Performance Place Sports Care https://www.p2sportscare.com Sports Chiropractors with Expertise in Low Back Disc, Piriformis, and Hip Thu, 15 Jun 2023 22:42:49 +0000 en-US hourly 1 https://wordpress.org/?v=6.4.3 https://www.p2sportscare.com/wp-content/uploads/2018/04/Favicon.png Performance Place Sports Care https://www.p2sportscare.com 32 32 What Causes Back Pain on the Lower Right Side? https://www.p2sportscare.com/articles/spine/back-pain-on-the-lower-right-side/ Wed, 04 Jan 2023 19:26:34 +0000 https://www.p2sportscare.com/?p=102152

Your Introduction to Recovery 

Whoever said, “There’s a light at the end of the tunnel”, was onto something. If a one-sided low back pain issue has you feeling like you’re in a dark tunnel, this article will help light your way out.

Are you:

Experiencing lower right back pain when driving?
Feeling lower right back pain while lifting weights?
Searching for answers to why you have one-sided lower back pain?

Don’t let your situation get worse; listen up!

Yes, it’s a fact:

Lower back pain on either the right or left side (or any location for that matter) can be one of the most frustrating and debilitating issues you can face, according to the National Institute of Neurological Disorders and Stroke. It can be hard to know where to start when it comes to understanding what is causing your pain, how to treat it, and how you can prevent it from happening again.

Do not despair. There’s hope.

Before you start chugging down the Advil® like it’s going out of style, in this article (updated in 2022), I’ll give you a quick rundown on what right and left side lower back pain is, plus I also cover the baffling situation of when your lower back pain CHANGES SIDES.

That’s not all, though. I won’t leave you hanging…

I’ll review possible diagnoses, causes, and treatment options for single-sided lower back pain. But if you want to learn more about sciatica (pain past the knee) and its causes and treatments, you can read all about it in one of my other articles right here!

But first, a disclaimer.

Back Pain On The Lower Right Side Banished!

A (Near) Unbelievable Recovery Story

Hey there! I’m Sebastian.

I’ve had lower right back pain and have been able to recover from it entirely.
When I was 15, I was told I would need back surgery to reduce my pain so I could play baseball again.

But guess what? They were wrong!

Long story short: I did not require surgery, injections, or medication to return to baseball.

It even gets better:

I am 38 now, play baseball two days a week, lift weights, sprint, and have no issues with my lower back holding me back from doing what I want.

So, why am I telling you this?

I’m telling you my story of recovery to let you know that you can recover as well (if you find the right person to help you as I did).

Hopefully, this article gives you better information to discuss with your sports chiropractor, physiotherapist, physical therapist, personal trainer, orthopedic, or medical doctor.

But here’s the thing, though:

Not everyone will get back to feeling 100%. 

As a general rule, the longer you’ve had it, the more challenging it can be. But this does not mean it’s impossible to feel physically capable again. And that’s what this article is about!

Let’s get to it:

What Is The Lower Back?

The lower back is the area of the body that extends from the last rib to the top of the pelvis. It includes the lumbar spine, which comprises five lumbar vertebrae (L1 – L5) and a sacrum. It is also called the lumbar spine or lumbosacral region.

The vertebrae (bones) are stacked on top of each other like a deck of cards, with the sacrum acting as the base of the cards. Discs between each vertebra act as ‘cushions’ – the discs are made from cartilage. This soft material helps absorb shock when the body moves.

Spinal joints are surrounded by muscles, tendons, and ligaments that help to hold the bones together and keep them moving. If any of these structures become weak or damaged, they can lead to pain in the lower back.

In addition to its role in standing, walking, bending, and lifting, the lower back also helps us twist and turn. Because it’s such a complex part of our anatomy, conditions affecting it can also affect numerous other parts of our bodies.

How To Stop Lower Back Pain Fast (TRY THIS)

What Does One-sided Low(er) Back Pain Mean?

Lower back pain often referred to as lumbago, is a general term for pain that occurs in the lower back region of the body and is not exactly a “specific disease diagnosis,” according to Healthline. It’s more accurately described as a collection of symptoms that may or may not be related to any underlying condition” with one or more parts of the lower back, such as ligaments and muscles.”

Therefore, by extrapolation, one-sided low back pain (left side lower back pain/right side lower back pain) can be defined as pain on either side of the lower back region arising from any musculoskeletal system disorder.

Causes Of One-Sided (Left Or Right) Lower Back Pain

Right or left side lower back pain can be caused by many things, including:

Cause #1: Driving

Did you know that driving is the #1 cause of single-sided lower back pain in people over 25? 

That’s right, the activity that most of us do every day—driving—is one of the leading causes of lower back pain. 

And this is backed by years of research too!

A review of studies published from 1975 to 2005: “Eight of the nine studies concluded that there was an increase in low back pain among car drivers…”

I’m sure you’ve been there. You’re driving to work in the morning when the traffic is heavy and stop-and-go. You tense your lower back muscles in anticipation of the next bump in the road. 

And then it happens: A sharp pain shoots down your right leg. It feels like someone has stabbed you in the back with a knife. You grimace, shift positions and continue driving.

It’s a familiar scenario that can leave many people wondering what causes lower back pain on one side only.

Here’s where it gets interesting:

If you’re a US-based driver, you might experience more pain in your right lower back. If you’re a European-based driver, you could experience more pain in your left lower back.

Why?

It has to do with the gas pedal.

Want to know how? We’ll get to that later.

For now, let’s take a step back and look at something central as we discuss single-sided low back pain in this article: 

Back Pains Are Not Created Equal.

But one thing almost all types of low back pain have in common is posture. 

Posture is simply defined as “the position in which someone holds their body when standing or sitting.” And when you look at it from the physiotherapy viewpoint, here’s how physiopedia defines posture:

“Posture is defined as the attitude assumed by the body either with support during the course of muscular activity, or as a result of the coordinated action performed by a group of muscles working to maintain the stability.”

In other words, posture is a relationship between your body parts—your head, neck, and shoulders; your hips, knees, and ankles; your upper back and lower back; even your hands and feet.

When these relationships are good, we say that our posture is good. When they’re wrong (or “slouchy”), we say that our posture is bad or slumped over, which can cause problems over time.

I know—you’re probably thinking, “I thought this was about one-sided lower back pain.”

But we can’t explain one-sided lower back pain without understanding all that goes into it. And we can’t understand all that goes into it until we understand the context of what’s happening in your life right now.

Think about it: 

When driving, you’re in a car with a steering wheel and pedals. Your hands are on the wheel, and your feet are on the pedals. Your spine is held upright by the seat belt, and your shoulders are relaxed because you don’t have to hold up your body weight (it’s all supported by the seat belt).

If we zoom out and look at everything together—the position of your arms and legs relative to one another—then suddenly things start making sense!

Now let’s get back to how driving causes one-sided low back pain…

If you are a driver in the US, lower right back pain can occur when you tense the sciatic nerve with every up and down on the gas pedal. It tends to happen more in stop-and-go traffic. 

You may think it is the stress of the traffic, but that may not be so!

I’ll explain:

The mystery lies in your sciatic nerve.

How Does Driving Affect Your Sciatic Nerve?

To understand why you are experiencing right or left side lower back pain, let’s look at the anatomy of the Sciatic nerve.

The sciatic nerve is the largest in the body, originating from your lower back and traveling through your hips and buttocks before reaching down each leg.

The sciatic nerve exits the spine through tiny holes called intervertebral foramen. In many cases, this nerve can become compressed (like when driving) at this location, causing it to swell, leading to stiffness and pain around the lower back.

