February 13, 2025 • 18 mins
Explore the complexities of hip impingement, from underlying anatomical issues to effective strategies for recovery. We focus on the roles of the iliopsoas, glutes, and proper movement mechanics in alleviating symptoms and promoting healthy mobility.
Our conversation doesn't stop at understanding; it progresses to actionable solutions for hip impingement and related conditions like snapping hip syndrome. We discuss practical strategies for enhancing posterior hip capsule mobility, releasing tension in the psoas muscle, and improving glute recruitment. With insights into how ankle mobility can impact hip health and the dreaded "butt wink" during squats, you'll find the tools to restore functional movement patterns. Whether you’re personally affected or know someone who is, this episode is filled with essential knowledge to help overcome hip challenges.
• Anatomical breakdown of hip impingement
• Common symptoms experienced during active movements
• Importance of assessing movement patterns and glute activation
• Strategies for enhancing posterior hip mobility and muscle recruitment
• Role of ankle mobility in overall function
• Understanding "butt wink" and its impact on squat depth
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
So this podcast is talkingabout hip impingement.
Hip impingement is a supercommon diagnosis and pathology
that we come across with ouractive and athletic individuals
(00:22):
that we see and it's beenathletes and it's a super common
report with pinching orimpingement type symptoms in the
front of the hip or feelinglike something's blocked, with
like the hip isn't able torotate as far as it can rotate
for like squat depth and andmovement with like lunges and
the hip mobility and some of thestability seems to be the
(00:45):
culprit with that, as in like,if the hip joint itself doesn't
have enough of the right jointplay and mobility in the right
direction, then it's going toallow the hip joint to move in
excessively a differentdirection and usually in this
case it's going to move moreanteriorly, it's going to slam
and glide anteriorly, which isforward and more of the uh in
(01:06):
like internal rotation position,all right, naturally.
So if somebody's hip joint whenthey squat, we need enough um
posterior role or mobility right.
It has to glide backwards inthe hip joint, the socket,
enough to clear and accommodatedepth with squat right, and if
it's lacking and just due to aperson's natural like movement
(01:30):
mechanics and movement system,it'll glide more forward in the
joint or anteriorly and like thepath of least resistance, water
right, our bodies are likewater and they take the path of
least resistance for movement inthe hip.
It's usually going to beforward in the anterior position
because a super common thing wesee is pain with pinching in
the front of the hip, with goingdeep in a squat or lunge or
(01:51):
something like that, so thatwhat tells us it tells us a
story, right, and we have towatch the person move.
But oftentimes what we findwith that is the anterior
capsule is lax and the posteriorcapsule is just not as pliable
or mobile as it could be.
So times that by a thousandreps the ball and socket joint
(02:13):
in the hip will continuallyglide and grind forward and
that's going to put more stress,stretch and strain pressure on
the anterior structures andthose anterior structures of the
anterior capsule, the psoas,and then some of the small groin
and hip flexor muscles in there, one of them being the
pectineus it's just a smallmuscle as a hip flexor and those
(02:33):
muscles and the anteriorcapsule will get overly
stretched and strained andcompressed or pinched and then
space will get narrowed with alack of the joint mobility going
in the posterior direction.
And that's where we're feelingthe symptoms, that's where we
feel pain.
People usually ask like what'sthe painful structure?
Like what's what's angry?
(02:53):
What tissue?
What's the angry tissue right?
And it's usually the anteriorcapsule, the psoas tendon of the
iliopsoas, the iliopsoas tendonand then uh tendon and then
some groin muscles in the frontand they're getting just pinched
Real quick.
The iliopsoas right gets a lotof attention.
It's actually two muscles thepsoas, that comes from the
(03:14):
anterior bodies of the lumbarvertebrae and it blends with the
iliacus, which comes from theventral side of the backside of
the ilium.
All right, I like the frontpart of the pelvic, the front
ventral aspect of the ilium bonein the pelvis, and those two
muscles blend together to makeup the ilio psoas and for short
(03:34):
people usually say psoas, andthey connect to the lesser
trochanter of the femur and it'sthe main hip flexing muscle or
trunk.
It's a major trunk flexor aswell and we're finding is like
if that thing it's overlydominant and very guarded and
tense, then it's going to bemore likely and susceptible to
get impinged with squats when itcompresses the movement and
(03:59):
also too, with, like, a lack ofcore stability.
