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Fixing Achy Hips

Thanks for this article in MassageToday Erik!

In my experience, the most overlooked and least appreciated area of compensation arises as the femoral heads become asymmetrically positioned in the acetabula. For example, when the pronated left foot internally rotates the thigh and the supinated right foot externally rotates the thigh, one would be walking sideways with each step. Of course, the body's sensitive proprioceptors immediately begin left-rotating the trunk with the axis of rotation primarily focused at the hips. As the femoral heads reposition in the acetabula, a great amount of stress is placed on the joint capsules, articular cartilages and supporting ligaments.

Replies to This Discussion

Permalink Reply by Erik Dalton, Ph.D. on December 11, 2009 at 2:31pm

Appreciate the post Geoffrey. Femoral Ascetabular Impingement Syndrome (FAI) is one of the least appreciate and most debilitating structural conditions we see--and sometimes don't see--in our bodywork practices. More manual therapy research needs to surface to treat this condition before Dr. Ganz (the father of FAI) and his buddies get them in for surgery. Manual therapy should be the first line of defense against this pervasive condition which ultimately leads to an unwarranted number of hip-replacements each year.

Permalink Reply by Danny Christie on December 18, 2009 at 7:38pm

Shirley Sahrrmann categorizes anterior femoral glides syndromes into several sub categories of rotation preferences.
She suggests all type of anterior femoral glides categories’ will lead to groin and general hip pain. Key signs and symptoms to look out for are:
• Painful hip flexion- I.e. pinching around the anterior hip during ROM testing, deep squats and climbing stairs
• Weak iliopsoas and gluteus maximus
• Short hamstrings especially bicep femoris and TFL- often resulting in an out toes gait, which can lead to a whole myriad of issues

Muscle spindle activation on the glutes and strengthening for the psoas combined with the Myoskeletal release techniques for the affected short muscles have proved very helpful in my practice.
Danny Christie

Permalink Reply by Erik Dalton, Ph.D. on December 20, 2009 at 8:54am

Isn't that Sahrrmann book a treasure Danny? Forty pages of "hips" including some mentionon of my favorite topic FAI (femoral acetabular hip) syndrome. Studies by Ganz (godfather of FAI) suggest a fairly large number of the population may present with structural (genetic) asymmetry of placement of the acetabulum in the ilium...now that's a problem.

If my usual treatment for balancing the femoral heads in the acetabula (correcting pelvic obliquity and lower quadrant disorders) proves unsuccessful (over time), I try to determine if there may be a malformed socet (depth, direction, placement).

I've unsucccessfully experimented with many assessments to determine if the client may be suffering a physical deformity of the femoral neck (too short/ crooked, etc.) or if the socet is malformed or misplaced in relation to the contralateral side...to no avail. It's a good idea to have a referral for a radiologist trained in FAI studies. Thx for the post.

Permalink Reply by Geoffrey Bishop on December 20, 2009 at 10:50am

I have an MD client right now who is suffering hip pain (more isolated at & around piriformis, no referal) associated with excessive running and walking, never resting for more than a day. She has never heard of FAI syndrome.

The Doc really was quite intrigued by our conversation about A/P tilt, arches, Harrison Fryette's Laws of spinal biomechanics,....all that, then she said "I wonder why there is asymmetry in the human body?".....GOD help us, we went all the way back to fetal development, getting squished as we grow into the womb, J.G. Zink CCP theory, coming through the birth canal, patent leather shoes, with wicked hard soles, for babies, feet spring systems,.....etc.....

Suddenly her hip pain started making sense, was not so mysterious and I think she might rest for a week. I have suggested she take an entire month off, type A, not going to happen. I recommended an MRI.....for her to quantify her pain & rule out serious damage, which there just may be.

I will keep you posted on how the Doc comes out...

Permalink Reply by Danny Christie on December 20, 2009 at 1:33pm

It is a great text, which requires quiet reading to grasp some of the complexities.

But her predictble patterns of dysfunction or spot on.

Erik Dalton, PhD said:

Isn't that Sahrrmann book a treasure Danny? Forty pages of "hips" including some mentionon of my favorite topic FAI (femoral acetabular hip) syndrome. Studies by Ganz (godfather of FAI) suggest a fairly large number of the population may present with structural (genetic) asymmetry of placement of the acetabulum in the ilium...now that's a problem.

