Workshop Series: Pilates & Yoga for Healthy Hips – Anterior Glide Syndrome

The hips are said to be the seat of our emotions – that we carry unresolved emotional trauma in the pelvis. I don’t know if that’s exactly true but our hips certainly aren’t allowed to play much. Our modern lifestyle favors a seated position with legs crossed or at least tightly adducted – rarely do we take the hips through their full range of motion.

Physically opening the hips allows us to energetically release some of the stress associated with a constant state of sympathetic stimulation – a state most of us find ourselves in chronically. We perpetually live in a “flight or fight” mentality that has all sorts of physiologic effects on our muscle, tendons and soft tissue structures. Unfortunately, the body bears the brunt of the minds’ ruminations resulting in abnormal holding patterns in the body, which eventually lead to postural imbalance.

Many of our activities of daily living promote imbalance in the muscles surrounding the hip, which in turn, puts pressure on the joint. A good defense against joint damage is to strengthen and lengthen opposing muscle groups to create efficient movement through postural balance.

Trying to get through the day with painful hips takes a toll physically and mentally. Pain is the body’s way of signaling that something is wrong. Listening to your body when it whispers can forestall more serious problems. If you have pain, particularly if it wakes you up at night, take stock of your posture and gait as a first step.

The way we hold our body in the resting position can greatly influence the way we move. If movement patterns are impaired, soft tissue structures can be injured causing pain and stiffness from inflammation. Correcting underlying postural imbalances are needed to prevent further damage and heal inflamed tissues.

Understanding the basic moving parts of the hip can help you make sense of your body’s signals…

The top of the leg bone (femur) sits in the hip joint (acetabulum) in the pelvis. The way the femur is angled into the acetabulum varies in everyone and largely determines an individual’s ability to laterally rotate the hips meaning sit in a cross – legged fashion. Trying to force the hips into positions not supported by the anatomy with which you were born can cause impingement at the hip with pain and stiffness.

Simplistically muscles in the front of the thigh (quadriceps) balance muscles in the back of the thigh (hamstrings) and muscles on the inside of the thigh (adductors) balance muscles on the outside (abductors). What makes it slightly more complicated is that most muscles exert a rotational pull when contracted and thereby rotate the hip in or out as they act.

Soft tissue structures protect the bones from banging directly into each other. These include the lining of the joint capsule (labrum), ligaments, tendons, joint fluid, fascia and other fibrocartilaginous materials. These tend to be the first structures to get damaged and, depending on the location of the damage, cause pain with specific movements.

With age soft tissue structures loose elasticity, become less flexible and resilient and produce less joint fluid. Moving the joint in its’ full range of motion helps to maintain the integrity of these structures.

If a joint is stiff, a longer warm up period is required to generate sufficient synovial fluid to hydrate surrounding soft tissue structures before more vigorous movements. That feeling that you get at the end of even one pilates or yoga class is the response of fascia and soft tissue to kinetic rebalancing – the effect is quick but not long lasting. A steady practice is required for permanent change.

As with the shoulder, impingement can occur in the hip because of movement disorders due to poor posture or postural imbalance. The muscles surrounding the hip control the movement of the head of the femur in the hip socket. The hip joint is a ball and socket joint with enough space for anterior and posterior movement of the head of the femur in the acetabulum or glide. In flexion, the glide is posterior and in extension the glide is anterior.

Anterior glide syndrome is a common cause of hip pain in runners, dancers, martial artists and yoga practitioners – really any sport that encourages excessive extension at the hip. It starts as pain in the groin with flexion of the hip but can progress to sharp severe pain radiating throughout the joint and onto the front and side of the thigh. First signs of discomfort may occur after prolonged sitting or walking up hills.

The disorder results from the head of the femur gliding anterior rather than posterior on flexion of the hip and banging into the labrum in the hip socket creating pain and inflammation. A typical resting posture associated with the syndrome would be extension at the hip (beyond 10 degrees), hyperextension of the knees, little gluteal definition and a relatively flat low back.

The postural “holding patterns” associated with the syndrome result in imbalances in the muscles surrounding the hips and pelvis. The anterior joint capsule becomes stretched and the posterior capsule becomes stiff and tight hampering the ability of a posterior glide. The iliopsoas is weak and stretched and is not able to pull the anterior joint capsule out of the way of being pinched. The hamstrings, which exert an anterior glide, dominate over weak glutes, which exert a posterior glide.

Pilates and yoga help to rebalance muscles and soft tissue structures. Stretching the posterior capsule of the hip can be done by starting in table and slowly working in and out of Child’s pose. Exercises allowing passive flexion of the hip (feet in straps) restore normal glide patterns – although it may need to be done in froggy to avoid pain. Hip extension should be limited. The glutes need to be strengthened with attention to the firing patterns of the glutes and hamstrings to avoid dominate hamstring activity with hip extension.

 

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