What we find is psoas dominance, where the psoas contributes
excessively for core stabilitycontributions, and it's just
going to further accelerate thepsoas to get more guarded,
hypertonic and that's going tocreate more tension.
(04:21):
Right, like my hip feels tight.
Right, it can contribute toback pain too, but anyway,
that's why the psoas gets a lotof attention.
So we can for sure work on softtissue, work with that and dry
needle it.
I'm going to talk abouttreatment in a second, but
anyway.
So for hip impingement, thestructure is getting impinged to
the iliopsoas tendon, somegroin and hip flexor muscles,
like the pectineus being one ofthem, and then the anterior
(04:43):
capsule.
So, as a person descends in asquat if their hip joint glides
forward excessively because ofjust the natural way that their
hip joint decided to move anddevelop over young adulthood and
adolescence, like youngadulthood and then young
adulthood and then as an adultand training, a bunch, right, it
just feeds the same movingpattern over and over again and
(05:04):
like the path of leastresistance bodies and like water
, the body's going to take thesame path of least resistance
for our movement and our jointsand that just feeds into and
accelerates the same movementpatterns over and over and over
again.
All right.
And then over time it's likeman, I don't know what I did,
but my hip feels impinged in thefront, I feel pinching in the
front right.
That would be, over time,developing hip impingement type
(05:25):
of symptoms.
All right, something commonthat comes along with that too
is snapping hip syndrome, whereit feels like something's
flipping over the front part ofthe joint of the hip, like it's
snapping across, like it's likea tendon's flipping over the top
of it.
It also represents what wewould call like anterior
instability of the hip joint orhip impingement type symptoms
(05:45):
From our standpoint.
All right.
So with some of the trainingthat I had done in the past, I
like to create diagnoses basedoff of movement.
All right, because we'removement experts, right, that's
what we do.
So movement diagnosis would beAGMR.
All right, we call thatanterior glide, medial rotation
syndrome.
(06:05):
All right, with a femur of theball of the socket joint, the
bone, the femur, the head of thefemur, with squat and movement
seems to glide anteriorly,anterior glide, and rotate
medially or internally withmovement.
It just glides and issusceptible to that type of
movement pattern with squats andlunges and things, and it just
(06:28):
feeds into that same kind of aproblem.
All right, so that's what ourdiagnosis would be.
We have to work on improving theposterior hip capsule mobility
to allow and accommodate moredepth and hip mobility for
squats and lunges and stuff Justyour hip flexion movements.
We have to accommodate andallow the hip joint to glide
(06:48):
posteriorly freely enough sothat it doesn't just like slam
anteriorly and continue tostress and strain the anterior
structures.
Right, that's step one.
So posterior hip caps andmobility, we'll do manual
therapy for that, to mobilizethat.
Then we for sure need torelease the psoas.
We find ourselves getting thepsoas muscle and tendon to be
(07:09):
less guarded, intense and lit up.
And a great way to do that atleast what we're finding is
prolonged pressure and that'd belike a release or like an
active release.
What are we going to call it?
An ART, active releasetechnique, or just a prolonged
pressure and release?
And a psoas release can be.
It can be tender, but it's veryeffective.
(07:31):
That we've found, and then youcan also needle it, right.
So we'll put some needles inthe psoas as well in the belly
up by the ilium, and that seemsto also help decrease the
guarding and the tension of theiliopsoas or the iliacus, and
that will be one golden BB of alot of things that will help
this get better, right.
(07:53):
Last thing we can't neglect iswe have to get the glutes to be
more active.
It's not like it's gluteweakness, it's more about
recruitment.
And when something is verychallenging for an athlete or an
active person, like running orbox jumps or front squats,
lunges, bulgarian split squats,whatever, when they feel these
hip impingement symptoms, theglutes have to get more
(08:15):
naturally recruitable duringthose challenging movements,
right, and so it's not likestrength, it's more about
recruitment patterns.
It's like can we get yourglutes to activate during these
movements without trying hard?
We have to do a lot of pre-workfirst to set them up for
success and get them moreactivated and recruitable.
(08:35):
It's a neurological recruitmentproblem.
The motor muscle, memory andmind muscle connection, right.
So like the neural muscularconnection and communication
from the nerves starts with thebrain, can't neglect that we had
to improve the recruitabilityof some of the muscles.