If my usual treatment for balancing the femoral heads in the acetabula (correcting pelvic obliquity and lower quadrant disorders) proves unsuccessful (over time), I try to determine if there may be a malformed socet (depth, direction, placement).

I've unsucccessfully experimented with many assessments to determine if the client may be suffering a physical deformity of the femoral neck (too short/ crooked, etc.) or if the socet is malformed or misplaced in relation to the contralateral side...to no avail. It's a good idea to have a referral for a radiologist trained in FAI studies. Thx for the post.

Permalink Reply by Erik Dalton, Ph.D. on December 20, 2009 at 1:54pm

That's a classic story about the Doc and body asymmetry. Unfortunately, it's probably not an isolated case...our job to educate and it sounds like you did a good job. Please keep us posted on her progress..

Geoffrey Bishop said:

I have an MD client right now who is suffering hip pain (more isolated at & around piriformis, no referal) associated with excessive running and walking, never resting for more than a day. She has never heard of FAI syndrome.

The Doc really was quite intrigued by our conversation about A/P tilt, arches, Harrison Fryette's Laws of spinal biomechanics,....all that, then she said "I wonder why there is asymmetry in the human body?".....GOD help us, we went all the way back to fetal development, getting squished as we grow into the womb, J.G. Zink CCP theory, coming through the birth canal, patent leather shoes, with wicked hard soles, for babies, feet spring systems,.....etc.....

Suddenly her hip pain started making sense, was not so mysterious and I think she might rest for a week. I have suggested she take an entire month off, type A, not going to happen. I recommended an MRI.....for her to quantify her pain & rule out serious damage, which there just may be.

I will keep you posted on how the Doc comes out...

Permalink Reply by Erik Dalton, Ph.D. on December 20, 2009 at 1:57pm

Found myself having a lot of 'Ah Ha' moments when reading her text. Seen any of her earlier stuff?

Danny Christie said:

It is a great text, which requires quiet reading to grasp some of the complexities.

But her predictble patterns of dysfunction or spot on.

Erik Dalton, PhD said:
Isn't that Sahrrmann book a treasure Danny? Forty pages of "hips" including some mentionon of my favorite topic FAI (femoral acetabular hip) syndrome. Studies by Ganz (godfather of FAI) suggest a fairly large number of the population may present with structural (genetic) asymmetry of placement of the acetabulum in the ilium...now that's a problem.

If my usual treatment for balancing the femoral heads in the acetabula (correcting pelvic obliquity and lower quadrant disorders) proves unsuccessful (over time), I try to determine if there may be a malformed socet (depth, direction, placement).

I've unsucccessfully experimented with many assessments to determine if the client may be suffering a physical deformity of the femoral neck (too short/ crooked, etc.) or if the socet is malformed or misplaced in relation to the contralateral side...to no avail. It's a good idea to have a referral for a radiologist trained in FAI studies. Thx for the post.

Permalink Reply by Danny Christie on December 20, 2009 at 2:41pm

I have seen some of her key notes speeches. Great Speaker!

Here is a 2008 hour long lecture titled:
Movement: A Science and a System
http://www.youtube.com/watch?v=CJIKsw3YwOU

Erik Dalton, PhD said:

Found myself having a lot of 'Ah Ha' moments when reading her text. Seen any of her earlier stuff?

Danny Christie said:
It is a great text, which requires quiet reading to grasp some of the complexities.

But her predictble patterns of dysfunction or spot on.

Erik Dalton, PhD said:
Isn't that Sahrrmann book a treasure Danny? Forty pages of "hips" including some mentionon of my favorite topic FAI (femoral acetabular hip) syndrome. Studies by Ganz (godfather of FAI) suggest a fairly large number of the population may present with structural (genetic) asymmetry of placement of the acetabulum in the ilium...now that's a problem.

If my usual treatment for balancing the femoral heads in the acetabula (correcting pelvic obliquity and lower quadrant disorders) proves unsuccessful (over time), I try to determine if there may be a malformed socet (depth, direction, placement).

I've unsucccessfully experimented with many assessments to determine if the client may be suffering a physical deformity of the femoral neck (too short/ crooked, etc.) or if the socet is malformed or misplaced in relation to the contralateral side...to no avail. It's a good idea to have a referral for a radiologist trained in FAI studies. Thx for the post.