Specifically…

Pressure on a spinal nerve root (not the sciatic nerve) creates a situation where your lower back pain is only on one side.

Right Or Left Side Low Back Pain When Driving: What Are The Common Symptoms?

The following symptoms also may describe your situation:

  • Lower back pain – right side above buttocks;
  • Pain on the right side under ribs towards your back;
  • Lower back and hip pain on one side;
  • Sharp stabbing pain in the lower back right side
  • Worsens while sitting in traffic;
  • Pain in upper glute muscle;
  • Chronically tight hip flexors (muscle group found on the front of your upper thigh);
  • Occasional changes of sensation in the thigh, calf, or foot (buzzing, tingle, numbness, or pain);
  • Pain with overstriding while running;
  • Chronic hamstring (that’s the tendons at the back of your thigh) tightness;
  • Achy Quadratus lumborum (QL) muscle, i.e., the deepest abdominal muscle located in your lower back on either side of the lumbar spine;
  • And tightness in your neck or shoulder blades.

How Do I Know If My Back Pain Is Sciatica Or Not?

Quite rightly, you may be confused about what’s happening in your back and how to tell the difference between sciatica and other causes of back pain. 

Here’s how you know the difference between sciatica and back pain:

Onset:  Sciatica is an absolute beast. It’s the kind of pain that can come out of nowhere, like a thief in the night –hitting you fast and hard, and then it just hangs out there for up to three to six months at a time until it decides to go away on its own.

Pathophysiology and symptom: Remember, if you’re experiencing pain on only one side of your lower back, it is most likely due to the pressure on a spinal nerve root and not the sciatic nerve which is the situation with sciatica. In a nutshell, sciatica is a pain radiating from your lower back (lumbar spine), traveling through your buttock and down the back of your leg.

Now that you’ve got a better understanding of how driving can cause left or right-sided low back pain, we can begin to address how we can medically diagnose and manage it.

How To Diagnose Low Back Pain On One Side Due To Compressed Sciatic Nerve?

The two most telling medical tests to determine if the pain on the left or right side of your lower back is due to a compressed sciatic nerve are:

  • The Straight Leg Test: According to “StatPearls,” a constantly updated medical database” for medical practitioners published on the official website of the National Center for Biotechnology Information, “the straight leg raise test, also called the Lasegue test, is a fundamental maneuver during the physical examination of a patient with lower back pain. It aims to assess lumbosacral nerve root irritation.”
  • Slumps Test:  The Slump Test is a test used to detect changes in neural tension or sensitivity.

Note:

These are called neural tensioning tests. And we can conduct both of them (in the office or virtually) to see if you have been placing pressure on a spinal nerve.

When they duplicate 1 sided low back pain, this tells us there is a high probability that you have a pinched nerve. Remember, pinched nerves don’t like it when you stretch them.

Interestingly, while you may not have formally had these tests performed on you, you may have already experienced a life situation that required you to perform a sloppy version of the test on yourself with daily tasks.

For example:

  • Lower back pain with a long seated hamstring stretch.
  • Bending over to touch toes (yoga forward fold).
  • Standing chair hamstring stretch.
  • Stiff-legged deadlift.

Up next: the most important thing you can do to make your life better…

How to Alleviate (“Treat”) One-Sided Back Pain Caused By Driving

The way to “treat” one-sided back pain caused by driving is to stop driving.

But since it is most likely impossible to do that though, or if it’s not an option for you at this time, here are some tips:

  • Move your seat closer to your steering wheel and increase the lumbar support on your chair (if you have one). Moving your car seat forward allows for more knee bend (this leads to sciatic nerve slackening) and less pain.
  • If you don’t have built-in lumbar support, roll up a towel and place it behind your lower back to let your lower back relax.

While you can slack the sciatic nerve by bending your knee – which is easy as pie, it’s not always the most effective.

That’s right. It does not solve the problem completely. It just removes the trigger.

So…

“What’s the best method to treat right side pain in my lower back?” you ask. I got you covered!

The most effective approach:

  • Addressing non-painful/dysfunctional areas of the body with mobility and stability exercises.

If you are experiencing one-sided back pain, likely, your body is not functioning correctly. The best way to alleviate this pain is by addressing the underlying issues with mobility and stability exercises.

It is important to note that for these exercises to have a lasting effect on your spine and body, they must be performed correctly.

The thing is this:

With one-sided back pain, the mid back and hips usually are the highest payoff point. Unfortunately, most remedies ignore this all-important detail.

Relieve Pain

To fix your 1 sided low back problem, we at Performance Place will help you perform mobility drills explicitly designed for your condition to increase joint range of motion and improve muscle activation patterns in those areas.

Restore strength and stability

After restoring mobility and stability to areas that did not hurt (but were not functioning well), the next step is to “save” your progress by strengthening the area.

Strength building helps the computer of the body (your central nervous system) retain movements and eliminate painful movement compensations.

A heads up:

You see, without some challenging rehabilitation, you may regress backward to having the same low back pain within months. 

To put it another way: The rehabilitation process was not completed, even if it was pain-reducing.

The Performance Place Shines Through

Performance Place offers a proven treatment program that helps long-term sufferers of left and right lower back pain weekly achieve their goal of pain-free living.

We know that feeling like you’ve been through the wringer is exhausting and can also take a severe toll on your wallet. That’s why we’ve made it our mission to help you get back on your feet without breaking the bank.

Our program is simple: 

We chill down your nerve before reintroducing the provocative (yet effective) movements that would effectively alleviate your problem. 

And if you live outside of Costa Mesa, we offer virtual sessions so you can still get treatment from us wherever life takes you!

We offer in-person sessions (Costa Mesa, CA) or virtual sessions online. That means we’ve got you covered if you’re looking for a place near you where you can treat your left- or right-sided back in Costa Mesa, CA. For those outside the city, you have the option of joining our virtual classes.

Action Tip: Stop sitting around with your left or right-sided back pain; allow Performance Place to end your one-sided back pain once and for all!

Cause #2: Sitting With A Twist

 “I don’t sit with a twist,” says almost no one. In today’s world, it’s hard to avoid sitting without a twist. 

In fact, you probably don’t even realize you’re doing it.

And it’s not just because you’re at your desk or in the car. You may be sitting on the couch, at your desk at work, or even on a bench with your legs crossed.

If you have to ask if this applies to you, check this out: 

Sitting at a traffic light or waiting for a call often defaults to twisting your upper body to your right side while your lower half is buckled in tight. You may be twisting to your left more often if you’re outside the US.

It’s not just you.

In the US, police or emergency personnel have laptops and radios on the right side of their body, so, naturally, they’ll twist to the right when reaching for their device.

Note: This does not mean all police officers, firefighters, and paramedics have right-side low back pain.

If you aren’t aware of the dangers, you need to be.

In the end, it turns out that sitting with a twist is terrible for your posture and can even end up screwing with your lower back. This is because the upper body’s weight is distributed unevenly between the two sides of your spine. The more weight you put on one side, the more pressure it will exert on that side.

Let’s look at it in depth:

Over weeks, twisting can make the right side of your spine sensitive due to the pinching effect I mentioned previously. 

And it’s not just the right-sided lower back alone…

Pain in the lower left back can also occur via different spinal mechanics. And if you remember, earlier, I spoke about how important it is to understand the mechanics of your back pain and how it helps in diagnosis and treatment.

Okay, how does this play out?

