A few weeks ago I wrote about my “unhappy pelvis,” which of course you can read about HERE.

I’ve been seeing my chiropractor on a weekly basis for the past two months. We’ve become quite the BFFs. Okay, maybe we were before since she is the one that keeps my body from completely falling apart…

Last week we had a breakthrough! ALLEHUJAH! My pelvis has settled down a bit and has finally managed to stabilize itself. Now that my pelvis has stability and isn’t playing the hokey pokey (and moving all-about), we can begin to focus on regaining mobility. ALWAYS train stability before mobility… that’s my take-away message today. You can thank me later.

Casey has determined that my right hip lacks internal rotation due to the fasica tissue surrounding my gluteus medius, semitendinosus, semimembranosus and adductor magnus. Being the total anatomy geek that I am, I started doing some research on the topic. There isn’t a ton of research out there on the topic because hip and groin injuries in athletes are less common than injuries in the extremities. However, when they do occur, they can result in extensive rehabilitation time (Anderson et al., 2001).

Fun fact – loads of up to eight times body weight have been demonstrated in the hip joint during jogging, with potentially even higher loads in more vigorous athletic competition. So, if you are a 200 pound man then you could have up to 1600 lbs of force working against your hip joints. Yikes! But, the hips are uniquely adapted to transfer such forces (Anderson et al., 2001). The body’s center of gravity is located within the pelvis, anterior (front) to the second sacral vertebra. The hips are essentially a series of arches, which according to Wikipedia (obviously a completely reliable source 😉 ) resolve forces into compressive stresses and, in turn, eliminate tensile stresses.

The major ligaments of the pelvis and hip are known to be some of the strongest in the human body and are well adapted to the forces transferred between the spine and the lower extremities. The iliac crest has multiple muscle origins and insertions, including the internal and external oblique, latissimus dorsi, paraspinal muscles, and fascia from the gluteus medius muscle. The gluteus medius (GM) is an important muscle during movement.

Source

A significant amount of GM muscle activity has been reported during the midstance and terminal stance of gait to provide pelvic stabilization during a single normal gait. The GM is generally referred to as a primary hip abductor (leg moves away from the center of the body); but, research has indicated that it most likely plays a more effective role as a pelvic stabilizer (Schmitz et al., 2002). The anterior fibers of the GM also play a role in hip internal rotation while the posterior (back) fibers play a role in external rotation. Lack of internal rotation of the hip has been linked to lower back pain (Vad et al., 2003) in several studies in athletes.

So, what does this mean for my hip? Well, it means that my chiropractor can beat the hell out of my hip musculature. Last week she broke out her graston tools and left me with major bruises on my hamstrings, piriformis, and GM. Though, I wanted to cry while she stuck her metal tools in my GM, it made a world of difference in my hips! All week I felt that I had a whole new hip.

We have now isolated the problem in my hips through the process of elimination. My GM is so much better now and most of the “bad” fascia tissue has broken up leaving me with more mobility in that muscle. Cue the theme song to “Happy Days.”

My chiropractor has identified that the lack of internal rotation in my right hip is due to the semitendinosus and semimembranosus (medial hamstring muscles) and my adductor magnus muscles. The adductor magnus muscle is actually an external hip rotator muscle, but it was playing a major role in pulling my pelvic symphysis apart a few weeks ago. The issue is isolated at the muscle origins, where each muscle attaches to the ischial tuberosity (sit bones). It is not actually my muscles causing the problem, but the fascia tissue surrounding each muscle that is restricting the muscle from flexing and moving correctly. Thus, stretching and yoga are not effect methods to “fix” the problem. Stretching and yoga certainly help, but myofascial release is the best method.

The Guilty Parties… (source)

My hip issues have been prevalent for the past couple of years and I feel like I am making process in finally determining the root cause of the issue and resolving it. I know that training and completing an Ironman on an injury was not the smartest move. My goal this year is to be smart about training and listening to my body. It’s hard for me to step back and take a break from training, but I know in the long run that it is a worthwhile investment to my health and my performance. I mean, it’s not like you would put a second floor on your house if you had significant cracks in your foundation making it impossible for the foundation to support a two-story home, right?

~ Happy Training!   

References

Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. The American Journal of Sports Medicine. 2001; 29(4): 521-533.

Schmitz RJ, Riemann BK, Thompson T. Gluteus medius activity during isometric closed-chain hip rotation. Journal of Sports Rehabilitation. 2002; 11:179-188.

Vad VB, Gebeh A, Dines D, Altchek D, Norris B. Hip and shoulder internal rotation range of motion deficits in professional tennis players. Journal of Science and Medicine in Sport. 2003; 6(1): 71-75.