Hip Pain In Athletes

Written on April 13, 2009 at 7:28 pm, by Eric Cressey

A New Perspective on Dieting

We’ve got some great content lined up for you in this newsletter, but before getting into that I want to give you a quick heads-up on something really cool.

Joel Marion just posted some interesting free videos for you about how you can use strategic dietary cheating and carbohydrate cycling to accelerate fat loss; they’re worth checking out before they get taken down in a day or two.  If you are someone who is interested in losing body fat, yet aren’t terribly excited at the idea of “dieting” or giving up your favorite foods, then you really need to check these out.

While I don’t necessarily agree with all of Joel’s methods, I do like the fact that he’s a big believer that fat loss nutrition doesn’t have to be “painful” – and he’s always looking for ways to turn “good” into “optimal.”  As a result, he’s gotten great results with clients time and time again.
See what he’s got up his sleeve this time over at CheatYourWayThin.com.

Also, at that page, you can register for a special list for a presale in which you’ll be able to get his brand new complete system at a $50 discount.  It’s a very sweet deal.

Now, on to the content…

A Common Cause of Hip Pain in Athletes

Hip pain – particularly of the anterior (front of the hip) variety – is a very common problem in the weight training population.

In her book, Diagnosis and Treatment of Movement Impairment Syndromes, Shirley Sahrmann discusses Femoral Anterior Glide Syndrome in excellent detail.  And, while it may seem like an obscure diagnosis, it’s actually a really common inefficiency we see in a weight training population.

In order to understand this syndrome, you have to appreciate the attachment points and functions of the hamstrings and gluteus maximus.  With the hamstrings, you’ll notice that they attach to the ischial tuberosity of the pelvis (with the exception of the short head of the biceps femoris, which attaches on the femur), and then run down to a point inferior to (below) the knee.  In other words, they are a two-joint muscle group.  All of the hamstrings aid in knee flexion, and all but the short head of the biceps femoris also aid in hip extension.

Conversely, the glutes attach on the pelvis and the femur; they’re a one-joint muscle – and this is why they can so directly impact hip health.

You see, when the hamstrings extend the hip (imagine the hip motion that happens when one comes out of the bottom of a squat), they do so in a “gross” fashion.  In other words, the entire leg extends.  In the process, there is little control over the movement of the femoral head (“ball” in the “ball-and-socket” hip joint) – and it tends to migrate forward during hip extension, giving you a femoral anterior glide syndrome.  In the process, it can irritate the anterior joint capsule, and this irritation can give a sensation of tightness in the front of the hip.

Fortunately, the glutes can help prevent the problem.  Thanks to their point of attachment on the superior aspect of the femur (closer to the hip), they have more direct control over the femur as it extends on the hip.  As a result, they can posteriorly pull the femoral head during hip extension.  So, in an ideal world, you get effective co-contraction of the hamstrings and glutes as one extends the hip; they are a system of checks and balances on one another.  If you use the hamstrings too much in hip extension, you’re just waiting to develop not only femoral anterior glide syndrome, but also hamstrings and adductor magnus (groin) strains and extension-based back pain.

As an aside, this hamstrings/glutes relationship is somewhat analogous to what you see at the shoulder with the subscapularis posteriorly pulling the humeral head as the infraspinatus and teres minor allow it to drift forward.  That’s another newsletter altogether, though!

Once the femoral anterior glide issue is in place, the first course of action is to stop aggressively stretching the hip flexors.  While the issue gives a sensation of hip flexor “tightness,” in reality, stretching the area only exacerbates the anterior hip pain.  A better bet is to just ditch the stretching for a few days, and instead incorporate extra glute activation work, as detailed in Assess and Correct.  Eventually, though, one can reintegrate both static and dynamic hip flexor stretches.

Just as importantly, it’s important to identify the causes.  We’ll see this issue in runners who have no glute function, but more commonly, I’ll see it in a weight training population that doesn’t understand how to complete hip extension.  Here’s what a hamstrings-dominant hip extension pattern would look like with squatting.