Reaching for your device and adjusting your posture can cause a cascade of destructive events leading to one-sided lower back pain, such as lumbar spine disc herniations, bulges, extrusions, and prolapse. It happens because the alignment of the vertebrae in your lumbar spine changes, causing the nuclear disc material (jelly) to shift and then slip out of position. It is the explanation to: “why do I feel pain on one side of my body when I stand after sitting for a while.”

 To help make it more straightforward for you, here’s an analogy:

Suppose you imagine a jelly donut as a model of the central canal. In that case, sitting with a twist is like putting more pressure on the donut, which leads to the nuclear disc material sliding to the outer walls of the donut.

In the case of twisting while sitting, the jelly will move away from the location of constant mechanical pressure from sitting and twisting.

So, if you have pain in the lower left back and often bend forward and twist to the right side, this may be your scenario.

What else?

Symptoms of One-sided Low Back Pain Due To Sitting With A Twist

The following symptoms also may describe your situation:

  • Pain is worse in the morning hours
  • Lower left side back pain above buttocks
  • Pain with sitting
  • Walking reduces pain after a few moments
  • Pain moving from a sitting to a standing position
  • Exiting your car becomes uncomfortable
  • Putting on your shoes and pants in the morning is challenging

Important Notes:

  • Spinal disc injuries do not happen with trauma. They often happen over time with no single injury event.
  • Secondly, they do not often require surgery, medication, or injection.

Talking about treatment…

With non-surgical treatment, you may experience a dramatic reduction of day-to-day pain within just weeks of starting a treatment plan.

That brings us to a common question I get a lot:

How Can I Treat Pain On My Left/Right Lower Back After Sitting (With A Twist)?

Walking: The simplest thing you can do is walk more. Walk when you get home and before you even drive to work.

Ideally, 30 minutes in the morning, but if you are busy, even a 5 – 10 minute brisk walk is better than nothing. Sprinkle it throughout the day!

That’s not all…

Be Proactive!

As I said in the beginning, the power to improve your situation is in your hands. Nobody can do the work for you.

If you must sit for a long time for work, having a nice chair with lumbar support can help reduce low back stiffness.

Finally…

Get Professional Help

At Performance Place, we specialize in non-surgical treatment for spinal disc herniations and pinched spinal nerves. With the proper guidance, you can improve within a matter of weeks.

Remember, you are in control, so act now!

Cause #3: Asymmetrical Sports

Let’s get this straight: 

This discussion can quickly become very specific, so I’ll try to keep it broad.

But guess what?

The myth that sports requiring many asymmetrical movements can directly cause back pain is far from true. We all think our back problems are due to “wear and tear” over the years. Still, we often just forget the fundamentals of good biomechanics and orthopedic posture.

And the next time you hear someone say that baseball and tennis cause back problems, I have a few things to say:

I’ve been playing baseball for over 30 years and don’t have back pain anymore. In effect, it means playing the same sport for 30 years and not having back pain proves that playing sports does not cause back issues.

However, here’s the truth:

Each sport comes with its own set of different risks. So then, what are these asymmetrical sports guilty of causing pain on only one side of the lower back?

Here are some sports whose athletes have been known to suffer from 1-sided low back pain:

  • Baseball
  • Softball
  • Cricket
  • Field Hockey
  • Ice Hockey
  • Tennis
  • Golf

If you play any of these sports and suffer pain on either the left or right side of your lower back, this might be your Aha moment. And the question begging for an answer would thus be: 

How can you solve this type of lower back pain?

“A sum can be put right: but only by going back till you find the error and working it afresh from that point, never by simply going on.” -C. S. Lewis.

The point I’m trying to make is that if you don’t understand the mechanics of the problem, it will only get worse. You might be doing everything right and still have back pain. 

The first step in solving any problem is understanding it.

And that brings us to: Your core.

The core is a system that has been around for as long as humans have walked the Earth. It’s a critical part of our bodies, helping us stabilize and protect our spine, hips, and other joints.

But what if I told you there’s a difference between core strength and stability? A strong core can be a great thing—but only when coupled with good stability. Conversely, a weak core predisposes you to lower back pain.

Why?

When the stability of your active systems, i.e., muscles, is weak, your passive system, which includes your joints and ligaments, tends to be overworked, resulting in pain.

But the solution is not to just “stay active” and try to push through a new workout program or make up for lost time with a more strenuous workout. 

The answer is simple: Core endurance and reactive stability are good starting points.

Here are some core strengthening exercises that work wonders we like at Performance Place.

Additionally, you may need to improve the function of your hips. Pinchy hips can rob your lower back’s ability to stabilize as you twist in sport. Thus, in this Youtube video, I discuss how hip mobility and core stability work with 1 sided low back pain.
That’s not all…

There’s good news:

Left/Right-Sided Lower Back Pain? Full recovery is possible!

Here’s the deal. You’ll follow a program created specially for you, combining proven exercises and stretches to help relieve your pain and strengthen your low back muscles anytime, anywhere. Most of the work is done at home or in a gym. You simply need to know what to do and how to do it – and that’s what we’re about at the Performance Place!

Wait! 

Before I jump to the next cause, there’s something you need to be aware of:

Other athletes can develop one-sided low back pain yet are not performing asymmetrical motions repeatedly.

Yes, that’s right.

The following sporting/recreational activities can lead to pain in one side of your lower back:

  • Ballet
  • Gymnastics
  • Ice skating

But…

These are unique situations that may require x-rays (and other images) to investigate the possibility of a spinal stress fracture. The area of interest is the pars interarticularis.

To save your time, I won’t spend much time on this topic since I have extensively covered it in podcasts. Here is the most recent one we did on Dancers with lower back pain.

Moving ahead:

Here’s something equally crucial you could be going through…

Compensated Movement From Old Aches /Pains

Generally speaking, compensating is a process by which the body adjusts to an imbalanced movement. In compensation, it’s the body’s effort to reduce the likelihood of misaligned movement causing severe long-term health problems.

A limp is a perfect example.

So…

  • Do you squat with a shift to one side?
  • Do you have a slight limp?
  • Have you had a repeated knee injury (or ankle) on the left side and experienced chronic lower right back pain?

Then, it is likely that your body can and will compensate for accomplishing a task. 

To my point:

If the task were to cross a busy street, you would run with a limp if you had a sprained ankle, yet you would still accomplish the task of avoiding a car.

The body will find a way to achieve the mission. Yet, sometimes it retains these movement compensations as a default even after your ankle pain is long gone.

Despite that, limping in the absence of any pain happens. 

Allow me to explain:

The Relationship Between Compensated Movement And Pain In One Side Of The Lower Back

Generally, we have three situations of compensated movement, which can create one-sided lower back pain.

  1. You have a current ache/pain in another part of your body that you’re compensating for (i.e., sprained ankle)
  2. You had a past ache/pain that you UNKNOWINGLY compensate for (Past left ankle sprain that shifts you AWAY from using the left leg).
  3. You had a past ache/pain that you KNOWINGLY compensate for (Past left ankle sprain that shifts you AWAY because you are afraid of hurting it again).

Let’s dig deeper into these scenarios:

In Situation 1, you have a current injury in another part of the body. You may notice your 1 sided low back pain may reduce on its own in the same timeline as the active injury. The injured area is called a “painful/dysfunctional” region, which creates short-term compensation.

In this case, your body will reduce the need to compensate over time. You will gradually apply weight to the injured part of the body, which deloads the opposite side of your lower back.

In Situation 2, your past injury is categorized as a “non-painful/dysfunctional” region that tends to create LONG-TERM compensation if not made functional again. I.e., limping in the absence of pain or swelling of the said ankle.

