Latest / The Driven Athlete / What Causes Hip Impingement, Hip Mechanics, & Treatment Solutions | Ep 66

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What Causes Hip Impingement, Hip Mechanics, & Treatment Solutions | Ep 66 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: So this podcast is talking about hip impingement.
• 0:14
  Speaker 1: Hip impingement is a super common diagnosis and pathology that we come across with our active and athletic individuals that we see and it's been athletes and it's a super common report with pinching or impingement type symptoms in the front of the hip or feeling like something's blocked, with like the hip isn't able to rotate as far as it can rotate for like squat depth and and movement with like lunges and the hip mobility and some of the stability seems to be the culprit with that, as in like, if the hip joint itself doesn't have enough of the right joint play and mobility in the right direction, then it's going to allow the hip joint to move in excessively a different direction and usually in this case it's going to move more anteriorly, it's going to slam and glide anteriorly, which is forward and more of the uh in like internal rotation position, all right, naturally.
• 1:09
  Speaker 1: So if somebody's hip joint when they squat, we need enough um posterior role or mobility right.
• 1:17
  Speaker 1: It has to glide backwards in the hip joint, the socket, enough to clear and accommodate depth with squat right, and if it's lacking and just due to a person's natural like movement mechanics and movement system, it'll glide more forward in the joint or anteriorly and like the path of least resistance, water right, our bodies are like water and they take the path of least resistance for movement in the hip.
• 1:43
  Speaker 1: It's usually going to be forward in the anterior position because a super common thing we see is pain with pinching in the front of the hip, with going deep in a squat or lunge or something like that, so that what tells us it tells us a story, right, and we have to watch the person move.
• 1:56
  Speaker 1: But oftentimes what we find with that is the anterior capsule is lax and the posterior capsule is just not as pliable or mobile as it could be.
• 2:07
  Speaker 1: So times that by a thousand reps the ball and socket joint in the hip will continually glide and grind forward and that's going to put more stress, stretch and strain pressure on the anterior structures and those anterior structures of the anterior capsule, the psoas, and then some of the small groin and hip flexor muscles in there, one of them being the pectineus it's just a small muscle as a hip flexor and those muscles and the anterior capsule will get overly stretched and strained and compressed or pinched and then space will get narrowed with a lack of the joint mobility going in the posterior direction.
• 2:46
  Speaker 1: And that's where we're feeling the symptoms, that's where we feel pain.
• 2:49
  Speaker 1: People usually ask like what's the painful structure?
• 2:52
  Speaker 1: Like what's what's angry?
• 2:53
  Speaker 1: What tissue?
• 2:54
  Speaker 1: What's the angry tissue right?
• 2:55
  Speaker 1: And it's usually the anterior capsule, the psoas tendon of the iliopsoas, the iliopsoas tendon and then uh tendon and then some groin muscles in the front and they're getting just pinched Real quick.
• 3:06
  Speaker 1: The iliopsoas right gets a lot of attention.
• 3:08
  Speaker 1: It's actually two muscles the psoas, that comes from the anterior bodies of the lumbar vertebrae and it blends with the iliacus, which comes from the ventral side of the backside of the ilium.
• 3:25
  Speaker 1: All right, I like the front part of the pelvic, the front ventral aspect of the ilium bone in the pelvis, and those two muscles blend together to make up the ilio psoas and for short people usually say psoas, and they connect to the lesser trochanter of the femur and it's the main hip flexing muscle or trunk.
• 3:42
  Speaker 1: It's a major trunk flexor as well and we're finding is like if that thing it's overly dominant and very guarded and tense, then it's going to be more likely and susceptible to get impinged with squats when it compresses the movement and also too, with, like, a lack of core stability.
• 4:02
  Speaker 1: What we find is psoas dominance, where the psoas contributes excessively for core stability contributions, and it's just going to further accelerate the psoas to get more guarded, hypertonic and that's going to create more tension.
• 4:21
  Speaker 1: Right, like my hip feels tight.
• 4:22
  Speaker 1: Right, it can contribute to back pain too, but anyway, that's why the psoas gets a lot of attention.
