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Hip pain

Back pain, Chronic Pain, groin pain, Hip pain

Quadratus Lumborum – Why it hurts and How to fix it

September 4, 2017 • By

Back pain, Quadratus lumborumThe Quadratus Lumborum can cause some real grief through your back, buttock, hip, and groin but with the right management, exercises and self-treatment, you can be pain free – long term.

Where is quadratus lumborum pain felt?

You can see the pain referral patterns below for the deep (closer to the spine) and superficial fibers of the QL muscle. Referral from the quadratus lumborum can vary a lot between people due to this varied referral pattern, in some, it can be a literal pain in the butt and others it is the side of the back, hip or the groin.

Quadratus lumborum pain Quadratus lumborum pain

Quick anatomy

You can easily see from the video below that is the quadratus lumborum tightens up, it can pull at your bottom ribs, vertebrae or pelvis and if this happens one side more than the other, it can lead to some real asymmetry and not just cause back pain but a whole raft of other things.

How can a tight quadratus lumborum effect you?

Apart from being painful, it can also increase the load on quite a few other structures. Often when one side tightens up it can lift that side of your pelvis a little making you feel out of place or out of alignment (even though your back can’t go out of place,1). It can also pull at your ribs, tilting you to the side, limiting your reaching and restricting your breathing. And last but not least if the QL is tight on both sides, you get more compression on your spine.

The QL can also:

  • Cause a sharp stabbing pain in the low back
  • Cause pain and limitation when trying to turn in bed or stand from sitting
  • Make it look like you have a leg shorter than the other by holding one side of your pelvis higher
  • Contribute to a lot of other issues such as patellofemoral pain, trochanteric bursitis and scoliosis due to asymmetrical tension

So how do we fix it?

In three steps:

  1. Ease the pain by decreasing tension by releasing the muscle (stretching often doesn’t help)
  2. Get you back to normal by regaining full range of motion through your back and hips
  3. And finally, treat the cause by improving strength of the QL so that it can handle everything you throw at it

 

1. Ease pain

For this, we need the muscle to relax so the most important thing is reducing aggravating activities and applying heat. Heat can be applied be a wheat bag, hot water bottle, heat rub or anything similar, it will make a big difference. Of course make sure you don’t make it too hot or hurt yourself, by following the instructions.

Also, you can directly release the quadratus lumborum, which is far more specific than stretching. Check out our past blog post to learn how to do a myofascial release for your Quadratus Lumborum.

2. Regain normal range

We need to now get everything back to normal – not just the quadratus lumborum but the muscles that have changed because of the asymmetry that the QL caused. The following stretch is perfect for this, just remember to relax into it and that it isn’t, no pain-no gain.

Gluteal stretch: This will help even you out and regain hip range

3. Strengthen

Now get you quadratus lumborum stronger so that it can handle what you want to be able to do. A stronger QL means less pain and you have more control and power, without having to avoid things constantly.

To load the QL, we need to load the side of your body and the best way to do this is the side planks and the one sided farmers carry:

Side plank Level 1

Hold for up to 1 minute. Once you can do that comfortably, progress to level 2 below.

side plank for core strengthening

Side plank Level 2:

In the side plank, raise your top leg up and down up to 10 times. Repeat 3 times each side.

 

Side plank leg raises

 

one sided farmers carry for QL strengtheningOne sided farmers carry:

Hold onto a dumbbell, kettlebell or anything with a bit of weight to it in one hand and do some laps (e.g. 10 x 10m laps on each side).

Carrying a weight on one side makes the QL and obliques on the opposite side work hard to keep you upright.

Note: Don’t do two sided carry like in the picture!

Tip: try to stay upright!

 

And that’s it.

Heat

Release

Stretch

Strengthen

Work at that most days and notice the results.

On a side note, once you are feeling improved, don’t slack off on the exercises, they are great to do just to maintain yourself in great condition, even if it is just three times per week.

 


Back pain, Health, Hip pain, Knee pain

The Wall Sit – Beat knee pain

July 5, 2017 • By

The Wall sit is one of the most do-able exercises and is a brilliant strengthening exercise for anyone with back, hip or knee pain.

Who would benefit from would wall sits, otherwise known as wall squats?

  • Those wanting to avoid or prepare for knee or hip surgery
  • Most with hip or knee arthritis will get massive benefit
  • Those of you that struggle to get up from chairs
  • Anyone at all who wants to strengthen their back and legs from home

wall sit exercise for knee pain arthritisSo what is a wall sit?

It is simple a squat hold with your back leaning against the wall as shown in the video below. the key  things to remember are:

  • Your knees should no go out past your toes. Aim to keep your knees over your ankles or feet
  • Keep your chest up and back straight
  • Do not push into pain
  • Expect some burning in your thigh muscles (this is a good pain and shows your muscles are working hard)

Top tip: Lean into the wall with a Swiss Ball, foam roller, basketball or anything that rolls to minimize friction – this makes the exercise far more effective and comfortable.


The idea for the wall sit is not to repetitively go up and down but squat down and hold for a period of time.