Your knee connects to your hip, your hip connects to your low back, and so on… we all know the song. It turns out it is all true!

In this situation, a customized program should be implemented to address all NON-painful/dysfunctional regions to deload the one side of your low back that hurts.

But here’s the catch:

To do this, you may need a skilled eye to identify non-painful/dysfunctional regions of your body that force the low back to work too hard.

Hang in there; it’s not all gloom and doom.

The Mobility, Stability, and Strength Model program design typically works well.

However, it’s always best to have someone narrow down what exercises will give you the most bang for your buck (and time). 

Because…

Some programs can take 1-2 hours a day if not narrowed down. That’s way too long for most people to do daily!

The truth is you only need 30-60 minutes of activity to reverse the compensation process and reduce right or left-sided lower back stiffness quickly.

In Situation 3, where you consciously avoid using certain joints, you need to get 1-on-1 coaching to implement a similar program design as I mentioned above. 

Warning! Do not try to do this on your own.

This is a “fear avoidance” case, and you’ll need reassurance that they are doing everything correctly.

Unfortunately, most people in Situation 3 end up with paralysis by analysis. Don’t let that be you.

Here’s what you should do:

Simply have a skilled coach, physical therapist, physiotherapist, sports chiropractor, or personal trainer tell you precisely what to do and how to do it.

And you will be surprised how much of your anxiety about movement will decrease by simply doing the exercises with the safety of a coach.

In Situations 2 and 3, no amount of massage, adjustments, electrical stimulation, heat, cupping, acupuncture, chiropractic adjustments, ice packs, medications, or surgery will change your movement patterns.

The only working solution?

Correcting compensated movement patterns requires coaching. 

Just like a professional pitcher in baseball, you need a coach to optimize your movements sometimes.

How Do You Correctly Diagnose Your Compensating Movement?

Usually, a simple mobility assessment gives enough information to move forward. A skilled trainer or medical professional can do this within 30 minutes or less.

Want to do it on your own first?

Have a friend take a video of you squatting, lunging, bending over, and backward. These movements will provide lots of information to start with a program. You will see and feel things that you have never noticed before. Consider this as your “discovery phase” of recovery.

You may notice your lower back rounding or extreme flatness as you move. You may notice your hips feel tight. You may see you dominantly shift towards one side or another.

You won’t know unless you look.

Chances are you are in Situation #2, where the movement compensation occurs without you knowing it. Don’t try to correct it. Typically the proper mobility, stability, and strength exercises will do it all for you, so you don’t have to overthink.

Just move, don’t think. The right program and coaching are all you need.

Cause #4: Internal Causes

One-sided hip or lower back pain can signify internal damage/issues/diseases to internal organs or tissues.

These include:

Impact (blunt) trauma, tumors, infections, kidney infection, pancreatitis, ulcerative colitis, uterine fibroids, endometriosis, kidney stones, testicular torsion, and much more are in this category.

Many of these are accompanied by odd symptoms of nausea, vomiting, fever, gas, bloating, urination, sweating while sleeping, constant pain, intense abdominal pain, and much more.

I know what you’re thinking: 

“I can do this myself.” But do you want to take that chance? I wouldn’t.

I am a medical professional, and I know firsthand what it’s like to spend hours looking for answers -it’s hard to wrap your head around all the information you have to sift through on your own. 

Instead, see a medical professional for a complete physical examination and medical workup. It’ll be a whole lot safer and a whole lot easier on you that way. 

Based on your medical presentation, the medical practitioner may decide whether you need blood work, X-rays, MRIs, CTs, nerve conduction tests, or any other advanced testing.

Cause #5: Deconditioned Or Poor Stability (Back Pain That Changes Sides)

Have you noticed that your lower back pain switches from side to side based on the day or the activity?

When this happens, many rehab professionals consider this an “instability case.” I’m not talking about a clinically unstable spine, such as what you could experience with high grades of spondylolisthesis or fractures. 

Then, what is it?

I’m talking about “deconditioned or poor stability.”

You know that saying, “You are what you eat?” Well, in this case, you’re what you do. 

In case you’re wondering, here are the findings of a 2014 review study published in Current Medical Research and Opinion:

“…the majority of evidence suggests LBP is associated with decreased strength/endurance, atrophy, and excessive fatigability of the lumbar extensors. Prospective studies also suggest lumbar extensor deconditioning may be a common risk factor predicting acute low back injury and LBP.”

Some hypotheses to help you understand the medical speak better:

  • If you had a trigger point within the lower back muscles, your pain would NOT change sides.
  • If you had an active disc injury, you would NOT have your back pain be on the left side one day and then move to the other side the next.
  • If you had a Sacroiliac (SI) joint sprain, your pain would NOT change sides.
  • If you had a pinched nerve in your lower back, the tension would NOT change sides.
  • Lower back pain that changes sides is NOT due to a true structural reason.

That is to say:

Lower back pain that changes sides results from one or a combination of the following: a biomechanical loading problem, a mobility problem, or a stability problem.

This is what we discussed in situations 2 and 3 above – where low back pain that switches sides is often seen.

What does this mean for you? 

It would be best if you started working on getting yourself healthy again as soon as possible. It may be worth it to see a specialist if this is the case—the sooner your spine can start getting straightened out, the better off you will be in the long run.

Bottom line: back pain can be an uncomfortable and debilitating phenomenon. Don’t be a slave to lower back pain. We want you to feel better to enjoy the things you love most. So, contact us immediately if you feel achiness in one side of your lower back that moves to another. We want to help ease your pain and lessen the chance of serious injury.

Valuable Resources For The Diagnosis of One Sided Lower Back Pain

I have written articles about these diagnoses already. If you want to investigate any of them further, just click on the links and use our sidebar on the following page to find what you are looking for.

  • Low back disc injury (Youtube Video).
  • Arthritis.
  • Bone spurs.
  • Spinal stenosis.
  • Muscle Strain or Sprain.
  • Facet Syndrome (Youtube Video).
  • Sciatica.
  • Low Back Pinched Nerve (Youtube Video).
  • SI Joint Dysfunction (SJD) (Youtube Video “What does it feel like”).

Others include:

  • Hip Flexor Syndrome (Youtube Video).
  • Hip Impingement
  • Pars Fracture
  • Piriformis Syndrome (Youtube Video).

A Quick Summary Of Non-Surgical Treatments For Lower Right Side Back Pain

  • Massage.
  • Injections.
  • Cupping.
  • Trigger Point.
  • Releasing scar tissue.
  • Active Release Technique.
  • Graston.
  • Chiropractic Adjustments.
  • Surgery.
  • Ice, Heat, and NSAIDs.

While the treatments above may temporarily relieve pain and control symptoms, they do not address underlying factors that led directly to the original condition. Therefore, none of them can help restore function or reverse movement compensations.

The same can be said of the non-surgical treatments. They’re just as effective when combined with the following:

  • Active care.
  • Corrective exercise.
  • Mobility exercise.
  • Stability exercise.
  • Strength training.
  • Dynamic Neuromuscular Stabilization (DNS).
  • Functional Range Conditioning (FRC).
  • Kinstretch.

Ultimately…

Returning to a pain-free and fully functional life is within your reach: Effortful exercise with good coaching can help return you to a pain-free and fully functional life. 

Don’t be fooled into thinking passive care is always the best approach – it is not required in many situations. Effortful treatment works wonders and can also reduce pain quickly.

