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August 15, 2017

Before we move into treating problems surrounding the hips and pelvis, let's get a basic understanding on how they contribute to static and dynamic posture, and why they're often the root cause of many other problems!

Hips Don't Lie

Many problems in other areas of the body can be traced back to dysfunction in the hips and muscles surrounding the lumbopelvic region. These muscles are crucial for many things such as generating power, providing rotation, maintaining good posture, spinal alignment and many others. However, when we experience asymmetry or incorrect motor patterning in this region we almost always end up with dysfunction in other areas of the body. Unfortunately, the way we live our lives in this day and age has created an epidemic of hip dysfunction that has lead to a huge increase in back pain. Let's take a look at the simplest and most common issue as an example.

Example 1: The Office Worker

Spending most of the day sitting in a chair is destroying your body. When we sit in a chair a couple things happen: our hip flexors spend an abnormal amount of time in a shortened state, our hamstrings become lengthened and inhibited because they are no longer needed to hold us upright or provide movement, our core disengages and our lower back slides into extension, and our shoulders round over creating a forward head posture. This isn't a glaring issue right away, but after a couple years of abuse you end up with something that looks like this:

 

See how to pelvis has tipped forward? Take note of how the lumbar vertebrae are pinching together in the lower back. It's also common for the knees to collapse inwards, putting them in a precarious position. But wait, the fun doesn't stop there! To compensate for the increased arch in the lower back, this is what you'll see in the upper body:

Look at that bend in the thoracic spine! This results in more pinching in the thoracic and cervical vertebrae, rounded shoulders and a forward slumping posture. Do you think the person on the right can efficiently complete most motor tasks? Probably not, at least not without compensation and likely some pain. Since the orientation of the hips/pelvis determine the positioning of our upper body, it easy to see how dysfunction in this area can result in problems as far away as the elbow! Yes you read that right, the orientation of your hips could be contributing to your case of tennis elbow.

In this case of our office worker, they spend hours sitting in a chair staring at a computer, only to spend another hour sitting in traffic on the way home. When they get home, they're sitting around watching TV. Worse yet, they might unknowingly be exacerbating the issue by loading the body while in a compromised position. Does that look like a spine that is ready for a heavy deadlift at the gym? Definitely not! When we try to apply load to our body in a situation like this it only further ingrains compensatory movement patterns in this posture, leading us further down the path to pain and injury. You'll often hear this posture referred to as anterior pelvic tilt or lordosis, both meaning a tipping forward of the pelvis. Additionally you'll also hear it called lower cross syndrome, referring to the anterior/posterior muscle imbalances that contribute to it as show below: 

 Unfortunately by this point, the problem can't simply be solved by spending more time standing anymore. Our body has now learned how to compensate and carry itself in this position all day long. Luckily since this is one of the most common issues amongst the greater population there is a ton of resources out there to help you fix it. With that being said, if you're experiencing debilitating back pain as a result of this condition it's always best to see a licensed healthcare practitioner. It should also be noted that this "lower crossed syndrome" can also work in reverse, creating a far less common condition called posterior pelvic tilt:

Take a look at the middle example in the diagram above (anterior tilt) and note how the distance between the back of the pelvis and the back of the knee has increased dramatically. This is why so many people complain of "tight hamstrings" and spend countless hours foam rolling and stretching them, only to make the problem worse. In this position, our hamstrings are actually lengthened causing us to perceive them as tight, when in reality our hip flexors are the tight and overactive muscles in this scenario. If this office worker example fits you, you'll find a list below of tight and lengthened muscles to treat (don't worry we'll be covering treatment for this condition later on in the course):

Tight/Overactive:

  • Iliopsoas
  • Rectus Femoris
  • Adductor Group
  • Lower Back (Spinal Erectors)
  • Quadratus Lumborum 

Lengthened/Inactive:

  • Hamstrings
  • Glutes
  • Abdominals

Just One Example 

By now you've probably gathered the fact that the orientation of our hips and pelvis has a significant impact on movement and posture, but this is only the tip of an iceberg. Our hips are responsible for much more than just tipping us back and forth, they also adduct (come closer to the midline), abduct (move away from the midline), internally rotate and externally rotate. This obviously leaves the door open for more asymmetries that can send dysfunction elsewhere in the body in different patterns than our example above. For the sake of simplicity, we'll only be covering one more tomorrow, but between these two common examples you will have a better grasp on how dysfunction in our hips migrates throughout the body.

 

 


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