• 4:26
  Speaker 1: So we can for sure work on soft tissue, work with that and dry needle it.
• 4:30
  Speaker 1: I'm going to talk about treatment in a second, but anyway.
• 4:33
  Speaker 1: So for hip impingement, the structure is getting impinged to the iliopsoas tendon, some groin and hip flexor muscles, like the pectineus being one of them, and then the anterior capsule.
• 4:43
  Speaker 1: So, as a person descends in a squat if their hip joint glides forward excessively because of just the natural way that their hip joint decided to move and develop over young adulthood and adolescence, like young adulthood and then young adulthood and then as an adult and training, a bunch, right, it just feeds the same moving pattern over and over again and like the path of least resistance bodies and like water, the body's going to take the same path of least resistance for our movement and our joints and that just feeds into and accelerates the same movement patterns over and over and over again.
• 5:15
  Speaker 1: All right.
• 5:16
  Speaker 1: And then over time it's like man, I don't know what I did, but my hip feels impinged in the front, I feel pinching in the front right.
• 5:21
  Speaker 1: That would be, over time, developing hip impingement type of symptoms.
• 5:25
  Speaker 1: All right, something common that comes along with that too is snapping hip syndrome, where it feels like something's flipping over the front part of the joint of the hip, like it's snapping across, like it's like a tendon's flipping over the top of it.
• 5:38
  Speaker 1: It also represents what we would call like anterior instability of the hip joint or hip impingement type symptoms From our standpoint.
• 5:46
  Speaker 1: All right.
• 5:46
  Speaker 1: So with some of the training that I had done in the past, I like to create diagnoses based off of movement.
• 5:54
  Speaker 1: All right, because we're movement experts, right, that's what we do.
• 5:56
  Speaker 1: So movement diagnosis would be AGMR.
• 6:00
  Speaker 1: All right, we call that anterior glide, medial rotation syndrome.
• 6:05
  Speaker 1: All right, with a femur of the ball of the socket joint, the bone, the femur, the head of the femur, with squat and movement seems to glide anteriorly, anterior glide, and rotate medially or internally with movement.
• 6:21
  Speaker 1: It just glides and is susceptible to that type of movement pattern with squats and lunges and things, and it just feeds into that same kind of a problem.
• 6:29
  Speaker 1: All right, so that's what our diagnosis would be.
• 6:33
  Speaker 1: We have to work on improving the posterior hip capsule mobility to allow and accommodate more depth and hip mobility for squats and lunges and stuff Just your hip flexion movements.
• 6:45
  Speaker 1: We have to accommodate and allow the hip joint to glide posteriorly freely enough so that it doesn't just like slam anteriorly and continue to stress and strain the anterior structures.
• 6:56
  Speaker 1: Right, that's step one.
• 6:57
  Speaker 1: So posterior hip caps and mobility, we'll do manual therapy for that, to mobilize that.
• 7:01
  Speaker 1: Then we for sure need to release the psoas.
• 7:05
  Speaker 1: We find ourselves getting the psoas muscle and tendon to be less guarded, intense and lit up.
• 7:11
  Speaker 1: And a great way to do that at least what we're finding is prolonged pressure and that'd be like a release or like an active release.
• 7:18
  Speaker 1: What are we going to call it?
• 7:19
  Speaker 1: An ART, active release technique, or just a prolonged pressure and release?
• 7:25
  Speaker 1: And a psoas release can be.
• 7:28
  Speaker 1: It can be tender, but it's very effective.
• 7:31
  Speaker 1: That we've found, and then you can also needle it, right.
• 7:34
  Speaker 1: So we'll put some needles in the psoas as well in the belly up by the ilium, and that seems to also help decrease the guarding and the tension of the iliopsoas or the iliacus, and that will be one golden BB of a lot of things that will help this get better, right.
• 7:53
  Speaker 1: Last thing we can't neglect is we have to get the glutes to be more active.
• 7:56
  Speaker 1: It's not like it's glute weakness, it's more about recruitment.
• 8:00
  Speaker 1: And when something is very challenging for an athlete or an active person, like running or box jumps or front squats, lunges, bulgarian split squats, whatever, when they feel these hip impingement symptoms, the glutes have to get more naturally recruitable during those challenging movements, right, and so it's not like strength, it's more about recruitment patterns.