Recap

If you read the whole article, you can probably tell that resolving lower back pain isn’t as easy as popping a few pills or buying a new mattress. 

Quick fixes do not improve mobility, stability, strength, or movement compensations (conscious or unconscious). If you want to get rid of your lower back pain for good, here’s what you need to know:

A Word On Performance Place

The word: Proven!

 Hey, you, reading this…

You’re here because you’re looking for a solution to end the agony of the pain you endure on the right side of your lower back. Or is it a left-side back pain?

Whatever it be, we’ve got you covered!

Performance Place provides a proven way to get the results you want. We’re not talking about “I’m gonna try this and see what happens” or “I’ve heard it can help me reduce the pain.” 

We’re talking about a proven system – customized programs that have helped thousands of people get rid of 1 sided lower back pain for good. We’re ready to show you how it works and, most importantly…how to do it. Discover how now!

Think less, do more and feel better quickly!

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Oblique Strain – The Worst Baseball Injury Ever https://www.p2sportscare.com/articles/spine/oblique-strain/ Wed, 23 Nov 2022 13:40:20 +0000 https://www.p2sportscare.com/?p=72031

This is my personal experience with my oblique strain (and my treatment) 

In this all-new guide you’ll learn:

  • Signs and Symptoms of an Oblique Strain
  • Rehabilitation Program for my Oblique Strain
  • How To Diagnose an Oblique Strain
  • Week by Week Improvement Expectations

Note: read the disclaimer and always see a doctor first. If you need some help virtually (or in-person) the “Locally World Famous Chiropractors®” at Performance Place Sports Care are ready to work with you!

Let’s get started.

 

Oblique Strain: A Personal Patient Perspective

What Is An Oblique Strain?

An oblique strain, AKA a side strain injury, is when one of the abdominal muscles (internal or external oblique muscles) becomes frayed, torn or detached. Often times from the lower four ribs, it is painful to breath, cough and laugh. This is treatable, with recovery ranging from weeks to months with the correct treatment plan.

The last thing I’ve ever wanted to do was write up my own experience with a sports related injury, but alas, here I am!

Many of you may know that I play baseball; I’m an avid baseball player, so I train as a baseball player.

Surely, with my knowledge and experience, I was training adequately to avoid injury, right? Wrong!

I learned a very hard and painful (not to mention scary) lesson about having an oblique strain. It was such a learning process for me that I felt compelled to share it with you.

I’ll start by saying it was extremely frustrating not being able to find ANYONE who could help me through this horrible injury.

Fortunately, my job is to provide others with the rehab/therapy for their condition; the sad thing was that I’ve NEVER treated anyone with an oblique strain. I was the first case for me!

I was forced to experiment on myself using available research on abdominal wall injuries. Long story short, I overcame the oblique strain to play baseball again and still play today.

I can run as fast as I want, throw as hard as I want and most importantly, I can sneeze again!

To not forget how this condition felt, I wrote this article about my recovery. I hope it assists you mentally and physically through any issues you’re having.

A Gameplan for Oblique Strains

Since writing this article (over the last 4+ years), I’ve received countless emails from people around the world who’ve experienced the same type of pain, and not knowing what it was or how to fix (rehab) it.

That’s why I created an 8 week oblique rehab video course to better assist those of you who’ve reached out to me but can’t come into my office because you’re not local. It shows you how to overcome your oblique strain over the course of 8 weeks. It’s not only tried and true – because I went through it successfully – but it’s stuff you can do on your own. 

GET THE GUIDE →

(For a limited time, use coupon code BREATHE50 to save $50 towards your recovery with this web guide!)

The rest of this article will shed light into some of the workouts you’ll find in this course.

Week 1 Pain and Debilitation

Any baseball fan can tell you that an oblique strain puts you on the Disabled List for at least 15 days if not more. As an athlete, I’ve had many injuries: a grade 2 hamstring tear, a rotator cuff strain, back pain, and cuboid syndrome.

So I can tell you from personal experience that an oblique strain is more debilitating than ALL of them. An injury to your core musculature makes it nearly impossible to do anything without pain.

You don’t realize how much you use your core in daily life until it hurts to use it.

Without being exhaustive, here is a list of things that caused me pain in week 1 of my oblique strain:

– Putting on shoes
– Getting into my car
– Pressing the brake pedal in my car
– Sitting up
– Rolling over
– Leaning to one side
– Running
– Walking
– Laughing
– Going to the bathroom (mostly #2…I know, but it’s a daily thing!)
– And most of all….sneezing!

Sneezing made me feel like I was going to explode! It literally brought me to my knees.

Diagnosing My Oblique Strain

I’m an outfielder. In the first inning, I had to dive for a ball coming directly over my head.

I caught it (of course), but over stretched my left side in the process. Over the next few innings, I could feel something a bit off on that side, just under the last rib as I was rounding the bases.

Everything seemed OK until the 7th inning. Up to bat, I swung and missed; that’s when I felt a “pop” and had intense pain.

Worried and confused, I looked over at the batter on deck wondering if I should continue? Despite the pain, I hung in there attempting to bunt despite a two strike count. After my at bat was over, I had to lay on my back behind the dugout.

Desperate to brace my core and stop the pain, I realized it was too late. I’d really hurt myself! I knew it was bad when I couldn’t even roll over to watch a play.

My mind started racing. How bad is my injury? Can I play next week? Can I play again ever? What if I have to sneeze?!

In all seriousness, I was really concerned about getting sick. Forget about baseball! I knew I had to fly out for a trip in a few days and dreaded the idea of being crammed up in a plane, ripe with contagion.

So when I boarded the plane, I opted to disinfect my seat in order to not be the “weird guy” wearing the SARS mask for the entire flight. I was desperate…that’s how painful a sneeze was!

I know, I’m digressing, but sneezing really was excruciating! Anyway, it took me about five days come out of the haze of my shock and disbelief and into a clear realization that I’d really, seriously injured myself.

Only then did I begin to think logically about what was going on.

Is this an oblique strain or a large tear?

Did I fracture a rib?

What the heck else could it be?

I decided I needed some imaging. I sought out Mike Jablon, a great Musculoskeletal (MSK) Ultrasound Sonographer. I knew he was the go-to guy as he’d helped me learn to use and read MSK Ultrasounds.

For those not familiar with MSK, it’s an ultrasound (just like those used in pregnancy) that is designed specifically for visualization of muscles and tendons. It’s a great cost alternative to MRI for those of you, like me, who may not have great insurance coverage. It’s very accurate when used correctly. Lastly, it was sitting right there in my office and would let me personally review my result!

Sure enough, the MSK Ultrasound led Mike to pronounce my diagnosis: an oblique strain with a small avulsion of the rib.

So there I had it.

Oddly, I wasn’t bummed. I became focused.

I knew I was going to get better and my intestines were staying put. Having a diagnosis of oblique strain gave me back a measure of power and control…I knew what my problem was and how I was going to fix it!

My Oblique Strain Recovery Plan

My first order of business was to start loading up on vitamin C; I wasn’t going to get sick (I’m really serious about the sneezing pain). Then I rested. My plan was simple. Sit tight for 3 weeks then attempt some rehab.

 

During that time, I didn’t workout or play baseball. I did get proactive about my injury. I knew I needed some stabilization of my core. If you check my Instagram feed (@PerformanceHB) during that time, you’ll see that I taped up the area to limit motion.

My specific goal was to limit my lateral flexion and extension.

I didn’t want to create more damage. I used Leukotape because it’s more resistant to stretching as opposed to Rock Tape and KT Tape.