(08:55):
It seems like at this point,when this patient comes in right
now, the psoas and some of theanterior structures are more
dominant and the other posteriorstructures in the glutes would
be one of them seem to be notquite as active and activated
and recruitable.
So we have to improve thatsymmetry of recruitment right,
(09:16):
and that disparity ofrecruitment.
We would call that muscleimbalance.
Does that make sense?
It's more of a recruitmentproblem.
And that muscular imbalance ofrecruitment, that disparity, is
what leads to issues down theroad, right, if things are
continually very strong and whatnaturally happens turned on as
soon as you do something hard.
That is more of the dominantmuscle, right.
(09:37):
Another sign we ask for peoplefor psoas dominance is if they
were to do a bunch of crunchesand sit-ups and leg raises and
V-ups and stuff.
Dominance is if they were to doa bunch of crunches and sit-ups
and leg raises and V-ups andstuff.
Where are you burning, like?
Where's the hard work burn,right For like muscle burn.
And if they, I often hear myhip flexors burn.
The front part of my hip isburning, right, I don't even
(09:57):
feel my abs.
That just tells me the psoasdominance, right.
So we can deactivate it withsome needling psoas release to
get it less guarded and maybemore pliable.
Posterior hip capsule mobility,glute activation, recruitment
exercises, and then we'll retesttheir squat pattern right.
Another thing we can't neglect,though, is ankle mobility.
Ankle range motion going intodorsiflexion all right.
When the ankle bends backwardsor up, like towards your face,
(10:20):
that's dorsiflexion, and a lackthereof is going to make a
person have to shift forwardanteriorly over their knees and
their hips, and that anteriorshift is a compensation pattern
for a lack of ankle dorsiflexionmobility, and that's another
contribution to maybe developinganterior hip impingement type
symptoms.
All right, so imagine this.
(10:42):
All right.
Imagine we got a athleticindividual who is coming in with
hip further hip pain issue andthey report hip pinching with
squats and lunges and stuff.
Okay, we check them out and wenoticed that when they squat,
their knee position divesinwards.
(11:03):
We call that valgus.
Their hips bottom out early.
We call that a butt wink.
Everybody has a butt wink.
Their hips bottom out at somepoint, but if they bottom out
too early, then that would tellus that their posterior hip
capsule mobility is limited andtheir heels are coming off the
ground on their ankles andthey're shifting more anteriorly
or forward when they do squat.
So they're shifting forward.
(11:25):
Their heels are coming off theground because they're lacking
ankle dorsiflexion.
Their knees are diving inwardsa little bit like to call that
dynamic valgus, knee valgus,genu valgum, and their hips are
bottom out early.
That is a great recipe foreither knee pain, anterior hip
impingement in the hip, or lowback pain with squats and lunges
and box jumps and Bulgariansplit squats and all that fun
(11:47):
stuff.
Step ups, whatever.
That's a very common thing,right, especially in like dudes
that are over the age of 30 footsix.
Right, because dudes areusually more stiff and it's a
mobility issue versus girl womenthat are usually more mobile.
Right, for women it's usually astability problem where the
stability in their hips, pelviscore and down the chain in their
(12:10):
knees sets them up for aberrantmovement patterns that puts
continual, undue stress on oneparticular area and that would
be like your psoas tendon,anterior capsule hip impingement
.
Hopefully that makes sense andyou can picture that in your
head because this is a supercommon recipe that we see.
So here's what the treatmentlooks like.
(12:30):
All right, so they come in.
We check them out, we figuredit out, we got it All right.
Hip impingement Cool, we'regoing to do posterior hip
capsule mobility, psoas releaseand psoas needling.
Okay, to get the psoas to calmdown.
We're going to work on ankledorsiflexion, mobility, manual
therapy.
This is all manual therapystuff.
First, all right, ankledorsiflexion, mobility of the
(12:50):
joint and then the posteriormusculature of the ankle with
the calf.
We have to work on soft tissuerestrictions too.
So the calf we have to stripthat or mobilize it, cup it,
needle it, whatever Soft tissueintervention.
And then glute recruitment andactivation.
So a glute exercise just toactivate and recruit the
(13:11):
posterior stabilizing glutealmusculature to keep the joint in
a better posterior positionthan we want it to, versus
diving, slamming forward.
So we'll do that.
At the end we'll say like allright, let's retest your squat.
When you came in, it hurt andyou felt a pinch.
We did a bunch of stuff.
Let's retest before you leave.
