Neurokinetic Therapy® Blog

Hip Joint Jam

Hip joint impingement or Femoroacetabular impingement is a common malady affecting millions of people. If left untreated, this condition will result in osteoarthritis, hip replacement, severe groin and buttock pain, and limited and painful range of motion. FAI can result from playing sports or sitting too much. A student of mine brought his client to me who was suffering for years from severe buttock pain. She had had several MRIs as the doctors suspected she had sciatica resulting from some impingement in her lower lumbar spine. The MRIs were of course negative. She also received anti-inflammatory injections in her lumbar spine which did nothing. After getting her history I put her through some range of motion testing which included her hip joint. I found her hip joint to be very jammed. After balancing the muscles around her hip joint, I applied light traction to her leg, and voila, there was an audible pop, and while weeping, she reported that her pain was completely gone.

Let’s go over the important muscular components of FAI. First and foremost are the obturator internus and externus. These two muscles suspend the femur in the hip joint. If they become too tight the femur jams into the acetabulum. The question then becomes why are they tight? A very common compensation pattern that I see is the obturator muscles inhibiting the gluteus maximus. This is something that happens from sitting too much. The obturator muscles can also inhibit the psoas. Again, this is due to sitting and sometimes athletics. The obturator muscles, just like the rotator cuff muscles, are not meant to do motions that require load bearing. So when there is a dysfunctional movement pattern, and they are required to compensate, naturally they tighten up. The result of all of this is a painful hip joint. I know about this from personal experience. From doing a lot of mountain biking, my hip joint became increasingly painful, to the point where when I sat with the soles of my feet together, my one knee was much higher than the other. I tried stretching my  adductors to no avail. Finally I learned about the obturator muscles, and was able to resolve my problem.

I use the standard range of motion tests to determine if FAI exists. I have the client perform internal and external rotation of the hip via the foot, knee to chest, cross one leg over the other, put the soles of the feet together, and do a circular range of motion. Often times many of these are restricted, and depending on the severity, sometimes only one is restricted. After balancing the obturators, the next thing I check is strength in the rectus femoris. With FAI, this is often inhibited. This muscle is also inhibited after hip joint replacement, and it’s facilitation is crucial in postsurgical recovery. What I find commonly facilitated is the iliacus. Naturally, the adductors can be facilitated and inhibit the rectus femoris. Dysfunction of the hip joint commonly can lead to lower back pain via antagonistic relationships, neck pain due to kinetic chain compensation, and knee pain also due to kinetic chain compensation. Only after all of these relationships have been resolved, will I gently traction the leg to facilitate a release of the hip joint.

Of course, if there has been too much degeneration in the joint, I will recommend a hip replacement. Optimally, if there hasn’t been too much damage, a hip resurfacing procedure can be done. Let’s remember that hip joint replacement is amongst the most successful of surgeries. I have seen people’s lives changed dramatically from such a procedure. Remember to be a pragmatist not a fanatic. Conservative management of FAI is very successful if you understand its components and how to resolve the specific dysfunctional movement patterns.

 

19 Responses

  1. This iss really interesting, You’re a very skilled
    blogger. I have joined your rss feed and look forward to seeking more oof
    your wonderful post. Also, I haave shared your web site in my social
    networks!

  2. Danny Starling

    Thanks for this great article. I have been struggling with this for years. This post is one of the first things I’ve read that really describes my condition. I’ve been pretty successful with self treatment, but I would love to hear more about what I can do to fix my bad hips!

  3. Casey Wollenberg

    Hi,
    I thought I had a hip flexor strain, but my PT today told me that it was more likely a jammed hip. My pain feels like it is AROUND the joint (i.e. groin, in the anterior fold of the leg, crest of the pelvis and lower back on that side), but not IN the joint itself. Does that sound like a jammed hip?

    • neurokinetictherapy

      Can’t comment without seeing you

  4. As a massage therapist for 17 years, I have been coming across more and more people with jammed hips. It is always with people who are runners. I don’t recommend any of my patients, to run. If you have a long torso, or are heavy boned, your chances of jamming a hip is high. Once the hip is jammed, every other joint through out the body, is permanently out of alignment. And unfortunately, I have not found any PT that has been able to unjam yet. If there is one in the Minneapolis/St Paul area I would love to find them, to direct my patients to them.

    • neurokinetictherapy

      Roger McNear

  5. Nicholas

    This describes perfectly what I am living with. Is there anything I can do for myself, other than visiting a NKT practitioner? And if I do manage to see a practitioner, will they recognise the problem? What I mean is, does this condition form part of their learning or does it depend – as it did for you – on personal insight?

    • neurokinetictherapy

      See an NKT practitioner. The system will guide them.

  6. Linda bleck

    Seeing as I have been on both sides of this coin and now have two hip replacements , I thought I would add my two cents. I follow the nkt posts and find valuable info. That being said It is important to note that sometimes you can unjam the joint and get pain free periodically . I did several times and on both hips through my 30s and into my early 4os . I Was able to go back to strengthening as well. Enough to to cycle the big island.:) Eventually the pain always referred back to sijs . This scenario went on for 15 years no one looked at my hips until I came in dragging my right leg. I was dx with bilateral hip dysplsia. We in the community of dysplsia are trying to get the word out.:) if pain persists go to a qualified hip specialist demand hip X-rays and tell them ” look for dysplsia” many have been missed by orthopedics. For me it was too late, arthritis and degeneration had set in and one hip to a point of subluxation. The joint was floppy but i kept it strong my whole life. It was 0 degree angle. My story is not unique. Many young people if caught early enough can have a PAO and not a thr. Regardless of pathology it’s important to keep strong and watch those functional patterns and persistent pain. I like your posts NKT.

  7. I know this web page provides quality depending articles or reviews and additional information, is there any other web page which presents such
    things in quality?

    • neurokinetictherapy

      Stop Chasing Pain

  8. Peyton

    Do you know any NKT practitioners near Asheville, NC? I’d like to refer several coaching clients to a reliable professional for similar maladies. Thanks for the article.

  9. Trou

    What do you mean by balancing the obturators? Can strengthening glutes and hamstrings help reduce the tension in the obturators?

    • neurokinetictherapy

      Not always, you have to test their relationship before strengthening.

      • Troy

        How would you test the relationship between the glutes, hamstrings, and obturators?

        • neurokinetictherapy

          Using NKT testing

      • Gosh, I wish I would have had that inrfomation earlier!

Post a Comment

(required)