"I put my hand upon your hip, when I dip, you dip...."....

"The thigh bone's connected to the hip bone...the hip bone's connected to the back bone..."http://www.songsforteaching.com/folk/dembones.php....
While this song isn't exactly correct, it does give a good and simple explanation of how our body is connected from head to toe.

When someone says "put your hands on your hips" we generally see the hands go to the top of the pelvis-called the iliac crest. The hip is actually a joint, located about a hands length down from that iliac crest. It is a ball and socket joint and allows for 3 planes of motion.

An excess or a  limitation in hip mobility can lead to low back and knee pain or injury. The same is true for the reverse: a weak core may cause the hip to stiffen up. I tend to see restrictions in hip extension and rotation in my work as a physical therapist. Our culture is such that we either sit all day or limit our mobility to the sagital (front to back) plane. We actually have the ability to move in 3 planes of motion (sagital, frontal/coronal-side to side, and transverse-rotation).

You can improve your mobility in a lot of ways. The important thing to remember is to allow and encourage yourself to move in all directions. Staying in one position will only contribute to the stiffness and dysfunction. Try integrating these motions every time you stand up today:

• Touch your toes than lean backwards
• Lean side to side
• Twist

Mix it up with your arms overhead or by your side; widen your stance; put one foot forward and then back; stand on one leg and do the above; raise a leg and kick it forward and back/side to side/across and behind your body; weight shift and step onto one leg then back in the 3 planes. Combine all the above and you will get your whole body moving in that 3D motion.

Strong and stable hips will support your back and knees. Taking your hip joints through full ranges of motion will allow the Glutes, Piriformis, Adductors, TFL, Obturators and entire Flexor group to do their job. 

Our hips carry us through most daily routines including squatting, putting on shoes, kneeling, picking something up from the floor, and climbing stairs. We start using our hips when we start rolling and crawling. We integrate all of these motions into higher level function when we start to walk. More advanced hip mobility integrates into our rotational power which is needed for any sport.

 Hip mobility should not hurt. If you have an pinch, ache or are tender to touch, you likely have some dysfunction to your hip mobility. If your back or your knee hurt, or you can't squat/kneel/sit/cross legs normally it could be stemming from a mobility issue at the hip. Having an assessment by a qualified individual can determine if you need to put your emphasis on mobility or stability and strength.

As the song implies, "everything is connected". Get your hips moving more efficiently and you may just improve your overall skill and function or decrease your pain. Why not take the steps to move and feel better?

*Title of blog quote from Freak Nasty's song "Da Dip

Improving Hip Extension

October is National Physical Therapy Month. Over the next few weeks, I will be talking about ways to improve your hip mobility. This week will focus on improving hip extension. This is my first attempt at a video piece, and I hope to get better at teaching the exercises as I go along. I welcome any feedback to help me get better.

I am in my car and sitting a lot these days. While I do get in and out frequently, I find my hip flexors are getting shortened and I am having a harder time assuming a clean ½ kneeling position. I notice it especially when transitioning from ½ kneel to stand and back down in the Turkish Get Up. I either hyperextend my back or place my knee too far forward. I also notice that in everyday activities, my back is a bit stiff and I have a harder time reaching overhead to put things away in my cabinets.

 I believe that muscle tightness can be due to a movement pattern and muscle group either over or underworking. I will usually recommend following a stretch or tissue release of one structure with an activation of a different structure. However, I also find that position will feed into stiffness and bodies are meant to move vs be in one prolonged position (i.e. sitting all day long). When we spend too much time in one position, structures will become shortened and feel stiff. It’s important to take these structures through different motions to keep the mobility. Sometimes isolated stretching is beneficial to get out of the same posture.

Since our joints are designed to move in three planes of motion and the muscles that move them control this motion, in order to improve my hip extension, and therefore positioning in the TGU and ½ kneeling position, I need to utilize a 3D movement pattern to effectively stretch.