And very often our expectationand what we hear often is it
(13:33):
doesn't hurt anymore.
They're like what did you do?
Right, like we spent 45 minutestogether because we talked, for
we chit chatted for five andthen at the end we chit chatted
again.
So like 45 minutes of liketreatment or 50 minutes of
treatment and now my hip doesn'thurt, I don't feel it pinching.
What did you do?
We just set up the joints forsuccess, for mobility and then
(13:54):
also activated something so thatit can keep it there for
stability, all right, I promiseyou this is a very common thing
that we help people with.
The other thing we can't neglectis core stability.
We're going to crush corestability, all right, and that's
like the homework would be likeglute activation, core
stability and just movementcontrol and coordination and
fixing the movement patterns,but like work on this, this and
this.
Come back next week We'll seeyou again, we'll check it out
(14:17):
and have good results with thatright.
And part of that is like we tryto convey to people that things
don't hurt for no reason unlessthere's a red flag of
underlying sinister diagnoses.
That not within my scope thatif we're thinking doesn't smell
right, then we refer you outbecause it's not us right.
(14:37):
If it's musculoskeletal, though, and we rule that stuff out
with some screening and 98%confidence according to the
research, 99% confident thatit's not us right.
If it's musculoskeletal, though, and we rule that stuff out
with some screening and 98%confidence according to the
research, 99% confident thatit's not some kind of underlying
systemic red flag, sinisterdiagnosis, then that means that
falls in our school of practice,which is neuromusculoskeletal.
Neuro being like recruitmentand movement control patterns,
maybe neural related pain, andthen musculoskeletal, like
(15:01):
muscles and bones and joints andstuff like that, and we can
intervene that.
So we're just setting things upfor success to move better and
then re-educating the joint tomove in a better way with better
recruitment of other things,muscle recruitment, muscle
strength, and that is thepathway to righteousness for
solving hip impingement typesymptoms.
But we see this all the timeand it's very common.
So I would encourage you, ifyou, if a person is battling
(15:24):
this like, please reach out.
We can at least give you someinsights.
The last thing before we stop isthe butt wink All right, this
gets a lot of attention and, um,everybody has a butt wink.
It just represents when thepelvis rolls from an anteriorly
tilted position into aposteriorly tilted position
through a squat or something ora lunge and more double leg
(15:49):
exercise like a squat, all right, and what that represents is
that either the hip mobility hasrun out or there's a lack of
stability to keep the trunk andthe pelvis in the right position
.
It's usually a combination ofboth.
The question is like, on ascale, of how much is
contributing for each and wherewe're going to focus our efforts
.
If it's a mobility issue andlike a stiff person, that's just
not moving well and they have astiff hip and back, or is it
(16:11):
muscle recruitment and we'regoing to crush either one right,
but that just represents whenthe hip mobility has bottomed
out and now we're moving throughthe pelvis in the low back.
So, in my opinion, risk benefitratio of squatting through and
below a butt wink.
It puts more shear in thelumbar spine and usually creates
(16:32):
more anterior shift in the kneeor knee pressure, but it's not
using.
It's gone beyond the hipmobility that's available and
the glutes aren't going to be asmore recruitable beyond that.
We're just shy of that.
It's going to be the mostactive, the glutes are going to
be the most active, so we canhave equal contributions of like
quad activation, hamstring andglute activation and some core
(16:55):
stability that's set up forsuccess without going through
the end range and bottoming outthrough our hips.
What's going to put unduestress in other structures If we
do that with like load on ourback, with like a front squat or
back squats?
It's just a recipe of increasedrisk benefit ratio that I would
analyze as in like what is itthat we're doing in the first
(17:16):
place?
Right, I'm going to get legstrength, cool.
Do you play a sport thatrequires extreme depth below
butt wink?
Like very, very below parallelthat, um, like a lineman in
football, right?
Or maybe a catcher in baseball?
If the answer is no, then youcan still get great leg strength
gains and not go through buttwink, like the depth bottoming
(17:39):
out where the risk doesn'toutweigh the benefit, especially
for people that we see wherethey're already in pain and in a
vulnerable state of hipimpingement back pain, knee pain
, like whatever.
So that's just what my thoughtis.
On that I'm open to discussion,but that's what the like.
When they say butt wink, it'swhen the pelvis rolls from an
anteriorly pelvic, when you'relike extended, and it rolls
(18:02):
through into a posterior pelvictilt and your back flattens and
that just represents bottomingout of the hip mobility.
