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)

Navicular Drop Test

Greetings

This is going to be a short one. As indicated before on my social media, this one is on the feet. Foot examination is a big part of my assessment with patients presenting with lower extremity pain and often back pain. Of the many dysfunctions of the feet that could cause pain anywhere along the lower extremity, a pronated foot often steals the lime light. While there are definitely problems that can be associated with  excessively pronated feet and has been well established in the literature, I must point out that the word ‘excessive’ is important here. When I first started looking at the body  not just as individual parts but as a unit together, the idea of regional interdependence was a game changer.

However, I was quick to jump on the bandwagon of blaming pronation for everything- shin splints, tibial stress fractures, ACL injuries, hip issues, global warming, oil crises (a bit too much, I know. Just my attempt to keep this as light reading). Remember that pronation is a regular part of the gait cycle during the suspension phase and also is a normal physiogical movement of the body. It is really the ‘excessive’ pronation and medial arch collapse that we should be worried about without demonizing foot pronation.

Apart from generally eyeballing movements for foot positioning during different movements like running, walking, squatting etc I like the Navicular drop test to assess ‘over pronation’/ medial arch collapse. Here’s a video of how I perform it.

 

If the difference between the two points is >10mm then the test is considered positive.

I’m keen to read  your thought on this subject. Do you often use this test? Any other tests you like to use in your assessment? Would you like that featured on this blog? Feel free to share your thoughts.

For those of you who are wondering what an excessively pronated foot has got to do with other lower leg problems (not you of course, you know this all to well), its might be useful to understand how problems at the feet might cause problems upstream at other joints, its called ‘regional interdependence’ and this is just one example. Understanding this is paramount. More on this in the next blog. Until next time

Pursue excellence

Abhijit Minhas PT

(BPT, MS, CMP, FMT)

Reference-

  1. Vinicombe A, Raspovic A, Menz HB. reliability of navicular displacement measurement as a clinical indicator of foot posture. J Am Podiat Med Assn 2001;91:262-8\
  2.  Flynn, Timothy. User’s Guide to the Musculoskeletal Examination. Evidence in Motion, 2008. Print.