In The Spotlight- ‘Hip Extension’

Welcome back

As we already know, the problem of glutes amnesia has reached epidemic proportions. Our lifestyle is not like what it used to be. More work gets done sitting on our behinds all day than ever before. Spend too long in sitting  and we slowly start to lose the important movement of hip extension. In this blog post I would like to discuss two conditions that I have often seen in the past which can be directly or indirectly related to loss of hip extension (both lack of active control and loss of ROM). Seen in the general population and often perpetuated in runners. Lets begin-

  1. Low back pain– while the causes for LBP could be endless, we will discuss the role of inhibited glutes and lack of proper hip extension in LBP. If we spend  8+ hours a day sitting on a chair (hip flexion), the glutes will be in an overstretched position and often inhibited. To add to those woes, the hip also gets stuck in a flexion position with classic ilicaus and psoas tightness. Now to maintain a upright posture and to compensate for tightness caused by excessive prolonged hip flexion which would put our trunk in a forward lean,  the back extensors have to work harder to keep us upright. This often manifests as an increased lumbar lordosis (low back curvature). Prolonged time in this position can cause increase in tone of the lumbar erectors and could potentially cause low back pain. I see this often with recreational runners or those who are new to running. During running, if your hip do not go in to enough extension, the back begins to arch and the erectors being part of the posterior chain have to work extra hard. Remember the body is a great compensator but over time this catches up. This, I believe is often one of the common reasons why recreational runners come to see us for low back pain with running.  If you are an athlete or a runner, this is not the best situation for running.  Your glutes have lost their VIP status.  No one likes weak glutes, unacceptable.
  2. Plantar fascitis– I often find people with plantar fascitis have well developed calf muscles. It appears like its ‘calf raises’ day everyday for these folks however on further questioning you may find that they might not have been doing any calf strengthening exercises. If such is the case, I implore you to  check for their active hip extension in walking or running especially during the midstance, heel off and toe off of the stance phase. This is the time when the leg should start to cross back behind the body due to hip extension. This is the primary movement that propels us forward. Now if the body lacks this crucial movement, due to weakness of the glutes max or tightness of the ilio-psoas etc the calf seems to become a more significant driver to push the body forward. Now multiply this a few thousand times a day (even more if you are a runner) over a few weeks, months or years and we have a overworked calf complex. As we all know, the calf exerts a pull on the plantar fascia (remember its a two joint muscle) and that irretates the PF blah blah, we all know this. So improving active hip extension and utilizing the full potential of the glutes is crucial to give the calf a break and in turn might relieve some stress of the PF.

The take home message is simple-  Hip extension is a crucial movement for many daily activities and a lack of which might cause LBP or PF. When treating these conditions, don’t make the mistake of running after the symptoms like I have so often in the past. Here’s a little video to give you an idea of my thought process when analyzing hip extension in running.

 

(PS- this is not the only thing I look for, I’m only focusing on Hip extension here).

You know the drill.

Pursue excellence-

Abhijit Minhas

(BPT,MS,CMP,FMT)

Check your Neck before you Wreck your Neck

This one resonates close to me. It was the winter of 2013, excited for having cleared my board exam to practice as a physical therapist in the US, I had just landed my first job overseas. However, apart from being my first job this was not just anywhere in the US, I was to begin working in ‘New York City’ (Oh the dream, I recall). Not just anywhere in NYC, this office was in Manhattan, and if you know anything about that awesome city, it was not just anywhere in Manhattan, it was right in the heart of it all in midtown Manhattan. It came with its pressures, servicing a relatively high end clientele in a very busy office. And if there is one thing I could tell you about New Yorkers it is this, they are extremely driven, outcome oriented and unapologetically blatant. There was no ‘see me for 3x/week for 4 weeks to see results’ or ‘physical therapy effects take time to show’. They would have none of that spiel. No pressure right (haha)? Dead wrong.

Within the first week I crumbled under the pressure like a house of cards(though I didn’t show it to anyone). But that’s New York, if you have lived there, you’d know what I mean. Lest I digress more, part of the problem along with me just being a new kid on the block was that doing countless patient charts looking down for hours apart from the non stop physical work that comes with working as a physio, I started developing neck pain with a burning sensation down my left shoulder blade. With the passing weeks, it only got worse. The problem was that a lot of my patients were seeing me for more or less a similar problem spending hours on their workstations. If I couldn’t fix myself, how could I help them? I did what I could for myself and them but it was no walk in the park. A few years and grey hair have imparted some wisdom and learning.  Having seen hundreds of patients since then, I am now at a better position to tackle this issue. Below are some of the most common advice I give to patients/people who are at a risk of neck pain. A general advice though, these exercises and strategies are to prevent this unpleasant occurrence. If you are already in pain, You must seek professional help and not rely on the videos presented below. There could be many reasons why you could have neck pain and everything is not covered here.

We all have been in this position. It could be a busy day at work staring at your monitor for 8+ hours, staring down into your books pulling an all nighter before that big test, driving through endless traffic to get home ending up spending more time behind the wheel than you’d like to, maybe a car accident, a weight training injury at the gym or just sleeping wrong, very few have managed to escape this annoying and often debilitating condition. And just like if you hang around with the wrong company for too long, you’d find trouble, if the neck remains troubled and painful, chances are that the shoulders, upper back, arms and/or the head might feel some of that pain too. That’s right, often pain (or tingling/numbness) running down the arms, shoulder, upper back pain and/or headaches ‘might’ be because of that nagging neck pain. This is important so I’d like you to read that line again. However, like I mentioned before, neck pain is a complicated topic and beyond the scope of just one blog.

So today’s post and my first ever not for physios, but just people in general who might benefit from common advise we give to our patients is going to be preventative in nature. You probably won’t be surprised to know that a big chunk of neck pain clients that I have seen over the years come from just sitting wrong and too long, staring into a screen all day, snap chatting every few minutes etc than from car accidents (this might be different for the USA and Canada, there are a lot of MVA’s here).

So here are some exercises and strategies you could use if you are at a risk to experiencing neck pain or its related symptoms.

  1. Good Posture

2. Chin tucks

3. Chin tucks and extension

(If you feel an increase in pain, tingling, numbness, dizziness etc with every repetetion, stop!!)

4. If you look on one side for extended  periods of time, correction for that-

5.Thoracic extension

6. Neck stretches

7. Sitting posture and recommendations

(If you’re a image conscious New Yorker, I know your struggle. Don’t carry a sheet to work, shell out some $$ and get that lumbar roll, lol).

8. Setting timer/ reminder

9. Finally, don’t forget to MOVE!!

The key is to not think of them as exercises but as habits. Habits that are acquired and need to be incorporated into one’s  routine on a daily note. Foremost remember, if you are in pain, go see a good physio and get it assessed. Some of the above advice might not be right for you depending upon what is going on. If some of the exercises seem to increase your pain, stop immediately. Comment below if you have questions.

Until the next post and always

Pursue excellence

Abhijit Minhas PT

(BPT, MS, CMP, FMT)