So reach out if you have anyquestions.
You're battling hip impingementyourself or know anybody,
because this is a very commonthing that we work with.
It usually representsunderlying other underlying
issues, like some core stabilityissues as well, and pelvic
instability, but for the purposeof just like pure hip
(18:22):
impingement, focus and themechanism that's without.
That's what that discussion wasabout, so don't hesitate to
reach out to me, to questions,and we'll catch y'all next time.
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
So this podcast is talkingabout hip impingement.
Hip impingement is a supercommon diagnosis and pathology
that we come across with ouractive and athletic individuals
(00:22):
that we see and it's beenathletes and it's a super common
report with pinching orimpingement type symptoms in the
front of the hip or feelinglike something's blocked, with
like the hip isn't able torotate as far as it can rotate
for like squat depth and andmovement with like lunges and
the hip mobility and some of thestability seems to be the
(00:45):
culprit with that, as in like,if the hip joint itself doesn't
have enough of the right jointplay and mobility in the right
direction, then it's going toallow the hip joint to move in
excessively a differentdirection and usually in this
case it's going to move moreanteriorly, it's going to slam
and glide anteriorly, which isforward and more of the uh in
(01:06):
like internal rotation position,all right, naturally.
So if somebody's hip joint whenthey squat, we need enough um
posterior role or mobility right.
It has to glide backwards inthe hip joint, the socket,
enough to clear and accommodatedepth with squat right, and if
it's lacking and just due to aperson's natural like movement
(01:30):
mechanics and movement system,it'll glide more forward in the
joint or anteriorly and like thepath of least resistance, water
right, our bodies are likewater and they take the path of
least resistance for movement inthe hip.
It's usually going to beforward in the anterior position
because a super common thing wesee is pain with pinching in
the front of the hip, with goingdeep in a squat or lunge or
(01:51):
something like that, so thatwhat tells us it tells us a
story, right, and we have towatch the person move.
But oftentimes what we findwith that is the anterior
capsule is lax and the posteriorcapsule is just not as pliable
or mobile as it could be.
So times that by a thousandreps the ball and socket joint
(02:13):
in the hip will continuallyglide and grind forward and
that's going to put more stress,stretch and strain pressure on
the anterior structures andthose anterior structures of the
anterior capsule, the psoas,and then some of the small groin
and hip flexor muscles in there, one of them being the
pectineus it's just a smallmuscle as a hip flexor and those
(02:33):
muscles and the anteriorcapsule will get overly
stretched and strained andcompressed or pinched and then
space will get narrowed with alack of the joint mobility going
in the posterior direction.
And that's where we're feelingthe symptoms, that's where we
feel pain.
People usually ask like what'sthe painful structure?
Like what's what's angry?
(02:53):
What tissue?
What's the angry tissue right?
And it's usually the anteriorcapsule, the psoas tendon of the
iliopsoas, the iliopsoas tendonand then uh tendon and then
some groin muscles in the frontand they're getting just pinched
Real quick.
The iliopsoas right gets a lotof attention.
It's actually two muscles thepsoas, that comes from the
(03:14):
anterior bodies of the lumbarvertebrae and it blends with the
iliacus, which comes from theventral side of the backside of
the ilium.
All right, I like the frontpart of the pelvic, the front
ventral aspect of the ilium bonein the pelvis, and those two
muscles blend together to makeup the ilio psoas and for short
(03:34):
people usually say psoas, andthey connect to the lesser
trochanter of the femur and it'sthe main hip flexing muscle or
trunk.
It's a major trunk flexor aswell and we're finding is like
if that thing it's overlydominant and very guarded and
tense, then it's going to bemore likely and susceptible to
get impinged with squats when itcompresses the movement and
(03:59):
also too, with, like, a lack ofcore stability.
What we find is psoas dominance, where the psoas contributes
excessively for core stabilitycontributions, and it's just
going to further accelerate thepsoas to get more guarded,
hypertonic and that's going tocreate more tension.
(04:21):
Right, like my hip feels tight.
Right, it can contribute toback pain too, but anyway,
that's why the psoas gets a lotof attention.
So we can for sure work on softtissue, work with that and dry
needle it.
I'm going to talk abouttreatment in a second, but
anyway.