• 8:22
  Speaker 1: It's like can we get your glutes to activate during these movements without trying hard?
• 8:29
  Speaker 1: We have to do a lot of pre-work first to set them up for success and get them more activated and recruitable.
• 8:35
  Speaker 1: It's a neurological recruitment problem.
• 8:38
  Speaker 1: The motor muscle, memory and mind muscle connection, right.
• 8:44
  Speaker 1: So like the neural muscular connection and communication from the nerves starts with the brain, can't neglect that we had to improve the recruitability of some of the muscles.
• 8:55
  Speaker 1: It seems like at this point, when this patient comes in right now, the psoas and some of the anterior structures are more dominant and the other posterior structures in the glutes would be one of them seem to be not quite as active and activated and recruitable.
• 9:12
  Speaker 1: So we have to improve that symmetry of recruitment right, and that disparity of recruitment.
• 9:18
  Speaker 1: We would call that muscle imbalance.
• 9:19
  Speaker 1: Does that make sense?
• 9:20
  Speaker 1: It's more of a recruitment problem.
• 9:22
  Speaker 1: And that muscular imbalance of recruitment, that disparity, is what leads to issues down the road, right, if things are continually very strong and what naturally happens turned on as soon as you do something hard.
• 9:33
  Speaker 1: That is more of the dominant muscle, right.
• 9:37
  Speaker 1: Another sign we ask for people for psoas dominance is if they were to do a bunch of crunches and sit-ups and leg raises and V-ups and stuff.
• 9:43
  Speaker 1: Dominance is if they were to do a bunch of crunches and sit-ups and leg raises and V-ups and stuff.
• 9:48
  Speaker 1: Where are you burning, like?
• 9:49
  Speaker 1: Where's the hard work burn, right For like muscle burn.
• 9:52
  Speaker 1: And if they, I often hear my hip flexors burn.
• 9:56
  Speaker 1: The front part of my hip is burning, right, I don't even feel my abs.
• 9:58
  Speaker 1: That just tells me the psoas dominance, right.
• 9:59
  Speaker 1: So we can deactivate it with some needling psoas release to get it less guarded and maybe more pliable.
• 10:03
  Speaker 1: Posterior hip capsule mobility, glute activation, recruitment exercises, and then we'll retest their squat pattern right.
• 10:10
  Speaker 1: Another thing we can't neglect, though, is ankle mobility.
• 10:13
  Speaker 1: Ankle range motion going into dorsiflexion all right.
• 10:17
  Speaker 1: When the ankle bends backwards or up, like towards your face, that's dorsiflexion, and a lack thereof is going to make a person have to shift forward anteriorly over their knees and their hips, and that anterior shift is a compensation pattern for a lack of ankle dorsiflexion mobility, and that's another contribution to maybe developing anterior hip impingement type symptoms.
• 10:40
  Speaker 1: All right, so imagine this.
• 10:42
  Speaker 1: All right.
• 10:43
  Speaker 1: Imagine we got a athletic individual who is coming in with hip further hip pain issue and they report hip pinching with squats and lunges and stuff.
• 10:55
  Speaker 1: Okay, we check them out and we noticed that when they squat, their knee position dives inwards.
• 11:03
  Speaker 1: We call that valgus.
• 11:05
  Speaker 1: Their hips bottom out early.
• 11:07
  Speaker 1: We call that a butt wink.
• 11:09
  Speaker 1: Everybody has a butt wink.
• 11:10
  Speaker 1: Their hips bottom out at some point, but if they bottom out too early, then that would tell us that their posterior hip capsule mobility is limited and their heels are coming off the ground on their ankles and they're shifting more anteriorly or forward when they do squat.
• 11:23
  Speaker 1: So they're shifting forward.
• 11:25
  Speaker 1: Their heels are coming off the ground because they're lacking ankle dorsiflexion.
• 11:28
  Speaker 1: Their knees are diving inwards a little bit like to call that dynamic valgus, knee valgus, genu valgum, and their hips are bottom out early.
