Question from Marsha:
Why are the adductors and hip flexors so irritable with hip joint pain/pathology?
Answer from Ginger:
Great question Marsha!
Here is my theory (albeit short version): There are several critical general variables that create a healthy joint. Those are form closure, force closure, motor patterning, and emotional factors, which are drawn from Diane Lee’s pragmatic integrated model of joint function.
Let’s start at the top: If form closure of the hip is interrupted – via loss of joint pressurization, femoral head/acetabular alignment, ligamentous integrity, or capsular length/tension, then all other components that create joint health are compromised and made far more difficult to achieve, if they can be achieved at all. Meaning, force closure – which is accomplished through muscular effort + all the variables above – will place an inordinate amount of stress (length/tension) on the remaining variables – the muscles and fascia.
Neuromuscular patterning is our third stop in answering your question – if form closure and if force closure are compromised – then patterning will be almost impossible to achieve, and since the surrounding musculature – and their related fascia – is a kind of last proviso for joint stability – know what happens? You guessed it – havoc has been set loose in the hip and pelvis.
Lastly – there is the emotional component – of which our physical health is intimately intertwined. Holstege called it the emotional motor system, which is very fitting to explain what happens to our emotional well-being when we have a physical problem, or perhaps more importantly, vice-versa. And here’s the rub – if we don’t have all those components – plus healthy fascia from the nearby pelvis and visceral areas – then the psoas and adductor are, in many ways figurative and literal, left hanging out on their own.
The double whammy is – we can’t “release or stretch” the anger out of them. That’s worth saying again – we cannot “stretch” or “release” our way out of psoas or adductor issues. They provide a valuable service: trunk and hip stability. However, we also cannot leave them this way, especially since the psoas can transmit compressive force over the anterior labrum, and that’s not ideal at all.
This is my short answer – I could go on for days, but first we will stop here and see if this answer has been helpful.
Very helpful, Ginger. I could listen to you talk as long as you want to! I’ve had ups and downs through PT as conservative treatment following my injury last August. As my job as a peds PT is ramping up (new position at a clinic that’s very busy over the summer) I’m having a lot more muscular pain. I figured it’s my body’s response to the increased load. We’ve been working on muscular stability and coordination to compensate for the decreased joint stability caused by the tear and I’ve made progress. The muscular pain can be pretty profound, though. I’m not sure if I can get strong enough to support my hip when demand is high like this.
Oh well thanks Marsha! Glad it was helpful! And your observation about muscular demand and response – is very astute, although an unfortunate reality. However, we can consider it part of the warning system of the body. When our body sends a message, sometimes in the form of discomfort or pain, it is my job as a PT to help patients listen carefully to those signs, and work with that individual to determine the “how’s and why’s” of what is happening so, together, we can work as a team to manage their pain, impairment, and improve their quality of life. I have found over my 20 years of practice that contemplative practices, especially yoga, are the best vehicle for creating patient success and delivering rehab!
Hope this helps!
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