As a former professional dancer, I have suffered several injuries that cause me to adapt my movement to compensate for my injuries. Over time I developed two labral tears in my right hip - the result of unequal weight bearing over the course of many years. What happened to me is a common occurrence.
A labrum is the cartilage that surround the ball and socket joint in either the shoulder or the hip. It provides stability. Labral tears are more common than many of us realize and, as my orthopedist admitted to me, there's not a lot of science about what to do about them. There is also a hesitancy about surgery when it comes to labral tears. Many professional athletes undergo labral tear surgery in order to get them back in the game, while other "normal" people are advised to "wait and see." Sometimes labral tear surgery isn't the magic pill many of us would like, while for some this kind of surgery, combined with post operative Clinical Somatic Education and functional strengthening can be a winning combination.
What is at the root of hip pain - especially when it's predominantly in one hip and isn't the result of a genetic abnormality?
Let's look at what happens when you have an injury...
Accidents and injuries, like spraining an ankle, slipping on ice, or a sudden fall, can cause muscles to involuntarily contract to avoid pain and protect from further injury. This is called the trauma reflex. The photo on the right shows a typical trauma reflex posture: the waist muscles on the left side of her body are tighter than the right, causing the left hip to be slightly higher up than the right. There is a slight tilt of her body to ther right. The client in this photo broke her left ankle and had to compensate for months using the right side of her body to protect the left side.
When you compensate to nurse an injury, this compensatory pattern causes tight, painful muscles and joints and inefficient movement.
Here are some basics that most people know, but forget to apply in looking at hip joint pain:
Chronically and habitually tight muscles around joints can cause a lack of joint mobility. Over time, too much compression on joints can cause serious structural damage - like labral tears or worn out hip sockets. Even sitting too much at a computer or in a car can cause habituated muscle tension that simply won't go away.
From my clinical (and unfortunate personal) experience, I have found this to be a cause of many cases of chronic hip pain.
And here's the missing link: those habitually contracted muscles that won't relax and are compressing the hip joint are most likely in a state of SENSORY MOTOR AMNESIA. This means that the muscles have learned to stay chronically contracted (in order to compensate to your accident, or injury) and the brain (the control center of the muscles) has simply forgotten how to relax them. What is needed is a reeducating of the brain to muscle connection - which is what we teach in Clinical Somatic Education:
Teach the brain to RELAX the underlying full body pattern of tight, compensating muscles, and the muscles around the hip joint will relax, muscle balance and strength will be restored, and your pain will "magically" disappear.
STRENGTHENING EXERCISES DO NOT RELIEVE HIP PAIN
Many medical professionals advocate strengthening to reverse hip pain. This doesn't make sense, and here's why:
If you have a muscular pattern of compensation that you're not aware of (which Clinical Somatic Education refers to as Sensory Motor Amnesia), as with my client in the photo above, and you strengthen the muscles of that compensatory pattern, you're merely making that dysfunctional action pattern even stronger. You will literally "strengthen your pain." If muscles are contracted and causing pain, they need to be relaxed and released, symmetry has to be restored, and then strength training to maintain that muscular balance will be beneficial.
So what about labral tears and what to do about hip injury? Here's the first step in figuring it out: stand facing a full length mirror. Close your eyes and sense how you're standing. Do what comes naturally. Now open your eyes and notice:
- Are you standing with your weight centered over both feet, or are you tilting slightly to one side?
- Are your shoulders level, or is one shoulder slightly lower than the other?
- Put your hands at your waist, on top of your hip bones and see whether or not one hip is sitting higher up than the other (look back at the client photo in this post).
- Now feel the waist muscles on both sides. Is one side of your waist tighter than the other? If so, is it the same side as your sore hip?
If you are "out of kilter," then the core muscles that attach into your hips are working harder on one side than the other. This can cause hip pain. The good news is that it can be reversed through patient sensory motor re-training of the muscles that have learned to stay tight and "frozen."
Here’s a recap:
- Labral tears are generally the result of athletic injury or wear and tear over the years due to accidents. Labral tears cause instability in the hip.
- Instability in a joint causes the muscles attaching into the joint and supporting the joint, to contract to try and create stability.
- The “Trauma Reflex” is a stress reflex that occurs due to a sudden accident or injury, or the need toavoid further pain. This causes your brain to change the way in which you would normally move.
- The muscles involved in this “Trauma Reflex” pattern must be trained to relax first before beginning any course of strengthening or exercise. Otherwise you will more deeply entrench a pattern of muscular dysfunction.
Some people are under the impression that hip pain can be reversed through repetitive exercises designed to strengthen the joint. One online forum author recommended yoga stretches and repetitive Jane Fonda-esque exercises, all under the article entitled, “Hip Exercises Will Hurt.” If you have a hip injury that hasn’t been addressed and muscular dysfunction that causes you to put more pressure on one side of your pelvis and hip joint, these hip exercises will hurt your chances of ever feeling really good again.
I’d like to offer a few easy movements you can do at home to begin to relax hip muscles that, when habitually contracted, contribute to chronic pain. Then I’d like to caution you against certain commonly prescribed exercises that do nothing positive for hip pain – they just make matters worse.
Instead of stretching the muscles as you go through these movements, you will re-set their length and relax their tonus by pandiculating – contracting the muscle first, then slowly lengthening it to a full relaxation (as if you were imitating a cat or dog getting up from rest). Pandiculation is the key to re-setting muscle length and restoring sensory awareness and motor control without forceful or painful stretching.
Arch and flatten: Click here for a video showing this movement. This movement relaxes the back muscles. Tight back muscles contribute to tight hip joints.
Arch and curl: Click here for an explanation/tutorial on how to do these two movements. Arch and curl helps to relax the abdominal muscles, while the washrag allows for easier full body twisting. It relaxes the back, waist, belly and hips.
Side Bend: This movement directly addresses the “Trauma Reflex” muscles of trunk rotation that, when habitually contracted, are probably the biggest contributor to hip pain. This movement will teach you to relax, release and lengthen the waist muscles so that both sides of your waist are the same length and have the same ability to bend from side to side. Click here for a video showing this Somatic Exercise.
Finish this series of hip movements with the Washrag: Click here for a video showing how to do this Somatic Exercise.
Remember to do all these movements SLOWLY, GENTLY and WITH AWARENESS.
When hip joints are tight, it’s because the muscles that attach into the joints are tight. This restricts the movement of the hip joint and can compress the joint. These muscles need to be retrained, slowly and intelligently (not forcefully, as if working out at the gym) so they move more efficiently and effortlessly. Once the muscles of the waist, back and abdominals are back under the brain's conscious control and can contract, lengthen and relax voluntarily, then a routine of functional strengthening is both beneficial and necessary.
Take a moment after doing these movements to notice the sensations of your body. Lie quietly. This allows your brain time to absorb the feedback of the movement in order to integrate it into the sensory motor system. This new sensory awareness will result in improved motor skill and flexibility.
To begin to relieve and eliminate chronic hip pain, learn the movements shown above in these two instructional DVD's: