Appointments

Make an appointment online

...or you can call us!

All clinics: (02) 6253 2388

Rebates Available

Our services are eligible for:

Private health care claims
Insurance claims*
Department of Veterans Affairs*
Medicare rebates* (ExPhys only).

*requires appropriate approval documents

Macquarie Clinic

Kelkiah Appartments
43/21 Wiseman St
Macquarie ACT 2614

For all enquiries
Phone: 02 6253 2388
Fax: 02 6251 9369

Mon-Thurs 8am-7pm
Fri 8am-5pm
Sat 9am-1pm

Deakin Clinic

Fitness First Gym (Inside)
81 Macgregor St
Deakin ACT 2600

Phone: (02) 6253 2388

Mon-Thurs 8am-7pm
Fri 8am-5pm

Woden Clinic

Skypark Multistory Car Park
1/12 Furzer St (Cnr. Furzer and Worgan St.)
Phillip ACT 2606

Clinic entrance on Worgan street

Phone: (02) 6253 2388

Mon – Thurs 8am-6pm
Fri 8am-5pm

Pilates Studio

2A Lawry Place
Macquarie ACT 2614

Phone: (02) 6253 2388

For current studio hours please check our time table.

Hip Stability

 

Lower Limb Pain & Hip Instability

David Halpin – Exercise Physiologist

Newsletter

A vast amount of muscles are required when running or cycling. During running, your two feet are never both in contact with the ground – one leg is driving against the ground to move the body forward, while the opposing leg is stabilising the body. Similarly, during cycling, one side of the body takes on a considerable amount of force which therefore overloads the muscles on one side. For both these tasks, the posterior pelvic muscles and gluteal muscles (or the butt area) are essential to achieve hip extension allowing the body to move forward. The body must react to a variety of forces and if the muscles are not functioning as required, other muscles will tend to compensate. This results in an altering of the biomechanical setup whereby the propulsive muscles become stabiliser muscles. For example, often the tensor fasciae latae (TFL) muscle takes the stabilising role, resulting in a pull and irritation of the Iliotibial band (IT band).

The cause of instability is commonly due to poor posture and long periods of sitting resulting in shortening of the hip flexors and lengthened of the hip extensors. This leads to over-active hip flexors and de-activated hip extensor muscles. The de-activated gluteus muscles cause the hip flexors to take over as the propulsive muscles, as well as the de-activated gluteus muscles required for hip rotation to shift the hip forward tend to lock up the hip capsule resulting in reduced mobility.

Resolving the condition is not as straight forward as reducing the amount of training. Instead, the cause of the hip instability must be addressed. To fix the condition, a three step process must be undertaken. This includes:

  1. Mobility – Lengthening the shortened hip flexors to unload the hip flexors,      shortening the hip extensors to make activation possible, and creating mobility      through the hip capsule.
  2. Positioning – Mobility will mean that adequate posture can be achieved by      positioning the hip into a ‘neutral’ position.
  3. Activation – Once the hip and other body parts are positioned correctly, the      necessary muscles can activate efficiently (firstly in an unloaded      position on the ground, gradually adding loading exercises when ready).

There are numerous exercises that athletes can do to improve their hip stability. The best initial exercises to conduct include:

  1. 1.     Mobility – Tennis ball & hip flexor stretch
  2. 2.     Positioning – Sit to stand (achieving correct posture) & single leg balance with hands on head
  3. 3.     Activation – Bridge & clam

For further information regarding hip stability, please read the full article at www.clinic88.com.au or call Clinic 88 to discuss your concerns with a therapist.

Lower Limb Pain & Hip Instability

David Halpin – Exercise Physiologist

Are you suffering from hip, knee or shin pain? Pain down the side of the leg, better known as ITB Syndrome, but the recommended treatment methods including a foam roller does not help? Have you focused on strengthening the location of the pain, but the injury just won’t go away?
Maybe the cause of the pain is not what you have been trying to treat???

