signs:
Lumbar hyperlordosis
Anterior pelvic tilt
Protruding Abdomen
Feet turned out
Groove in Illiotibial band
Muscle hypertrophy in lower back

Just remember that any form of rehab will take time to re-balance the muscular system and gain stability.  Discomfort is okay, but increases in pain are not, so take it slow and consider your form in exercise to be the most important.  In addition you mentioned Stuart Mc Gill...yeah he has done some awesome research...you may also be interested in a book called 'Low Back Disorders:  Evidence-Based Prevention and Rehabilitation"  ISBN 0-7360-4241-5.

Respectfully,
Dr. J. Shawn Leatherman