So for hip impingement, thestructure is getting impinged to
the iliopsoas tendon, somegroin and hip flexor muscles,
like the pectineus being one ofthem, and then the anterior
(04:43):
capsule.
So, as a person descends in asquat if their hip joint glides
forward excessively because ofjust the natural way that their
hip joint decided to move anddevelop over young adulthood and
adolescence, like youngadulthood and then young
adulthood and then as an adultand training, a bunch, right, it
just feeds the same movingpattern over and over again and
(05:04):
like the path of leastresistance bodies and like water
, the body's going to take thesame path of least resistance
for our movement and our jointsand that just feeds into and
accelerates the same movementpatterns over and over and over
again.
All right.
And then over time it's likeman, I don't know what I did,
but my hip feels impinged in thefront, I feel pinching in the
front right.
That would be, over time,developing hip impingement type
(05:25):
of symptoms.
All right, something commonthat comes along with that too
is snapping hip syndrome, whereit feels like something's
flipping over the front part ofthe joint of the hip, like it's
snapping across, like it's likea tendon's flipping over the top
of it.
It also represents what wewould call like anterior
instability of the hip joint orhip impingement type symptoms
(05:45):
From our standpoint.
All right.
So with some of the trainingthat I had done in the past, I
like to create diagnoses basedoff of movement.
All right, because we'removement experts, right, that's
what we do.
So movement diagnosis would beAGMR.
All right, we call thatanterior glide, medial rotation
syndrome.
(06:05):
All right, with a femur of theball of the socket joint, the
bone, the femur, the head of thefemur, with squat and movement
seems to glide anteriorly,anterior glide, and rotate
medially or internally withmovement.
It just glides and issusceptible to that type of
movement pattern with squats andlunges and things, and it just
(06:28):
feeds into that same kind of aproblem.
All right, so that's what ourdiagnosis would be.
We have to work on improving theposterior hip capsule mobility
to allow and accommodate moredepth and hip mobility for
squats and lunges and stuff Justyour hip flexion movements.
We have to accommodate andallow the hip joint to glide
(06:48):
posteriorly freely enough sothat it doesn't just like slam
anteriorly and continue tostress and strain the anterior
structures.
Right, that's step one.
So posterior hip caps andmobility, we'll do manual
therapy for that, to mobilizethat.
Then we for sure need torelease the psoas.
We find ourselves getting thepsoas muscle and tendon to be
(07:09):
less guarded, intense and lit up.
And a great way to do that atleast what we're finding is
prolonged pressure and that'd belike a release or like an
active release.
What are we going to call it?
An ART, active releasetechnique, or just a prolonged
pressure and release?
And a psoas release can be.
It can be tender, but it's veryeffective.
(07:31):
That we've found, and then youcan also needle it, right.
So we'll put some needles inthe psoas as well in the belly
up by the ilium, and that seemsto also help decrease the
guarding and the tension of theiliopsoas or the iliacus, and
that will be one golden BB of alot of things that will help
this get better, right.
(07:53):
Last thing we can't neglect iswe have to get the glutes to be
more active.
It's not like it's gluteweakness, it's more about
recruitment.
And when something is verychallenging for an athlete or an
active person, like running orbox jumps or front squats,
lunges, bulgarian split squats,whatever, when they feel these
hip impingement symptoms, theglutes have to get more
(08:15):
naturally recruitable duringthose challenging movements,
right, and so it's not likestrength, it's more about
recruitment patterns.
It's like can we get yourglutes to activate during these
movements without trying hard?
We have to do a lot of pre-workfirst to set them up for
success and get them moreactivated and recruitable.
(08:35):
It's a neurological recruitmentproblem.
The motor muscle, memory andmind muscle connection, right.
So like the neural muscularconnection and communication
from the nerves starts with thebrain, can't neglect that we had
to improve the recruitabilityof some of the muscles.
(08:55):
It seems like at this point,when this patient comes in right
now, the psoas and some of theanterior structures are more
dominant and the other posteriorstructures in the glutes would
be one of them seem to be notquite as active and activated
and recruitable.
So we have to improve thatsymmetry of recruitment right,
(09:16):
and that disparity ofrecruitment.
We would call that muscleimbalance.
Does that make sense?
It's more of a recruitmentproblem.
And that muscular imbalance ofrecruitment, that disparity, is
what leads to issues down theroad, right, if things are
continually very strong and whatnaturally happens turned on as
soon as you do something hard.