From my medial training, I knew when to attempt my first workout.

Most soft tissue injuries normally have the ability to carry some load after three weeks.

Apprehensively, that’s when I attempted my first workout at a CrossFit near my home. To my relief, I was actually finally able to perform sagittal plane motion under a light load!! The sagittal plane is like a hip hinge or squat, but not a full baseball swing. I had a long way to go, but this was an encouraging start!

Here is my first workout lifting post oblique strain:

  • Isometric abdominal work as a warm-up
  • Concept 2 rowing at 50% effort for 1000 meters
  • Barbell hip thrusters 65lbs for reps
  • Bulgarian split squat 26lbs for reps
  • Front squats at 85lbs for reps

I had no pain at all doing this workout!

But, I still couldn’t sneeze!!

This brings me to an important concept in rehabbing an oblique strain (or any soft tissue injury):

If you know what you’re doing in the gym, start to test and learn what you can tolerate post injury. If you don’t know what you’re doing, then get with someone who does and get back to being active at the appropriate time.

Before that, be proactive in week 1 about your oblique strain. Seek out a sport injury specialist that can accurately diagnose you with ultrasound, recommend and demonstrate taping for your core and start you with activities you can still do like planks, etc.

It took one more week for me to not have pain with sneezing (finally!), but I did end up getting sick with a cough at that point. It was a nagging cough that even woke me up at night, so I opted for a week off of training to recover.

At week 5, I attempted swimming, which was a little uncomfortable the first few laps, but I was able to work through it. I also began a TRX Rip Trainer for some isometric rotational training before I picked up a bat again.

So, after a total of 6 weeks post oblique strain, I was finally able to swing a bat again!

You wouldn’t imagine the fear of swinging a bat until you do so after an injury. I actually slapped liners to right field for a few games before I even attempted to hit an inside pitch. I don’t think the pitchers ever caught on, but I was letting everything middle in go right by!

I tried to make this “restricted hitting” time productive. I worked on picking my pitches and oppos. Hell, I even worked on push bunting… why not.

At 9 weeks, I decided I was NEVER going to have an oblique strain again. I began adding more days of rotational and lateral motion into my training regimen. I realized that for 6 months prior to my injury, I’d only been doing front and back squats, deadlifts and cleans.

This routine was sorely lacking for the core demands of a rotational athlete, and I had just simply lost sight of my own training needs!

Results and Conclusion

Today, well over a year later, and well into my next baseball season, I can honestly say that I don’t have any discomfort from my oblique strain.

I have stepped up my training, adding even more lateral motion power and rotational moves to prep my muscles and tendons for the quick action needed to smash the baseball.

And interestingly at the office, I ‘ve had quite a few oblique strains come through the doors in the past 6 months!

I hope my sharing this story has given you some insight into what it’s like to have an oblique strain. It’s the type of injury that can literally make you question if it’s “the end”.

Despite my extensive sports medicine knowledge, I still had quite a lot of fear and doubt about my recovery. I can only imagine what the average athlete goes through with this injury!

It has certainly provided me with precious insight of what it’s like on the other side of the table, and more importantly, it’s given me powerful knowledge to be able to empathize with and take better care of my patients with an oblique strain.

If you’re dealing with an oblique strain and you don’t live in Southern California, you should look at my video course. I find that most people just need a game plan of what to do as it heals. Watch the course preview video to get a really good idea of what to do (it’s the video at the top of this article, but you can also find it HERE.)

Good luck!

Dr. Sebastian Gonzales DC, DACBSP®, CSCS

 

 

Live in Southern California? Come see me in person!

How long does it take for a torn oblique muscle to heal?

A torn oblique muscle recovery time varies depending upon the severity and your activity level during your recovery. Most strains can recover in 5-10 days, while more severe injuries can take 1-2 months. We have spoken to people who have suffered from pain associated with a torn oblique muscle that has lasted upwards of a year.

You can delay your recovery by “picking the scab.” Stretching the oblique muscle or too much activity too soon can increase recovery time. Be sure to have a complete examination by a qualified medical professional to see what you can and can’t do at this stage in your recovery.

If you’re in California, set up your first session with us here.

How do you treat a torn oblique muscle?

Google searches show that most people treat a torn oblique with a combination of cold, heat, over-the-counter painkillers, compression, rest, and general exercise.

I’ve recovered from a torn oblique muscle, and I agree with only some of these treatment suggestions.

Ice and rest are acceptable for the first five days, yet using them beyond that can decondition your body and prolong recovery.

Walking (when it is tolerable) is one of the best things to do. Walking often doesn’t stretch on the torn area and can help “lubricate” other body joints that will help your recovery move forward.

Luekotape or a movement check tape job can help keep you out of the ranges of motion that can “pick the scab” and delay your recovery. Taping is a great way to keep moving while keeping the torn region out of a stretch position, triggering pain.

Exercise can be helpful, but exercise should be used for a specific purpose, like medication. Some corrective exercises can significantly reduce pain, while others may induce more hurt.

A rehabilitation professional with experience in working with athletes with a torn oblique muscle is best. Corrective exercises can often be implemented as early as a week after the injury occurred.

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13 Best Lower Back Pain Stretches & Exercises For Relief https://www.p2sportscare.com/articles/spine/lower-back-pain-stretches/ Mon, 21 Nov 2022 08:22:57 +0000 https://www.p2sportscare.com/?p=102909 If you’re looking for a way to get rid of lower back pain, try these 13 best stretches and exercises for relief. They’ll help you find more movement in your day and keep that pain at bay!

If you’re one of the millions of people suffering from lower back pain, you know it can be much more than just uncomfortable.

We’ve all been there: You’re just trying to get through your day, and then suddenly—you feel it

That ache in your lower back that makes you wince. The pain that makes you want to curl up in a ball and never move again can make it hard to do even the simplest of tasks.

It’s awful.

Well, don’t despair:

One of the best ways to deal with lower back pain is through stretching and exercise. These exercises will not only help alleviate your current discomfort, but they’ll also help prevent future flare-ups by strengthening and stretching your muscles.

Bonus TIP – Check our exclusive video

Low Back Stretches For Pain

We’ve rounded up 13 of our favorite lower back stretches and exercises sure to give you much-needed relief!

But before we dive in, keep the following in mind:

  • Your lower back is essential to you. It’s where your spine connects to your pelvis, and it’s the part of you that keeps your body upright while you’re standing. But if you spend a lot of time sitting, it can get tight and stiff, leading to pain if you don’t stretch out (and exercise) regularly.
  • Stretching is not a cure-all for back pain, but for some people, it can help relieve tight hips and legs—which sometimes cause lower back pain. For a more comprehensive non-surgical solution you can do at home, check out this guide.
  •  In most cases, gentle stretching can be done even while in pain to provide fast relief—plus, it’s easy to fit into your schedule.
  •  Also, before executing any of these stretches and exercises, check in with your doctor if you have any major health concerns or existing injuries.
  •  Finally, there are many different types of stretches and exercises; it’s vital to choose the right one for your needs. To help you out, we’ve put together this list of 13 that will help relieve lower back pain:

Bird Dog

The bird dog is one of the best lower back pain stretches for stabilizing the lower back. It targets the muscles of the lower back, core, and hip muscles.

Bird dog can be done as follows:

  • Start on all fours (hands and knees on the floor).
  • Next, lift one of your legs off the floor, extending it behind you while ensuring your hips are kept in position; your stomach and low back muscles tightened.
  • Hold this position for 5 seconds or more before lowering back down to repeat on the other leg.
  • Repeat this exercise 8-12 times on each leg. Aim for a longer duration of time to hold each leg in the air.

