Q: I read your article on T-nation regarding trigger points and I was thoroughly impressed. I have had extreme pain in my left hip abductors (I group them together in part because I am not 100% certain which one is the culprit). I have been using a tennis ball and foam roller to attempt alleviation but the process seems very slow and I seem to have plateaued. Static stretching is extremely painful when applied directly to the TFL, yet I find very few trigger points on the TFL itself. I saw a physical therapist who helped me greatly, but given the cost of his service (and the fact that I can do virtually everything he did by myself), I no longer see him frequently. Do you have any other suggestions for me?
A: Wow, I can’t remember the last time someone was “thoroughly impressed” with anything that I did. Granted I spend my free time reading scripture to blind children, and helping old ladies bake chocolate chip cookies at the local nursing home- but I do those things for the sheer enjoyment it brings my heart. It has nothing to do with trying to impress the hot front desk girl we just hired here at the new facility. Nothing to do with that at all.
“Hey Ethel. ETHEL!!! Didn’t I say the recipe called for 17 chocolate chips per cookie and not 15? What? You couldn’t read the recipe because your glaucoma is acting up? Well, you just pulled landscaping duty this afternoon missy.” I love old people. They’re so cute.
To answer your question, postural alterations can occur as a result of alterations in the timing, sequence, and coordination leading to altered muscular recruitment patterns. Often postural corrections are difficult to make since there are underlying causes to these muscle imbalances including altered recruitment strategies. I think in your case, you may just be trying to resolve the symptoms (soft tissue wort on the TFL) and not really doing anything to resolve the actual problem (weak glute medius perhaps).
**Side note: to all those who are reading this and want a great resource on functional anatomy, but are a little too intimidated by those ginormous text books, I highly recommend this book.
“Inhibition and weakness of the prime mover will create a compensatory increase in the activity of the synergists. Chronic over-activity of the synergists will often cause the synergist muscles to become the dominant movers of the particular movement. The subsequent compensatory over-activation in which the synergist become the primary movers is known as synergistic dominance.”
The glute medius (pictured above) functions as the primary muscle of hip AB-duction and stabilizer of the pelvis during single leg stance. Unfortunately, many people have a weak glute medius due to a variety of factors- the biggest culprit of course, a prolonged sedentary posture. In short, we’re lazy and sit in front of our computers and televisions all day, and when we do actually go to the gym, we sit even more, plopping ourselves on the pec dec machine and stationary bike. Makes no sense, but that’s another blog post.
As Osar further notes:
“In response to the weakened glute medius, there is an increase in the activity of the TFL which takes over the role as the primary frontal plane stabilizer during single leg stance. The problem with this is the TFL is also a primary mover of internal rotation of the hip and has a significant response on the iliotibial band. If the TFL is allowed to function unopposed, it will pull the hip and lower extremity into internal rotation during single stance, causing ITB syndrome, patellar tracking issues, and a host of other postural dysfunction.”
So what can you do?
1. Perform more single leg movements. Please for the love of god stay off the leg press, leg extension, and leg curl machine. I love squats and deadlifts, but in your case, a healthy dose of single leg movements (reverse lunges, step-ups, single leg squats to a box, etc) would be in order since they will automatically force you to fire your glute medius to stabilize the pelvis.
2. Perform dedicated glute medius activation exercises. One of the most simple exercises would be X-band walks.
Key points to remember: Chest tall, shoulder blades down and together, knees out. Your knees should not cave in at all, and your hips should stay at a level plane (no hiking). I typically have clients perform two sets of 10-12 reps for each leg.
Another simple activation exercise would be the Bowler Squat, as popularized by Dr. Stuart McGill .
Standing on one leg, you simply lower yourself to the floor as if you were a bowler releasing the ball. It’s a bit more challenging than it looks. Simply “hike” the standing hip out and in order to return back to the neutral (starting position), you have to fire the glute medius. Also, try your best to maintain a neutral (straight) spine.
Lastly, my favorite (and most sexy) activation exercise is the side lying clam. And yes, that’s Nas playing in the background, bitches.
With this one, simply place a small resistance band above your knees. From there, place your lower body at a 90 degree angle and make sure that your spine is aligned in a straight line. Place your thumb on your glute medius (right above the hip joint, in the “divit”). Keeping your feet together, raise your knee high enough to the point where you “feel” the glute medius fire. Perform two sets of 8-10 reps on each side.
All in all, spend more time activating the glute medius using the drills above (one drill per day would suffice, you don’t need to do all three everyday), continue with the soft tissue work, and include more single leg work into your programming. That just may clear stuff up.