Vail Daily health column: Hip pain? Retrain the brain
December 1, 2014
Is a labral tear in your hip the source of pain, or is it a symptom? Many of those who elect to have the tear surgically repaired struggle with recurrent pain and dysfunction, despite arduous rehabilitation efforts. What if the tear itself is not the problem? What if a torn labrum is actually a symptom, the byproduct of a compressed hip?
A good analogy is a roof without gutters. Rain and melting snow run unobstructed, which in time erodes the siding. Cleaning the mold, repainting the surface and even replacing the siding will provide a temporary fix. Ultimately, unless gutters are installed, the problem will persist. Focusing on the labral tear alone is akin to replacing the siding while ignoring the gutters.
ADDRESS THE SOURCE
In a healthy hip, the head of the femur (ball) smoothly rolls and glides in the socket. The labrum acts to deepen the socket and keep the ball in place. Due to trauma, repetitive postures or faulty movement patterns key hip muscles lose their function. Other muscles compensate to get the job done. With chronic and habitual imbalances, the ball gets pulled off center.
By changing the axis of rotation, the labrum is now exposed to abnormal stress. The labrum is continually pinched, pulled and beaten. It is the chronic exposure to unbalanced forces that leads to a torn labrum. Repairing the labrum will improve the anatomy, but it does not resolve the underlying problem. It treats the "what" (tear), not the "why" (compression).
In most patients with labral tears the Psoas (a major core muscle that connects the lower body to the spine) has shut-down. The brain literally forgets how to use the muscle. As a result the hip now lacks a critical stabilizer. The brain is good at cheating, so it locks-down (via compensation) to create some form of stability. These supporting muscles (iliacus, piriformis and even the capsule itself) become chronically tightened. Simply releasing or stretching the tight muscles won't do either.
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The key to successful rehab is specifically identifying and correcting the pairing of underactive and overactive muscles. Isolated stretching or strengthening won't work. The brain has learned the pattern of using muscle B, when it should be using muscle A. The solution lies in first releasing the overactive muscles. The brain then has a 30 to 60 second window where it says "now what?" This is where you fire/retrain the underactive muscle. With this formula, the brain re-learns the correct pattern of muscle activity. The hip regains normal function.
It's not just the anatomy; it's how the brain uses it. Retrain the brain, or live with the pain.
Physical therapist Julie Peterson, owner of Concierge Physical Therapy, has a background in manual therapy and functional movement. Peterson is the only specialist in the Vail Valley certified to perform neurokinetic therapy. She can be contacted by email at info@conciergePTcolorado.com or by phone 970-306-3006.