Aim to hold until your muscles start fatiguing and then come back up again and repeat 10 times – over time your hold time will get longer and longer and your back and legs will get stronger! (1)

Tip: Only go down as far as is comfortable for YOU and don’t go past horizontal thighs.

Progression

The one-leg wall squat is often used as a test of lower limb endurance(2,3) and also makes for an excellent exercise when you want to push your leg strength further while still looking after your knees.

All you need to do differently for the one leg hold is lower yourself down, keeping your feet shoulder width apart and then carefully lift one foot just off the ground – hold as long as you can (without losing form).

Below is a table giving average times to gauge where you are at:

wall sit values

The wall squat is a great exercise and well worth persevering with whether you can just hold a double leg wall sit for 20 seconds or a one leg squat for 100! Make it a challenge every night for one month and notice the difference.

References:

 


Hip pain, Knee pain, Spine

How to Protect and Strengthen Cartilage

July 19, 2016 • By

strengthen cartilageWhat if I told you that to keep your joint cartilage strong you need to put load on your joints – Not bike and swim?

Your articular cartilage forms the smooth covering inside your joints and often when someone has degenerated cartilage they are told to decrease loading and get into non-weight-bearing exercise – such as swimming and cycling.

strengthen cartilageIn a way this makes sense in that if you want to preserve and strengthen your cartilage, you wouldn’t run and jump and lift weights, would you? But our body doesn’t work like that, it responds positively to the force we put through it and really lives by the use it or lose it motto.

Recent research shows that:

Through putting load (body weight) on our cartilage we actually promote Transforming growth factor beta (TGFbeta) gene expression which helps to maintain our articular cartilage strength – That is pretty awesome.(1)

So without going into boring detail – By doing exercise which loads and compresses your cartilage, you actually help to strengthen cartilage and maintain homeostasis.

So get out there and walk, run or lift to keep your joints healthy – whether it is your knees, hips, back or any other weight-bearing joint.


Back pain, Health, Hip pain

The Best Glute Stretch

August 25, 2015 • By

This is the stretch my patients rave about the most and about the only stretch they keep doing once injury free – because it makes you feel so much better – and gets results! So give this glute stretch a shot, it can really work wonders.

The great thing is that the title is not an exaggeration.

First of all I will show you the glute stretch and a video to make sure you are doing it right and then I’ll fill you in on why it is so good for your hips, knees shoulders and especially your low back.

 

The Best Glute Stretch:

What you’re stretching:

  • the best glute stretchYour glutes, hamstrings and other hip rotators. All of these muscles at the back of your hips get stretched out here to unload the pull on your low back and hips. This also increases the mobility of your hip joint by increasing the rotation – which is essential for something as simple as walking, but also for sports such as golf where hip rotation is crucial.

 

  • Lat stretchYour latissimus dorsi is stretched out when you bring your arm across your body as shown in the video. When tight the lats can pull your shoulder down and forward, so great to stretch out!

 

Try and do this stretch daily and make it part of your routine as it can work wonders, but as with other exercises, it isn’t a quick fix!

 


Health, Hip pain

Trochanteric Bursitis – The Best Exercises and Self-Treatment

January 25, 2014 • By

Trochanteric bursitis is a an all too common cause of hip pain throughout the population, from athletes to the elderly. In this post I will clearly explain, what trochanteric bursitis is, what causes it, and what the best rehabilitation exercises and self-treatment techniques that can be done at home to help you get back to your best!

Also often called: Greater trochanteric bursitis, trochanteric pain syndrome

  • Anatomical location/body part affected: Trochanteric bursa lies over the greater trochanter of the femur, deep to the tensor fascia lata-iliotibial band (ITB) and the attachment of the gluteus medius/minimus muscles.

Trochanteric-BursitisTFL_ITBandWhere is the bursa and what does it do: The bursa lies over your greater trochanter which is the bone you can feel on the outside of your upper thigh (right behind your side pocket). All bursa in your body (there are about 160 of them!) work to help all the structures in your body move smoothly. The bursa is like a small balloon of fluid – normally a very thinly filled one – and in this case it lies over the greater trochanter so your iliotibial band (as seen in the picture to the right) can glide over the bone smoothly.

What is the cause of trochanteric bursitis?

The two main causes are:

  • The most common cause is repetitive friction or compression of the bursa by the structures/tissue that glide over it. This is what I am going to tell you about in more detail below as there are some main contributing factors that lead to the excessive friction and compression on the bursa which have to be addressed to get long term results.
  • The other is direct trauma such as a fall on to you hip.

Both of these cause the inflammation within the bursa so that if is blown up by the inflammatory fluid like a balloon and the walls of the bursa thicken.

Contributing factors (lets find the real reason you get bursitis!): The simple mechanism of injury in cases without direct trauma is excessive friction/compression of overlying tissues on the trochanteric bursa. What leads to this excessive friction/compression is the important thing – if we find this, we can treat this very well!