That is more of the dominantmuscle, right.
(09:37):
Another sign we ask for peoplefor psoas dominance is if they
were to do a bunch of crunchesand sit-ups and leg raises and
V-ups and stuff.
Dominance is if they were to doa bunch of crunches and sit-ups
and leg raises and V-ups andstuff.
Where are you burning, like?
Where's the hard work burn,right For like muscle burn.
And if they, I often hear myhip flexors burn.
The front part of my hip isburning, right, I don't even
(09:57):
feel my abs.
That just tells me the psoasdominance, right.
So we can deactivate it withsome needling psoas release to
get it less guarded and maybemore pliable.
Posterior hip capsule mobility,glute activation, recruitment
exercises, and then we'll retesttheir squat pattern right.
Another thing we can't neglect,though, is ankle mobility.
Ankle range motion going intodorsiflexion all right.
When the ankle bends backwardsor up, like towards your face,
(10:20):
that's dorsiflexion, and a lackthereof is going to make a
person have to shift forwardanteriorly over their knees and
their hips, and that anteriorshift is a compensation pattern
for a lack of ankle dorsiflexionmobility, and that's another
contribution to maybe developinganterior hip impingement type
symptoms.
All right, so imagine this.
(10:42):
All right.
Imagine we got a athleticindividual who is coming in with
hip further hip pain issue andthey report hip pinching with
squats and lunges and stuff.
Okay, we check them out and wenoticed that when they squat,
their knee position divesinwards.
(11:03):
We call that valgus.
Their hips bottom out early.
We call that a butt wink.
Everybody has a butt wink.
Their hips bottom out at somepoint, but if they bottom out
too early, then that would tellus that their posterior hip
capsule mobility is limited andtheir heels are coming off the
ground on their ankles andthey're shifting more anteriorly
or forward when they do squat.
So they're shifting forward.
(11:25):
Their heels are coming off theground because they're lacking
ankle dorsiflexion.
Their knees are diving inwardsa little bit like to call that
dynamic valgus, knee valgus,genu valgum, and their hips are
bottom out early.
That is a great recipe foreither knee pain, anterior hip
impingement in the hip, or lowback pain with squats and lunges
and box jumps and Bulgariansplit squats and all that fun
(11:47):
stuff.
Step ups, whatever.
That's a very common thing,right, especially in like dudes
that are over the age of 30 footsix.
Right, because dudes areusually more stiff and it's a
mobility issue versus girl womenthat are usually more mobile.
Right, for women it's usually astability problem where the
stability in their hips, pelviscore and down the chain in their
(12:10):
knees sets them up for aberrantmovement patterns that puts
continual, undue stress on oneparticular area and that would
be like your psoas tendon,anterior capsule hip impingement
.
Hopefully that makes sense andyou can picture that in your
head because this is a supercommon recipe that we see.
So here's what the treatmentlooks like.
(12:30):
All right, so they come in.
We check them out, we figuredit out, we got it All right.
Hip impingement Cool, we'regoing to do posterior hip
capsule mobility, psoas releaseand psoas needling.
Okay, to get the psoas to calmdown.
We're going to work on ankledorsiflexion, mobility, manual
therapy.
This is all manual therapystuff.
First, all right, ankledorsiflexion, mobility of the
(12:50):
joint and then the posteriormusculature of the ankle with
the calf.
We have to work on soft tissuerestrictions too.
So the calf we have to stripthat or mobilize it, cup it,
needle it, whatever Soft tissueintervention.
And then glute recruitment andactivation.
So a glute exercise just toactivate and recruit the
(13:11):
posterior stabilizing glutealmusculature to keep the joint in
a better posterior positionthan we want it to, versus
diving, slamming forward.
So we'll do that.
At the end we'll say like allright, let's retest your squat.
When you came in, it hurt andyou felt a pinch.
We did a bunch of stuff.
Let's retest before you leave.
And very often our expectationand what we hear often is it
(13:33):
doesn't hurt anymore.
They're like what did you do?
Right, like we spent 45 minutestogether because we talked, for
we chit chatted for five andthen at the end we chit chatted
again.
So like 45 minutes of liketreatment or 50 minutes of
treatment and now my hip doesn'thurt, I don't feel it pinching.
What did you do?
We just set up the joints forsuccess, for mobility and then
(13:54):
also activated something so thatit can keep it there for
stability, all right, I promiseyou this is a very common thing
that we help people with.
