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Lateral rotation issue with left hip

 
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heidikeithyoga



Joined: 26 Sep 2011
Posts: 4
Location: Los Angeles, CA

PostPosted: Mon Sep 26, 2011 5:05 am    Post subject: Lateral rotation issue with left hip Reply with quote

Hi - I have been on a quest to figure out how to open up my left hip for about a year now and have been running into all sorts of dead ends. I am hoping that yinyoga.com can help me get to the bottom of this!

Here is an overview of my general situation - some of it is fact and some it is self diagnosis - please feel free to correct me at any point and I apologize in advance if this is too much information. I just know that the body is so interconnected that I figured I better be thorough.

I have been told that I have tight hip flexors. My iliopsoas muscles are shortened from prolonged sitting which has created a situation where my upper body is sort of sitting out in front of my lower body. I have a bit of an anterior tilt in the pelvis but instead of having increasing curvature in the lumbar spine which is typical in lordosis, it is actually sort of flattened out and forward (I have been told it's because my lowest lumbar vertebrae is actually fused to the sacrum on one side) and then rather than a nice smooth curve into the thoracic spine, there is almost like an inflection point where the lumbar sharply turns into the thoracic spine. Think "V" instead of "U". It is not dramatic, like you would have to be a professional chiropractor or PT to see it, but it's there. I used to be phenomenally sensitive in this region - like if I got a massage the muscles surrounding that area would feel like they were receiving an electric shock (not fun) but from the advice of a physical therapist I started rolling my back out on a foam roller and while I'm still sensitive there, the tension has subsided a lot.

I have shortened hamstrings from spending the last 10 years sitting at a computer. In my earlier days of practicing yoga I took it too far too fast and ended up tearing my hamstring attachments, the left side was more injured than the right but definitely both were injured. I had it diagnosed and the orthopedist told me about the torn hamstring attachment. She didn't say which hamstring though. I thought it was maybe the semi-tendinosis at first because it was the back of the inner thigh that was always tender. But then the pain and tightness started to also come from the inner groin area. I went to a physical therapist and she also pointed out that I have very tight adductor muscles. After a lot of study and analysis, I figured out that it was the adductor magnus that was torn at the ischial tuberosity and it was also starting to feel strained at the other insertion point in the front pelvis area. So I started rolling out the inner thigh and groin region with a foam roller and using tennis balls and with being really careful, I have been able to heal the tear and open the hamstrings more without reinjuring myself.

The other issue that I have discovered in the past year is discomfort in my left knee from sitting in sukhasana (which is so ironic considering it literally means comfort pose). After trying to do stretches to help open up my left hip, it just seems like it is stuck. I have barely any lateral rotation in the left femur when the hip is flexed and abducted ( I would say it rotates less than 45 degrees, the right hip alternatively is probably closer to 65-75 degrees). I don't feel pain in the left knee when sitting in baddha konasana (so when I have increased the abduction of the leg) but the knees still sit up really high. The knees sit up even higher when I try to anteriorly tilt my pelvis and sit directly on the sit bones).

Poses like sukhasana, square pose, ardha matsyendrasana, pigeon pose, cow pose are all nearly impossible to do on my left side because my femur will not laterally rotate enough when flexed. I do not have this problem at all on my right side. I am still tight relative to most yogis on the right side but I can at least enter these postures and hold with no pain. No matter what I do on the left side though the stretch always seems to transfer into my knee. It doesn't usually hurt while in the pose, but it definitely feels sore after on the outside of the knee and in the back of the knee. This makes it even harder to try opening my hip because I am afraid to hold a pose too long because I can't tell if it is going to hurt my knee or not until after the fact.

I have had x-rays and mris done and it doesn't seem that compression in the hip is the issue. It literally feels like its a joint capsule issue possibly combined with some tightness from previous injuries. I'd like to know if anyone out there can tell me what's going on with my left hip, if they know what is causing it and if there are common reasons why the femur will not laterally rotate and asanas and modifications that I can apply to help open up the joint capsule without hurting myself. I'd also be interested in knowing the part of my knee is getting compromised - as I mentioned before its the outside and back of the knee. I don't feel the need to be a "lotus" yogi, I just would like to be able sit comfortably in sukhasana without killing my left knee.

Anyone out there with any advice, I welcome it wholeheartedly. I am open to trying different asanas, stretches, physical therapy, chiropractor, you name it. I just want someone to really help me figure out whats going on with my left hip so I can get it unstuck!