  • Osteoarthritis – of the hip or low back
  • Tightness of the ITB – The iliotibial band crosses over the bursa, so if this is tight it will cause excessive compression and friction.
  • Leg length discrepancy – Causing a muscle imbalance and glute dysfunction in the pelvis.
  • Weak hip abductors (glutes medius and gluteus minimus) – These are the muscles that stop your leg going inwards while walking and stop your hip dropping – so if these are weak you will have poor hip stability and biomechanics – putting more pressure on the bursa.
  • Weak core
  • Tight or over active and tensor fascia latae – This muscle attaches on to the iliotibial band and so if this is working too hard (such as when your hip abductors are weak) it causes tension on the ITB.
  • Risk factors
    • Higher prevalence in women than men; 4 times more likely! This is due to decreased oestrogen post-menopause decreasing muscle tone and also broader hips and a narrow stance in women.

How do you know if it is trochanteric bursitis and what else could it be:

  • Presentation/signs and symptoms
    • The main complaint is aching in the upper lateral(outside) thigh. If acute/quick onset, pain can be sharp and intense. However, pain in chronic hip bursitis is usually dull and diffuse and may radiate down to or below the knee, mimicking low back radicular symptoms.
    • There is tenderness with direct pressure, such as when lying on the affected hip. Pain can disturb sleep and general mobility(walking). Painful activities include prolonged standing, squatting, and the first steps after rising from a chair. Pain increases with hip flexion and external rotation – as in crossing affected leg over the other while sitting. The main and most accurate test during physical exam is intense or sharp tenderness on deep palpation of the greater trochanter.

Glute med and minLateral hip pain is far too often diagnosed as trochanteric bursitis, even if there is no bursal inflammation. The primary (most common) cause of lateral hip pain is tendinopathy or dysfunction of the Gluteus Medius and Gluteus Minimus muscles(you can see in the image to the right that they attach straight onto the Greater Trochanter). In a new study where over 800 patients with trochanteric pain syndrome were scanned, 50% had gluteal tendinopathy and just 20% had trochanteric bursitis. So given that often gluteal tendinopathy is the primary cause of lateral hip pain it is important for long-term pain relief, rehabilitation exercises and correction of any biomechanical deficiencies (muscle imbalance, leg length discrepancy, poor foot mechanics etc) are followed through with and addressed.

 

So, because lateral hip pain can be caused by both trochanteric bursitis and tendinopathy – the following rehabilitation exercises and self-treatment will help both of these!

1. Glute strengthening:

  • Side lying Abduction exercise for hip and glut strengtheningSide lying hip abduction: Making sure to keep your top elbow down to stop your hips rolling back.
  • 3 sets of 12 repetitions

 

 

 

 

 

  • Clam exercise plus - gluteus medius strengthening, pelvic stability, leg strengthClams: Top elbow down again, keep your ankles together, lift the top knee up about 20cm.
  • If you find it is too easy, roll your pelvis forward more.
  • If it hurts your hip then place a towel or small pillow between your knees
  • Your Goal is 50 repetitions, nice and slow

 

 

 

2. Advanced hip strengthening: This is for really getting the hips strong and balanced out and best to start when you are recovering well and pain free.

  • Bulgrarian split squat for hip stability and strength - trohcnateric bursitis and lateral hip painBulgarian split squat: Don’t get scared off by the name – you can do this! Just remember the back leg is just for balance – not to help you up and down.
  • Tips: Make the front leg work. Start a good distance out from the step/chair. Take it slowly and control it.
  • 3 sets of 8 repetitions.

 

 

 

 

3. Myofascial release of your tight TFL (tensor fascia latae muscle)

tensor fascia latae and itb myofascial releaseasis anterior super iliac spineIt is a great to loosen off this muscle as it can really add compression over the bursa. The TFL is, as you can see the image below a little muscle at the side of your hip. to find it, place your fingers on your ASIS which are the bones on either side of your pelvis at the front. From the side of these, drop down a couple of inches and you should be right on it!

Lie on your side and place a ball under your TFL – you can use any ball you like, massage ball, lacrosse ball, tennis or golf ball. Then slowly roll the ball around that area, working out all the knots and tight spots – this can take 2-5 minutes but is well worth your time!

And remember, a bit of trigger point pain is expected here.

  • You can also check out this mobility WOD video  – The main bit I want you to do is the ball work from about 3 mins and 36 seconds. This is a great release to do and will give your awesome relief!

4. Footwear: Supportive footwear (with arch and heel support) is a huge plus – it stops your foot over pronating or supinating which would put your hip in a bad position (try standing in bare feet and rolling your feet in and out and notice what it does to your hip position). Alternatively you can go to the podiatrist and see if you need orthotics.

 

Maintenance and prevention – This is big, you cannot stop the exercises once the pain has gone – you can do them less, absolutely, but you need to persevere.

Steroid injections: If you get one for your bursitis, remember it takes away the inflammation but it does not fix out the things that caused it (such as hip stability) and there is a high chance it will come back if you don’t rehab it. Also it is important to get a clear diagnosis before injection as cortisone is basically poison for tendons (and remember  only 20% of lateral hip pain is actually Bursitis – a lot more are tendinopathies).

Back pain? Low Back Pain and dysfunction can have a big impact and even cause lateral hip pain so make sure you address this also.

 

For more reading on lateral hip pain – This is a good resource.

Check out this quick hip stability and balance test!