• 11:37
  Speaker 1: That is a great recipe for either knee pain, anterior hip impingement in the hip, or low back pain with squats and lunges and box jumps and Bulgarian split squats and all that fun stuff.
• 11:47
  Speaker 1: Step ups, whatever.
• 11:48
  Speaker 1: That's a very common thing, right, especially in like dudes that are over the age of 30 foot six.
• 11:54
  Speaker 1: Right, because dudes are usually more stiff and it's a mobility issue versus girl women that are usually more mobile.
• 12:00
  Speaker 1: Right, for women it's usually a stability problem where the stability in their hips, pelvis core and down the chain in their knees sets them up for aberrant movement patterns that puts continual, undue stress on one particular area and that would be like your psoas tendon, anterior capsule hip impingement.
• 12:22
  Speaker 1: Hopefully that makes sense and you can picture that in your head because this is a super common recipe that we see.
• 12:29
  Speaker 1: So here's what the treatment looks like.
• 12:30
  Speaker 1: All right, so they come in.
• 12:31
  Speaker 1: We check them out, we figured it out, we got it All right.
• 12:34
  Speaker 1: Hip impingement Cool, we're going to do posterior hip capsule mobility, psoas release and psoas needling.
• 12:40
  Speaker 1: Okay, to get the psoas to calm down.
• 12:42
  Speaker 1: We're going to work on ankle dorsiflexion, mobility, manual therapy.
• 12:46
  Speaker 1: This is all manual therapy stuff.
• 12:47
  Speaker 1: First, all right, ankle dorsiflexion, mobility of the joint and then the posterior musculature of the ankle with the calf.
• 12:56
  Speaker 1: We have to work on soft tissue restrictions too.
• 12:58
  Speaker 1: So the calf we have to strip that or mobilize it, cup it, needle it, whatever Soft tissue intervention.
• 13:04
  Speaker 1: And then glute recruitment and activation.
• 13:08
  Speaker 1: So a glute exercise just to activate and recruit the posterior stabilizing gluteal musculature to keep the joint in a better posterior position than we want it to, versus diving, slamming forward.
• 13:19
  Speaker 1: So we'll do that.
• 13:21
  Speaker 1: At the end we'll say like all right, let's retest your squat.
• 13:23
  Speaker 1: When you came in, it hurt and you felt a pinch.
• 13:26
  Speaker 1: We did a bunch of stuff.
• 13:28
  Speaker 1: Let's retest before you leave.
• 13:29
  Speaker 1: And very often our expectation and what we hear often is it doesn't hurt anymore.
• 13:34
  Speaker 1: They're like what did you do?
• 13:35
  Speaker 1: Right, like we spent 45 minutes together because we talked, for we chit chatted for five and then at the end we chit chatted again.
• 13:42
  Speaker 1: So like 45 minutes of like treatment or 50 minutes of treatment and now my hip doesn't hurt, I don't feel it pinching.
• 13:50
  Speaker 1: What did you do?
• 13:50
  Speaker 1: We just set up the joints for success, for mobility and then also activated something so that it can keep it there for stability, all right, I promise you this is a very common thing that we help people with.
• 14:03
  Speaker 1: The other thing we can't neglect is core stability.
• 14:04
  Speaker 1: We're going to crush core stability, all right, and that's like the homework would be like glute activation, core stability and just movement control and coordination and fixing the movement patterns, but like work on this, this and this.
• 14:13
  Speaker 1: Come back next week We'll see you again, we'll check it out and have good results with that right.
• 14:19
  Speaker 1: And part of that is like we try to convey to people that things don't hurt for no reason unless there's a red flag of underlying sinister diagnoses.
• 14:31
  Speaker 1: That not within my scope that if we're thinking doesn't smell right, then we refer you out because it's not us right.
• 14:37
  Speaker 1: If it's musculoskeletal, though, and we rule that stuff out with some screening and 98% confidence according to the research, 99% confident that it's not us right.
• 14:43
  Speaker 1: If it's musculoskeletal, though, and we rule that stuff out with some screening and 98% confidence according to the research, 99% confident that it's not some kind of underlying systemic red flag, sinister diagnosis, then that means that falls in our school of practice, which is neuromusculoskeletal.