We call the movement of bringing our knee closer to our trunk hip flexion. The muscles that flex the hip are called the hip flexors. Although it is thought that there is only one muscle there are quite a few muscles that contribute to hip flexion. These are the Iliacus, Psoas, Rectus Femoris, Sartorius, Pectineus, Adductors Longus, Brevis and Magnus and Tensor Fascia Lata. These muscles not only create flexion, but also adduct, abduct, internally and externally rotate the hip.

In the attached video, I demonstrate my current favorite hip flexor stretch. I like to do it first thing in the morning after I’ve been curled up in a ball all night. I start on my side with my knees at 90/90 flexion and my head and trunk in a relaxed/neutral position. I then bring my legs into a ½ kneel position while lying on my side. I alternate each leg forward on both sides. In this position I can get hip extension, adduction and internal rotation. While this is generally more of a static stretch, if I rock slightly forward and back or raise my arm overhead it will elongate and change the stretch while adding a multi-directional component. 

I would encourage you to change your position frequently throughout the day to take your joints through different movements. This hip flexor stretch can help if you are having a hard time coming out of a flexed position. It is normal to feel a nice stretch in the front and side of your thigh and into your lower abdomen. If it is painful ease back out of the stretch. If you are continually stretching and not able to make a lasting change, you may need to be activating a different pattern or actually strengthen your hip flexor pattern instead of releasing it. And as always, if you’re having pain or not making a lasting change I encourage you to get assessed by someone who specifically works with movement dysfunction.

Physical Therapists are the people to see for movement disorders

I had a very frustrating week by way of numerous messages coming at me that people really don't understand the benefit of working with a physical therapist (PT). There were multiple times when an MD reportedly said that they would decide if someone was in need of a PT and that they would first prescribe exercises for their client. In one case, the physician said there were good enough exercises on You Tube for a client with vertigo symptoms. (Side note: 1st there are multiple reasons someone can experience vertigo and not one specific exercise routine is right for all of them. 2nd anyone who is experiencing vertigo symptoms knows they cannot feasibly look at a computer screen without wanting to vomit let alone search for a video to do their exercises).

I heard a wife say that her husband with a neurological dysfunction was just going to go work with a personal trainer vs a PT because said trainer knew the muscle that was weak and was just as knowledgeable as a PT. I have the utmost respect for most personal trainers and strength coaches and am constantly seeking more knowledge from my colleagues who have knowledge in strength training and fitness. However, our education is different and we do focus on different things. This particular person needs work on walking and correcting movement beyond what he will receive in a gym setting.

I heard someone who had major surgery say they didn't want to go to outpatient PT after their home care because she thought just getting independent in her home would get her back to a normal level of function.

PT's who are practicing these days have anywhere from 4-7 years of education in the field of physical therapy. The majority of PT's now have a doctorate degree in physical therapy. They may have an undergraduate degree in some sort of movement field (Kinesiology-the study of movement; Exercise Physiology-the study of the underlying mechanisms of physical activity). I myself have both degrees directly in Physical Therapy (because that is how it was set up 30 years ago).

PT's have extensive knowledge of the musculoskeletal and neurological systems. We are able to diagnose and treat movement disorders. We are educated on our limitations and do not diagnose medical problems. We refer out if someone does not have a movement disorder, if there appears to be an underlying medical reason for their movement disorder or if they are not improving with what appeared to be a movement disorder.

We evaluate gait and safety. We prescribe movement corrective strategies that allow better function. We know how to regress a movement to allow gradual return to a higher level of movement.

We are NOT medical doctors. We do not prescribe medicine. We are NOT personal trainers/strength coaches with our PT degrees, though some PT's do further education to be able to include more fitness into their treatment bag. We are NOT massage therapist though we do have a baseline knowledge of therapeutic massage (again, some PT's go for further education to do more advanced soft tissue and lymph work). We are NOT chiropractors, even though we have knowledge of how to mobilize a joint it takes further education on how to safely manipulate a joint.