The final portion of hip extension is when the glutes are most active, so it’s important to “pop the hips through” at lockout of deadlifts, squats, pull-throughs, and other exercises like these.  In the same squat example, it’s really just as simple as standing tall:

Of course, this is just the tip of the iceberg when it comes to hip issues in athletes, but it’s definitely something we see quite a bit.

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The Most Important Thing for Rookie Trainers

Written on February 11, 2009 at 5:03 am, by Eric Cressey

Earlier this week, we had a gentleman stop by our facility to observe Tony, Brian, and I in action.  He is new to the industry – less than one year under his belt, in fact – but has a solid roster of clients of all ages and ability levels.  I give the guy a ton of credit for coming all the way to MA from across the country to get better at what he does; I wish more people were passionate enough about helping their clients to do so.

Anyway, while he had quite a few questions, he asked me flat-out what I think the most important thing to do is for an up-and-coming personal trainer or strength and conditioning coach.  My answer was simple: learn functional anatomy.  Very simply, everything you do with a client or athlete comes down to understanding how their body is built.  And, if you know how the body is built (statically), you can start to understand how it functions (or malfunctions) dynamically.  This is a skip that, in my opinion, far too many trainers and coaches overlook.  It may be boring to memorize all this stuff, but it’s incredibly important.

I mean, honestly, have you ever met a mechanic who didn’t know what a radiator did or where it was located?  A car’s anatomy is probably just as expansive as the human body, but you don’t see mechanics fixing car troubles before they learn where all the parts are – or what they’re supposed to do.  Sadly, I think that if I asked every trainer on the planet what a coracobrachialis was, only half could even tell me where it’s located, and even fewer would be able to relate its functions.

At risk of sounding overconfident, this is one reason why I’m so proud of our Building the Efficient Athlete DVD Set.  In my experience, there isn’t a single product out there that delves into functional anatomy in as detailed a fashion as Mike Robertson and I do, and there certainly isn’t anything that relates that anatomy to what you see when your clients and athletes perform exercises, encounter injuries, or struggle to grasp some new technique.

Here’s a little sample of what you can find on the first two (of eight) DVDs in the set:

DVD #1: Introduction

• Why learn functional anatomy?
• What resources do the BEST use to improve their skills?
• What resources will absolutely make you regress as a trainer, coach or athlete, and how do you avoid them?
• How will improved posture not only keep you healthy, but also improve your performance?
• How can you use the Law of Repetitive Motion to rapidly elicit changes in posture?

DVD #2: Lower Body, Core and Upper Body Functional Anatomy

• Are the hip flexors tight? If so, which one(s)? We show you specific tests to figure out exactly which areas are short or stiff.
• Why are well functioning glutes an absolute necessity if optimal performance is your goal? How can they help us to avoid hamstring pulls, groin strains, and lower back pain!
• How is it that we’ve misunderstood the role of various core muscles for so long? And, how can we modify our training to “undo” the damage that’s been done?
• How can the pectoralis major and subscapularis be both antagonists and synergists, and what are the implications on health and performance?
• Have we been missing the boat on how we view rhomboids?
• Why doesn’t anyone think about pectoralis minor?

Again, this is just the tip of the iceberg.  There is a whole lot more on the other six DVDs, including live static and dynamic assessments, programming strategies, and loads of troubleshooting for common resistance training exercises.

For more information, check out Building the Efficient Athlete.

Foam Rollers and Football

Written on August 24, 2007 at 10:14 am, by Eric Cressey

Q: Hey Eric, I’ve been a member of T-Nation for about three years now. I really enjoy your articles. And one caught my attention abouta year ago. The foam roller article. I bought one, asked my PT about it and he didnt know much so i kind of threw it aside. Well to make a long story short. I play high school football, its my senior year. I’ve been playing and training for seven years now. My ultimate goal of course is to get a scholarship to play some college ball.

However the day before practice I pulled my hamstring doing sprints down the beach. I’ve been going to PT and seen about three doctors. Its not that serious of a pull id say a mild grade 2. I’ve been feeling alot of pressure from my coaches to get back on the field and have tried to comeback twice. Whenever i put any pressure on the thing it just tighens right up. But running on it seems to be fine. There is a pretty good size knot on the lower part of my left hamstring right above the back of the knee. So tonight i read your article again and busted out the foam roller.