Bridging

Bridging (or Bridge pose) strengthens your glutes and hamstrings and improves posture by working on your hip, hamstring, and low back muscles as you lift your hips up toward the ceiling. This exercise is good for improving core stability and reducing lower back pain.

Bridging can be done as follows:

  • Lay on your back with your knees bent.
  • Place your hands on the floor with your arms pointing straight ahead.
  • Push through your heels and raise your hips off the floor while squeezing your buttocks with your feet hip-width apart until your body forms a straight line from shoulders to knees. Do not arch your back while at it.
  • Hold for up to 30 seconds. Then lower back down slowly, and relax for 15 seconds before repeating.
  • Repeat 10 times or as many times as is comfortable.

Cat-Cow Stretch

This basic stretch helps to relieve tension from your lower back by opening up the joints in your spine. This allows the muscles around them to relax more efficiently so they can work properly again, relieving lower back pain.

Cat-Cow stretch can be done as follows:

  • Get down to all fours in a tabletop position.
  • After that, you should arch your mid-back toward the ceiling, pulling up on your mid-back in a similar motion to when a cat arches its back.
  • Hold it in that gentle outward curve for five seconds. Then let your low back sink down as you arch your lower back next; hold here for another five seconds.
  • Repeat these motions for 30-120 seconds.

Child’s Pose

Child’s pose is a simple yoga pose that stretches out your hips and back, so it’s great for relieving lower back pain and tension.

Furthermore, it is one of the easiest poses to do. It can be done before bed, during your lunch break, or even during an intense workout at the gym.

The child’s Pose can be done as follows:

  • Get your hands and knees on the floor, with your wrists under your shoulders and your knees under your hips.
  • Sit back on your heels with a straight spine. Your knees and palms should still remain on the floor.
  • Lower your forehead and bring your belly to rest on your thighs with your hands stretched out in front of you or on either side of your head.
  • Stay in this position for up to 60 seconds, breathing deeply and letting the tension drain from your body.

Happy Baby Pose

The happy baby pose is a perfect resting stretch for when you’re feeling incredibly sore. This stretch will open up your hips, giving those muscles room to stretch out and relax, which can help you get rid of your lower back pain. It’s also a great way to relieve not only the stress from tight muscles but also from a long day of work.

Follow these steps to do a happy baby pose:

  •   Lie face up on the floor.
  •   Bring your knees toward your chest while your feet are lifted into the air and facing the ceiling.
  •   Next, reach out and hold the outside of your feet. Each hand grabs the corresponding feet.
  •   Hold this position or move from side to side for a few seconds.
  •   Repeat as many times as comfortable.

Knee-to-chest Stretch

The knee-to-chest stretch is a classic lower back pain exercise that works to relieve pain, reduce stiffness, and help prevent future injury. It targets the lower lumbar muscles and can help relax the hip, glutes, and thighs.

Follow these steps to perform the knee-to-chest stretch:

  • Lie on your back with knees bent and feet flat on the floor.
  • Slowly lift one leg off the ground and pull it toward your chest; keep your spine straight and hip firm on the floor.
  • Hold this position for up to 30 seconds, then return your foot to its starting position.
  • Switch to the other leg and repeat steps 2 and 3.

Lower Back Rotational Stretch

The lower back rotational stretch can help relieve tightness in the buttocks, hamstrings, and gluteal muscles. It’s also good for improving posture and increasing flexibility in the spine.

  • Lie flat on your back, bend your knees and keep your feet flat on the floor
  • Ensure your shoulders are flat on the floor and gently move your bent knees (while your thighs are held together) to one side of your body.
  • Hold this position for up to 10 seconds, then move your knees back to the position you started.
  • Next, repeat the same movement in the opposite direction.
  • Repeat the entire exercise a few times.

Pelvic Tilt

These are simple moves that engage your core muscles and can help increase mobility in your pelvic area, relieving your low back pain and improving your posture over time.

Here’s how to complete a pelvic tilt stretch:

  •    Lie with your back, knees bent, and feet flat on the floor.
  •    Tighten your abdominal muscles as if you were about to do a sit-up. Keep your low back on the floor.
  •    Tilt your pelvis upward by engaging your core muscles.
  •    Do this repeatedly up to 15 times.

Plank Exercise For Lower Back Pain

The plank is one of the most effective exercises you can do. It strengthens your core, shoulders, and glutes. Various studies prove it improves the health of your muscles responsible for spinal stabilization. This exercise also helps improve posture and reduce stress on the spine.

To perform a plank:

  •  Lie on your stomach with your feet together.
  •  Lift up into a push-up position so that only your elbows directly below your shoulders, forearms, and toes touch the ground. Your body forms a straight line from head to toe when executed correctly.
  •  Hold this position for 30 seconds or more if possible.

Pilates

Pilates is a form of exercise that focuses on the core muscles, which are the muscles in your lower back, abdomen, and pelvis. Pilates can be done with various equipment, such as a mat or resistance bands. Pilates moves help to strengthen and stretch these muscles to improve posture and reduce back pain. How to do it: You will need the guidance of an experienced instructor 

Reclining Hand-to-Big Toe Stretch

The reclining hand-to-big-toe stretch is an easy, fun way to stretch your lower back and hips. This exercise will help work your tight hip flexors, adductors, and hamstrings, which can be contributory factors in lower back pains.

  • Reclining hand-to-big toe stretch can be done as follows:
  • Lie on your back with your legs straight out in front of you.
  • Lift one leg straight up and bring it up toward your face. Keep your head, shoulders, the other leg, and opposite hip flat on the floor.
  •  Grasp the big toe with the hand on the same side as the lifted leg. You should feel a nice stretch in your hamstring, calf, and lower back area.
  •   Hold for 30 seconds and repeat at least three times on each side.

Seated Spinal Twist

This move is meant to stretch and relax tight muscles in your back, hips, and glutes — which may relieve some of your pain. You’ll also feel your shoulders and abdominals stretching. This stretch also stimulates your internal organs and gives you a well-rounded stretching experience.

Seated spinal twist can be done as follows:

  • Get down on the floor and sit with your legs extended in front of you.
  • Bend your left knee and cross your left foot onto the outside of your right thigh.
  • Next, put your right arm on the outside of your left thigh and rest your left hand behind you to provide support.
  • Twist your body to the left – ensure the movement originates from the base of your spine(lower back).
  • Hold the position for 30-60 seconds(or more).
  • Do the same thing on the other side.

Supine Twist

The supine twist effectively stretches the lower back and glute muscles.

Supine twist can be done as follows:

  • Lie on your back with your knees bent and arms extended outward on both sides. Meanwhile, ensure both feet and shoulders should remain flat on the floor.
  • Slowly move both knees (held together) to one side and hold for 20-30 seconds before returning to your starting point.
  •  Next, repeat the same range of movement on your opposite side.

Eliminate Lower Back Pain With Stretches And Exercises: Tips To Get The Best Results From Your Workouts

When you’re stretching, there are a few things to keep in mind, so you get the most out of your workout:

Start slowly and gently. Don’t try to push yourself too far or too fast. Don’t jerk or bounce; don’t rush through each exercise/stretch either – instead, strive to enjoy the process.

Make sure your posture is correct. When stretching, maintain the proper form as you go through the exercise. This will help prevent injuries and also let you get the best results.

Remember to breathe! Breathing helps relax tense muscles and keeps them from getting too tight. When you’re stretching, take slow, deep breaths through your nose.