I believe there is a place for us all to work together. I think someone who is not moving well needs to be evaluated and perhaps treated by a PT. I think there are times when further work up is needed. I think there are times when surgery is needed. I think there are times when someone is moving optimally but needs to get stronger or leaner to move better. I believe there are times when people need the calming hands of a massage therapist or skilled hands of a chiropractor to correct an alignment dysfunction. I think there are times when accupuncture can facilitate improvement in dysfunction. I believe a nutritionist is important to general healthcare to prevent a lot of movement dysfunctions.

I am tired of healthcare being driven by the insurance companies who think there is a one size fits all model and don't want to pay for restorative, preventative and maintenance care. I am floored that physicians say they won't refer to PT in order to save a buck because they will get more in their pocket if they cut outside costs. There is no incentive to give a PT more money if we actually correct a mobility issue and prevent an unnecessary surgery or use of long term pain medication.

I truly believe in a collaborative model where an MD/Nurse Practioner, a PT, a Chiropractor, an Accupuncturist, a Massage Therapist, and a Personal Trainer/Strength Coach all work together to provide their clients with the best HEALTH care possible. This is my vision and mission.

Tidd-bit of the day: A reminder of postural health

I now travel by car for my work as a home care physical therapist. I carry a bag full of necessary equipment. These two activities play a toll on my postural health.

 I was recently reminded, by a 90 year old patient of mine, how important it is to alternate the shoulders that I carry my bag on. This was an incredible observation and reminder for us all.

I think kids today are more aware that it is important to carry your backpack on both shoulders. It wasn't the norm when I was growing up.

I think both men and women need to be reminded to carry their bags (laptops/purses/groceries etc) on alternating sides to avoid overuse of one side. Stop wearing your shoulders as earings and you may be able to decrease neck pain and shoulder pain. If you're in the car like I am, check yourself at the wheel to avoid hunching forward all day long. Alternate your positions by sitting up tall and then sitting back into the seat. Shift your bottom side to side. Rotate your upper body back and forth, and again, drop those stressed shoulders out of your ears while taking a relaxing, slow deep breath.

Posture isn't static. Our bodies want and need to move. Change position frequently and work toward balance. I'm willing to bet this will help you to reduce some pain and stiffness in your own life.

Just say hello

One reason I love being at my lake house is that most people have no problem saying hello. Whether I'm riding my bike around the lake, or walking or just going food shopping, people seem to be friendly.

Most of us have gotten into the routine of ignoring others. They might shun us, or snap at us, or give us a dirty look. The ability to say hello or good morning to our fellow population is a gift.

I challenge everyone to take a risk. Look someone you pass in the eye and say hello. It doesn't matter if it's a scared deer, bold bear, snapping turtle, bitchy dog, sketchy mole or skittish cat. Just do it.

I will bet it will make you smile, and you will make someone's day brighter. Let alone your own day.

I want to ride my bicycle

I am really getting into riding this year. My goal is to ride around half of the Great Sacandaga Lake by my birthday. (That’s only 40 miles. The whole lake is about 70…but that’s for another year.) I think some of my enthusiasm is from a bike talk my company, South County Physical Therapy, did for women a few months ago.  Gene from Gear Works in Leominster (www.gearworkscyclery.com/)  came and did a phenomenal job at teaching us things from shifting appropriately to equipment needs, and bike maintenance. Here are some of my takeaways.

·         If you have knee pain have someone check your saddle height. A lower saddle will create more knee flexion and  your quadriceps will have to work twice as hard, potentially leading to a tendonitis.

·         The reach and the drop are specific to each individual. When in doubt have your bike professionally assessed for proper fit.

·         A smaller seat is better for long rides because it creates less pressure on the perineum and will help to decrease the chance of numbness or tingling.

·         Get bike shoes. Sneakers are too soft to ride with a purpose and your feet will react. **Side note, I am a fan of barefoot training, and improving foot mobility vs keeping our feet stiff, but there are times when it is important to have  more stiff footwear. Skiing and biking, my two favorite activities are some examples.