After the first 10 minutes of the hamstring it felt 100 times better. I’ve done it three times in the past three hours. I got a big game on friday that I have to play in and I’m doing as much as i possibly can to get this thing healthy. I know you guys dont diagnos over the internet or anything like that i just wanted to tell you thank you for the info on the foam roller. I’m gonna use this thing everyday before and after practice/games and hopefully i can get back to 100% as soon as possible. Thanks again for all the great info!

A: I’m glad to hear that the roller worked out for you.

Just remember that work you do with the roller is just treating the symptoms (scar tissue). You have to get to the bottom of why your hamstrings are so knotted up if you want to fix the problem rather than just take one step forward and one step back.

In most cases, the hamstrings get locked up because they’re overactive – because the glutes aren’t doing their job as hip extensors. It’s one reason why after hamstrings go, you also see groin pulls (adductor magnus is a synergist to the glutes in hip extension) and piriformis strains (piriformis is a synergist in lateral rotation).

Check out our Magnificent Mobility DVD; it would be a good investment. It’s worked for a lot of guys w/their hamstrings problems, and provided that the right exercises are selected, you should see some great improvements.

Eric Cressey

Talking Shop: John Pallof

Written on July 18, 2007 at 9:34 am, by Eric Cressey

Eric Cressey:

Randomly throw some idea out there that will really make our readers say “Oh, crap, that really makes sense!”

John Pallof:

1. A muscle that often gets overlooked with shoulder impingement type problems – like the plain looking girl at the dance – the serratus anterior. It’s very important for a few reasons: helps rotate and protract the scapula/acromion up and out of the way of the humeral head, and is also important for force coupling with the rhomboids/lower and middle trapezius.

2. Many “hamstrings pulls” – especially chronic ones – are actually symptoms of a mild nerve irritation – neural tension dysfunction. Just like a brake cable on a bike, your nerves need to glide through the tissue they travel through. If they get hung up, they will become symptomatic to varying degrees. Picture a brake cable on a bicycle – the metal cable glides through the plastic casing. Your nerves need to be able to glide through the structures and tissues they travel through – as much as 7 to 10 mm in some areas!

3. A topic of contention – the elephant in the room – the psoas. While there are many theories out there, I believe the psoas acts along with the TVA/multifidus/internal oblique as a local/segmental stabilizer of the spine. Think about the origins on the anterior surface of the transverse processes of the lumbar spine. Why the hell would it attach so intricately if all it did was flex the hip? The psoas atrophies in a fashion similar to the multifidus with back pain. The multifidus and the psoas form a force couple/agonist-antagonist relationship, giving stability of one vertebrae on the other.

Boxers or Briefs

Written on June 11, 2007 at 3:06 pm, by Eric Cressey

Q: I am a strongman competitor and am thinking about incorporating squat briefs into my training. I talked to a powerlifter buddy of mine and he said he would recommend briefs for max effort squats and deadlifts to keep the hips healthy. What do you think about this?

A: Well, my first observation is that you’re not going to be using the briefs in competition, are you? Specificity is more important than people think; what’s specific for a powerlifter won’t necessarily be specific for a strongman.

However, given the nature of the training you’ll be doing (powerlifting-influenced), I wouldn’t rule the briefs out right away. It depends on whether you’re regularly box squatting and/or squatting with a wide stance. If you are, I’d say that they’re a good investment, and you could use them 1-2 weeks out of the month.

I would, however, caution against using them as a crutch against poor lifting technique. There are a lot of guys who just throw on briefs because their hips hurt, not realizing that it isn’t the specific exercise that is the problem; it’s the performance of that exercise that gives them trouble. For example, hamstrings dominant hip extension/posterior pelvic tilt allows the femoral head to track too far anteriorly and can cause anterior hip pain. If the glutes are activated appropriately, they reposition the head of the femur so that this isn’t a problem. Unfortunately, a good 80% of the population doesn’t have any idea how to use their glutes for anything except a seat cushion.

Eric Cressey

Efficient Athletes will always be Better Athletes