• 14:54
  Speaker 1: Neuro being like recruitment and movement control patterns, maybe neural related pain, and then musculoskeletal, like muscles and bones and joints and stuff like that, and we can intervene that.
• 15:03
  Speaker 1: So we're just setting things up for success to move better and then re-educating the joint to move in a better way with better recruitment of other things, muscle recruitment, muscle strength, and that is the pathway to righteousness for solving hip impingement type symptoms.
• 15:18
  Speaker 1: But we see this all the time and it's very common.
• 15:20
  Speaker 1: So I would encourage you, if you, if a person is battling this like, please reach out.
• 15:25
  Speaker 1: We can at least give you some insights.
• 15:28
  Speaker 1: The last thing before we stop is the butt wink All right, this gets a lot of attention and, um, everybody has a butt wink.
• 15:36
  Speaker 1: It just represents when the pelvis rolls from an anteriorly tilted position into a posteriorly tilted position through a squat or something or a lunge and more double leg exercise like a squat, all right, and what that represents is that either the hip mobility has run out or there's a lack of stability to keep the trunk and the pelvis in the right position.
• 16:00
  Speaker 1: It's usually a combination of both.
• 16:01
  Speaker 1: The question is like, on a scale, of how much is contributing for each and where we're going to focus our efforts.
• 16:05
  Speaker 1: If it's a mobility issue and like a stiff person, that's just not moving well and they have a stiff hip and back, or is it muscle recruitment and we're going to crush either one right, but that just represents when the hip mobility has bottomed out and now we're moving through the pelvis in the low back.
• 16:22
  Speaker 1: So, in my opinion, risk benefit ratio of squatting through and below a butt wink.
• 16:29
  Speaker 1: It puts more shear in the lumbar spine and usually creates more anterior shift in the knee or knee pressure, but it's not using.
• 16:36
  Speaker 1: It's gone beyond the hip mobility that's available and the glutes aren't going to be as more recruitable beyond that.
• 16:44
  Speaker 1: We're just shy of that.
• 16:46
  Speaker 1: It's going to be the most active, the glutes are going to be the most active, so we can have equal contributions of like quad activation, hamstring and glute activation and some core stability that's set up for success without going through the end range and bottoming out through our hips.
• 16:59
  Speaker 1: What's going to put undue stress in other structures If we do that with like load on our back, with like a front squat or back squats?
• 17:09
  Speaker 1: It's just a recipe of increased risk benefit ratio that I would analyze as in like what is it that we're doing in the first place?
• 17:16
  Speaker 1: Right, I'm going to get leg strength, cool.
• 17:20
  Speaker 1: Do you play a sport that requires extreme depth below butt wink?
• 17:24
  Speaker 1: Like very, very below parallel that, um, like a lineman in football, right?
• 17:29
  Speaker 1: Or maybe a catcher in baseball?
• 17:30
  Speaker 1: If the answer is no, then you can still get great leg strength gains and not go through butt wink, like the depth bottoming out where the risk doesn't outweigh the benefit, especially for people that we see where they're already in pain and in a vulnerable state of hip impingement back pain, knee pain, like whatever.
• 17:51
  Speaker 1: So that's just what my thought is.
• 17:53
  Speaker 1: On that I'm open to discussion, but that's what the like.
• 17:56
  Speaker 1: When they say butt wink, it's when the pelvis rolls from an anteriorly pelvic, when you're like extended, and it rolls through into a posterior pelvic tilt and your back flattens and that just represents bottoming out of the hip mobility.
• 18:07
  Speaker 1: So reach out if you have any questions.
• 18:09
  Speaker 1: You're battling hip impingement yourself or know anybody, because this is a very common thing that we work with.
• 18:15
  Speaker 1: It usually represents underlying other underlying issues, like some core stability issues as well, and pelvic instability, but for the purpose of just like pure hip impingement, focus and the mechanism that's without.
• 18:26
  Speaker 1: That's what that discussion was about, so don't hesitate to reach out to me, to questions, and we'll catch y'all next time.