·         Pay attention! You can’t tell if a car is coming from behind you or in front of you. Don’t assume that they see you.

·         The goal is to keep the same cadence while pedaling. Instead of looking at your gears for when to shift, start to feel when you need to. Use your mind to guide you. Use the lever on the right to downshift or upshift as far as you can and then use the left.

o   This has been key for me this year. I was trying to avoid being big ring/big ring or little ring/little ring. The point is, you can go there, but don’t stay there for a long time. Ideally, you will only need to pass through, and it won’t become a problem.

o   Also, feeling with your legs, connecting to where your body is at really helps to know WHEN to shift. Keep it steady. Don’t grind it out. SO much easier!

·         Things to take with you on your rides:

o   Spare tube

o   Tire lever

o   Air (CO2 cartridge)

o   Phone

o   Food (this can make a huge difference as you are increasing your mileage. It sucks to bonk when you’re half way home)

o   Cash, in case you need water or food

o   Your license and insurance card

·         How to change a tire: ladies, we must learn this. In my opinion it is important to practice, practice, practice. I still don’t get it, but I’m learning and observing all the time.

·         Also, learn how to clean your bike. Chain maintenance will help you ride easier for a long time. Ideally this should occur after every ride so that the chain lube has time to set in before your next ride.

Bike riding is a great way to see the world. On a quiet morning, you can see all kinds of wild life and hear the stillness of the day.  Keep it safe and get out there to enjoy.

 

A topic near and dear to my heart, cheerleading. I recently learned that March is National Cheerleading Safety Month. http://www.cheersafe.org/safety/march-is-national-cheerleading-safety-month .   What a better time to look at ways to keep cheerleaders safe and able to continue doing the amazing tricks we are used to doing.

 According to the STOP Sports Injuries Campaign, “the U.S. Consumer Product Safety Commission estimates that cheerleading led to 16,000 ER visits in 2002(the latest year for data.) While not as frequent as injuries in other sports, cheerleading injuries tend to be more sever, making up > ½ the catastrophic injuries in female athletes.” http://www.stopsportsinjuries.org/cheerleading-injury-prevention.aspx#types 

Over the last 30 years I have watched cheerleading evolve from an activity in which we wore bowling shoes and barely moved, to a very athletic activity in which people are performing amazing tricks. Kids start at All Star gyms and youth programs as young as 6 years old. Some then perform through college, and even after as adults. Specializing in any sport at that young age will lead to injuries, let alone the fun and crazy stuff we are attempting to do.  So how do we reduce these injuries, and what can you do to promote safe cheering?

NCAA (and the cheer governing bodies) doesn’t recognize Cheerleading as a sport, so it's not. It's too bad that they won't even give it club sport status. It’s even sadder that so many kids miss out on scholarships and even funding for safety equipment and training. http://www.kwch.com/kwch-news-jlr-cheerleading-not-a-sport-20130307,0,4126497.story

Anyone involved in cheering knows “perfection before progression” and performer readiness. Coaches, parents and cheerleaders need to abide by this. Stunts must be hit 10/10 times in order to perform them on the field, and in order to progress. Cheerleaders must have the strength, flexibility, and general conditioning to perform what we are asking. They need to be fully “present” when practicing and performing. The bottom line is if they are not ready, they must not move forward.

From a physical standpoint, cheerleaders to have the mobility and stability to perform the skills we want them to. They need to create length while holding the body tight without moving. They need core stability. They need to strength train, do the mobility/recovery work, and learn how to care for their bodies. As a physical therapist, and former cheer coach I want to help promote a knowledge base for safe cheerleading. I want to help cheerleaders move away from the conditioning programs of 30 years ago, and embrace a strength and conditioning lifestyle that will not only keep them safe, but will allow them to keep progressing and doing fun tricks.

 Cheerleading can be a safe, athletic activity. We just need to do the work