The other thing we can't neglectis core stability.
We're going to crush corestability, all right, and that's
like the homework would be likeglute activation, core
stability and just movementcontrol and coordination and
fixing the movement patterns,but like work on this, this and
this.
Come back next week We'll seeyou again, we'll check it out
(14:17):
and have good results with thatright.
And part of that is like we tryto convey to people that things
don't hurt for no reason unlessthere's a red flag of
underlying sinister diagnoses.
That not within my scope thatif we're thinking doesn't smell
right, then we refer you outbecause it's not us right.
(14:37):
If it's musculoskeletal, though, and we rule that stuff out
with some screening and 98%confidence according to the
research, 99% confident thatit's not us right.
If it's musculoskeletal, though, and we rule that stuff out
with some screening and 98%confidence according to the
research, 99% confident thatit's not some kind of underlying
systemic red flag, sinisterdiagnosis, then that means that
falls in our school of practice,which is neuromusculoskeletal.
Neuro being like recruitmentand movement control patterns,
maybe neural related pain, andthen musculoskeletal, like
(15:01):
muscles and bones and joints andstuff like that, and we can
intervene that.
So we're just setting things upfor success to move better and
then re-educating the joint tomove in a better way with better
recruitment of other things,muscle recruitment, muscle
strength, and that is thepathway to righteousness for
solving hip impingement typesymptoms.
But we see this all the timeand it's very common.
So I would encourage you, ifyou, if a person is battling
(15:24):
this like, please reach out.
We can at least give you someinsights.
The last thing before we stop isthe butt wink All right, this
gets a lot of attention and, um,everybody has a butt wink.
It just represents when thepelvis rolls from an anteriorly
tilted position into aposteriorly tilted position
through a squat or something ora lunge and more double leg
(15:49):
exercise like a squat, all right, and what that represents is
that either the hip mobility hasrun out or there's a lack of
stability to keep the trunk andthe pelvis in the right position
.
It's usually a combination ofboth.
The question is like, on ascale, of how much is
contributing for each and wherewe're going to focus our efforts
.
If it's a mobility issue andlike a stiff person, that's just
not moving well and they have astiff hip and back, or is it
(16:11):
muscle recruitment and we'regoing to crush either one right,
but that just represents whenthe hip mobility has bottomed
out and now we're moving throughthe pelvis in the low back.
So, in my opinion, risk benefitratio of squatting through and
below a butt wink.
It puts more shear in thelumbar spine and usually creates
(16:32):
more anterior shift in the kneeor knee pressure, but it's not
using.
It's gone beyond the hipmobility that's available and
the glutes aren't going to be asmore recruitable beyond that.
We're just shy of that.
It's going to be the mostactive, the glutes are going to
be the most active, so we canhave equal contributions of like
quad activation, hamstring andglute activation and some core
(16:55):
stability that's set up forsuccess without going through
the end range and bottoming outthrough our hips.
What's going to put unduestress in other structures If we
do that with like load on ourback, with like a front squat or
back squats?
It's just a recipe of increasedrisk benefit ratio that I would
analyze as in like what is itthat we're doing in the first
(17:16):
place?
Right, I'm going to get legstrength, cool.
Do you play a sport thatrequires extreme depth below
butt wink?
Like very, very below parallelthat, um, like a lineman in
football, right?
Or maybe a catcher in baseball?
If the answer is no, then youcan still get great leg strength
gains and not go through buttwink, like the depth bottoming
(17:39):
out where the risk doesn'toutweigh the benefit, especially
for people that we see wherethey're already in pain and in a
vulnerable state of hipimpingement back pain, knee pain
, like whatever.
So that's just what my thoughtis.
On that I'm open to discussion,but that's what the like.
When they say butt wink, it'swhen the pelvis rolls from an
anteriorly pelvic, when you'relike extended, and it rolls
(18:02):
through into a posterior pelvictilt and your back flattens and
that just represents bottomingout of the hip mobility.
So reach out if you have anyquestions.
You're battling hip impingementyourself or know anybody,
because this is a very commonthing that we work with.
It usually representsunderlying other underlying
issues, like some core stabilityissues as well, and pelvic
instability, but for the purposeof just like pure hip
(18:22):
impingement, focus and themechanism that's without.
That's what that discussion wasabout, so don't hesitate to
reach out to me, to questions,and we'll catch y'all next time.
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