Introduction

Every day I see athletes walk into Clinic 88 with various lower body injuries. The most common reports are they cannot isolate one specific reason for the pain, the injury can frustratingly ‘move’ around the lower limb, and what was initially a niggle has now turned into a chronic injury that keeps reappearing. Rest and recovery methods, such as ice and foam rollers, can assist with the pain, but once the training load increases again, the injury returns.  Often, previous therapists have focused on the specific part of the anatomy that is painful, however don’t look above and below the site of injury.  Is this familiar to you?

Whether the pain is isolated to the back, or further down towards the feet, the hips are most likely to have influenced the injury.

Compensatory Mechanism

During running, there are never two feet on the ground -when moving forward the hip is the fulcrum of the lower body – one leg is driving against the ground to move the body forward, while the opposing leg is stabilising the body. Similarly, during cycling, one side of the body takes on a considerable amount of force, which therefore overloads the muscles on one side, resulting in a considerable force on the hip region to maintain balance. A vast amount of muscles are required for these complicated movements, however the posterior pelvic muscles and gluteal muscles (or the butt area) are essential to achieve hip extension allowing the body to move forward.

The body must react to a variety of force and if the muscles are not functioning as required, other muscles will tend to compensate. This results in an altering of the biomechanical setup whereby the propulsive muscles become stabiliser muscles. For example, if the gluteus medius and minimus muscles aren’t doing their job (which is to stabilise the pelvis and trunk), often the tensor fasciae latae (TFL) muscle (which attaches to the gluteus maximus and runs down the side of the leg) takes the stabilising role, resulting in a pull and irritation of the Iliotibial band (IT band). This is known as IT Band Syndrome that can cause pain anywhere along the IT Band – at the hip, and down the side of the leg around the knee.

Impact of Reciprocal Inhibition

Muscles in the body work in partnership – when one muscle activates, the opposite muscle relaxes to assist a smooth movement. During long periods of sitting, the hip flexor muscles (front of the hip) shorten while the partnered muscles, being the hip extensors (gluteus maximus muscle), relaxes and switches off.  Given the amount of time most people spend sitting, we all tend to have overactive hip flexors and relaxed hip extensors. This results in poor posture and slouching.

Not only are the hip flexors over-active and at a greater risk of overuse, the de-activated hip extensor muscles cause a reduction in forward propulsion. Furthermore, the de-activated gluteus muscles required for hip rotation to shift the hip forward tend to lock up the hip capsule resulting in reduced mobility.

The Concern

The change in biomechanics results in a reduced running efficiency as the propulsive muscles aren’t activating and other propulsive muscles must change priority to stabilise and keep the body upright. Not only does hip instability cause a reduction in efficiency and therefore speed, but it places a considerable load on other muscles and joints resulting in overuse injuries and pain.

How to resolve the condition

Resolving the condition is not as straight forward as reducing the amount of training. Instead, the cause of the hip instability must be addressed. Conducting weighted squats and lunges incorrectly, with poor hip stability, will not fix the problem and will most likely aggravate the conditions further.

To fix the condition, a three step process must be undertaken. This includes:

  1. Mobility – Lengthening the shortened hip flexors to unload the hip flexors, shortening the hip extensors to make activation possible, and creating mobility through the hip capsule.
  2. Positioning – Mobility will mean that adequate posture can be achieved by positioning the hip into a ‘neutral’ position.
  3. Activation – Once the hip and other body parts are positioned correctly, the necessary muscles can activate efficiently (firstly in an unloaded position on the ground, gradually adding loading exercises when ready).

There are numerous exercises that athletes can do to improve their hip stability. The best initial exercises to conduct include:

  1. Mobility – Tennis ball & hip flexor stretch
  2. Positioning – Sit to stand (achieving correct posture) & single leg balance with hands on head
  3. Activation – Bridge & clam

It is recommended that these exercises be conducted daily (mobility exercises conducted 2-3 times a day) for the first week. After the first week, progressive strengthening exercises should be conducted every second day (double leg bridge progressed to a single leg bridge) and mobility exercises can usually be reduced to every second day. Five minutes of exercises are also beneficial as a warm-up, prior to exercise, to achieve adequate hip positioning and assist in muscle activation for the given exercise.

Whether the pain is isolated to the back, or further down towards the feet, the hips are most likely to have influenced the injury.