Thank you!
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Kat



Joined: 30 Aug 2008
Posts: 2
Location: Vancouver

PostPosted: Thu Sep 29, 2011 1:01 pm    Post subject: Reply with quote

Hi Heidi,
I'm a physiotherapist(as we call ourselves here in Canada) and a yogi.
After reading through your post, I have a few suggestions. It is really difficult to give any advice without assessing your hip in person, so these are all just suggestions of avenues you could explore.
It sounds like you have a lot of history with tight muscles and tears. Some avenues for muscle release that I would suggest would be intramuscular stimulation (aka IMS or dry needling)--a form of acupuncture that can sometimes be used to release shortened, tight muscles, usually done by physios and some MDs. Often these muscles are tight because of problems in the lower back. So I would suggest that you get some thorough assessment done of you lower back region as well as sacroiliac joint to see if there is over activation of the muscles in the hips from irritated nerve roots or stiffness in those regions. IMS can also be quite effective with treating this. Another form of treatment for those really stubborn tight muscles would be active release therapy, usually offered by chiropractors but some physios do it as well.
If it is a capsular problem, your hip should be limited in flexion, abduction and internal rotation(the capsular pattern of the hip). Some mobilization of the hip joint by a manual physiotherapist may help with this.
See if you can find a physio that has the FCAMT designation, they will have a high level of assessment abilities to check all of the above out for you.
I have tight hips too, so I know how frustrating it can be not being able to do externally rotated poses very well.
Hope you can find some suitable solutions.
BTW, whatever you try, give it a bit of a chance to work:)
Kat
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bellabodyjoy



Joined: 30 Sep 2011
Posts: 2
Location: Sacramento

PostPosted: Fri Sep 30, 2011 6:04 am    Post subject: Tight hips Reply with quote

Kudos to you for staying on the investigation path. It is a lifelong journey. The information you have offered is valuable but does not paint the full picture I need to help move you forward on this journey. I invite you to search your local community for a physical therapist with a specialty in orthopedic manual therapy. Someone who always schedules an hour for a first appointment and does not hand you off to an aide for follow up appointments.

If I were that person for you, I would first take a more complete history, one that gave me a sense of the evolution, past treatment responses and who you are as a person, other than the physical. The physical exam would include observing your active range, especially in the spine, hips and knees, and getting a sense of the end range feel of your physiological range. Yes the degrees of hip flexion, extension, abduction, adduction, internal & external rotation are important. But so is the end range feel: hard, squishy, empty, noisy. Logic and information only go so far; hands on information is needed to give a fuller picture.

Besides the physiological range, there is the feel of the joints in motion that the body cannot produce and an outside pair of skilled hands can feel. I would want to get a sense of the posterior anterior glide at the lumbar and the thoracolumbar joints. The hip also has so many accessory motions to assess that can only be felt passively on the treatment table.

Soft tissue restrictions need to be manually assessed. I would focus on the connective and muscular tissues across the back of the pelvis, especially where the quadratus inserts, the back of the ilium and deep to the region between the ischial tuberosity and the femoral greater trochanter, the anterior pelvis & iliopsoas, the adductor origins and insertions and the feel of the hams coming off the tuberosity. Comparing the right & left is so helpful. Any restrictions need to be manually released and then the objective findings need to be re-assessed to determine validity.

Because this is an issue that has been going on a long time, there is good likelihood that it not just the musculoskeletal system that is involved. Only skilled hands can assess if the neurological system is compromised as well through straight leg raise and prone knee bend sensitization and assessment that correlates with the history and other objective findings.

There are no shortcuts and healing from a long-standing compromise takes time, patience, perseverance and the help of a witness and skilled coach. The physical path is an amazing road to unfolding awareness. Good luck on your journey. Bella Dreizler, P.T.
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Bella Dreizler, P.T.
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heidikeithyoga



Joined: 26 Sep 2011
Posts: 4
Location: Los Angeles, CA

PostPosted: Mon Oct 17, 2011 2:23 pm    Post subject: Thank you! Reply with quote

Thank you both so much for your response, I wish I would have seen it sooner I'm not sure why I didn't get a notification. I realize neither of your responses has "the answer" but it's nice to know that there are people out there that care and really want to help solve the problem. I practice yoga and stretch all the time and it helps a little but not as much as it should if it was just tight muscles (my hamstrings and lower back have become a lot more flexible, but this dang lateral rotation thing is not budging!)

Do either of you happen to be in the Los Angeles area? Or Seattle?
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bellabodyjoy



Joined: 30 Sep 2011
Posts: 2
Location: Sacramento

PostPosted: Mon Oct 17, 2011 10:17 pm    Post subject: Reply with quote

I am in Sacramento...you can check my web site at bodyjoy.net.....bella
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Bella Dreizler, P.T.
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admin
Site Admin


Joined: 29 Jan 2006
Posts: 55

PostPosted: Mon Oct 17, 2011 11:00 pm    Post subject: missing notifications Reply with quote

I checked the database and it appears that you were notified of these replies, but I suspect the notification emails were caught by your spam filter. Cheers!
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