Hold each stretch for 30 seconds or more. A good rule of thumb is that if it feels good, hold longer; if it hurts, stop immediately! Remember that the longer you hold, the more low back pain relieving benefits you get.

Stretch regularly. Stretching should become part of your daily routine, so make sure you do it daily. It doesn’t have to be lengthy — just 10 minutes of simple stretches can help relieve some of your back pain.

Get comfortable. You should be relaxed when exercising or stretching, so make sure your environment is comfortable and free from distractions and hazards. Use appropriate clothing and equipment.

Work with a professional. If you have lower back pain, it’s essential to work with a professional who can help you develop a customized plan for your specific needs.

One more thing:

Sometimes exercise and stretches won’t work – the cause of your lower back pain may be beyond what these workouts can alleviate. Most importantly, you don’t want your condition to get worse and thus require costly expenses and invasive interventions like surgery.

So, what do you do?

It is simple:

Performance Place Can Help You Get Rid Of Your Lower Back Pain 

You’ve tried common treatments and physician visits, but nothing is working. You may even have had surgery, but you’re left with the same lower back pain in the end. We want to help!

Here’s the thing: 

No matter the cause of your back pain, there’s a good chance you don’t want it anymore. The real trick is understanding what works best for you in terms of what to do, when, and how to do it. And that’s where the Performance Place shines through:

Our programs are based on research and have proven to work for the thousands of people we’ve helped. That’s not all:

At the heart of our solutions, we combine a customized program fashioned around your personal needs with evidenced-based techniques to provide simple, non-invasive, affordable solutions for lower back pain.

In the end, back pain sufferers are better for it. Those who have worked with us tell us that after just a few days of doing the exercises we design for them, they start feeling better. And as time passes, their body’s strength builds, and the pain is gone forever before they know it.

Now back to you…

You don’t have to live with lower back pain anymore. We can help you eliminate it for good without drugs or surgery. However, there’s a catch: Our hands-on and detailed routines mean we can only work with a few clients simultaneously, so hurry and book a spot. Head over here to get rid of your low back pain, irrespective of your location (yes, we offer virtual programs and guides).

Final Words

A good combination of stretching and strengthening will keep your lower back strong while helping to keep your pain in check. So, keep this list of stretches and exercises handy to help relieve your low back pain. Having said that, what is most important is that it’s crucial to treat the root cause of your lower back pain so that you don’t have to rely on these stretches forever – Performance Place can help.

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12 Best Hamstring Stretches For Runners https://www.p2sportscare.com/articles/lower-extremity/best-hamstring-stretches/ https://www.p2sportscare.com/articles/lower-extremity/best-hamstring-stretches/#respond Tue, 25 Oct 2022 15:01:51 +0000 https://www.p2sportscare.com/?p=72039

Hamstring Stretches and Exercises

12 Best Hamstring Stretches & 4 Eccentric Strength Exercises

In this article we will cover the 12 best hamstring stretches in existence.

  • Toe Touching Hamstring Stretch
  • Sit and Reach Hamstring Stretch
  • Door Jamb Contract- Relax Supine Hamstring Stretch for Beginners
  • Standing Upper Hamstring Stretch
  • Standing Hamstring Stretch
  • Seated Hamstring Stretch – Easy Hamstring Stretch for Athletes
  • Leg Swings- Advanced Hamstring Stretch for Athletes
  • Contract- Relax Partner Hamstring Stretching
  • Self Myofascial Release of the Hamstring
  • Supine Kicks To Stretch The Hamstring
  • Supine Ankle Rolls To Stretch Tight Hamstrings
  • Foam Rolling the Lower Hamstring

And 4 Killer Hamstring Eccentric Strengthening Exercises:

  • Romanian Deadlift For Eccentric Strength of Upper Hamstring
  • Single Leg Deadlift For Stance Leg Eccentric Hamstring Strengthening
  • Heel Dig/ Slides For Eccentric Strength of Lower Hamstring
  • Tall Rocking Exercise For Hamstring Strength

Never Stretch Without Doing This First

STOP!… Do this before you start these stretches!

Get the blood moving. Go for a walk, sit in a chair and get up a few times, or walk some stairs. Do some normal human movement enough to get your heart rate up above resting. It should feel like you’re “getting warm” that’s why they call it a warm up.

It is always a good idea to warm up before you start any hamstring stretches. (Last thing you want is a strain!)

Other options are (but not limited to):

  • Standing leg curls
  • Walking lunges
  • Bridges
  • High knee walks
  • Planks
  • Rolling around on the ground

The hamstring muscle group is located at the back of your thigh and pelvis (at the very bottom) is partly responsible for a well-aligned pelvic position, back health and nerve health.

The hamstring muscles attach from the sit bone (or thigh bone) to the bones below the knee joint. They assist in hip extension and knee bend, which is why they are so important in running gait. Chronic contraction of the hamstrings can dramatically affect pelvic tilts (forward and backwards), creating uncomfortable feeling of tightness in the hamstrings themselves, the low back or groin.

The hamstring muscle group is located at the back of your thigh and pelvis (at the very bottom) is partly responsible for a well-aligned pelvic position, back health and nerve health.

The hamstring muscles attach from the sit bone (or thigh bone) to the bones below the knee joint. They assist in hip extension and knee bend, which is why they are so important in running gait. Chronic contraction of the hamstrings can dramatically affect pelvic tilts (forward and backwards), creating uncomfortable feeling of tightness in the hamstrings themselves, the low back or groin.

The Case For Hamstring Stretching

The question remains… what does hamstring tightness have to do with low back pain?

The roots of the problem is lies within the pelvis region. The following image demonstrates a concept called Lower Cross Syndrome, which shows correlates with low back pain via the “pelvic dial.” When the pelvis has too much forward motion (see the large arrows) this alters the lower back curvatures.

Back pain is common when the lumbar spine is forced to arch too much, as it accommodate to excessive anterior pelvic tilt.

Let’s work on reversing Lower Cross Syndrome, by stretching the hamstrings using a few of the stretches in this article.

 

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Why Do You Have Tight Hamstrings?

Hamstrings can become tight for a variety of reasons:

  • Overuse
  • Nerve pressure
  • Too much sitting
  • Too much running
  • Lack of hip mobility

Throughout this guide, I’ll show some of the best hamstring stretches in existence. If they don’t work for you then you may need to address your hamstring tightness with a non-stretching correction. Stretching does not fix all hamstring tightness, regardless if it feels good in the moment or not.

In the end of the article, I’ll guide you to another reference that will probably work better if you fall into this category.

What To Expect In This Article

All of the hamstring stretches that you will ever need to know.
How to stretch specific areas
Pictures + Instructions included
Strengthening exercises that actually improve your flexibility
What to do if these exercise aren’t working for you

Toe Touching Hamstring Stretch

The most common old-fashioned way to stretch your hamstrings is with a forward fold toe touch. To ensure that you’re releasing long-standing hamstring muscle tension, start the forward bend from the hips. The verbal cue of “pushing your hip pockets backwards seems to work for most beginners.

Since the hamstring starts at the sit bones of the pelvis, “pushing your hips behind you” is all you’ll need to stretch your hamstring in isolation. If you are looking to open up the back as well, simply breath into your yoga pants waistline and segmentally bend from each section of the spine (starting with the lower sections). Keep your feet grounded the entire time.

Don’t bounce in and out of the stretch because it will trigger a protective reflex that will make your hamstring tighten up to protect against the bounce. Hold this forward fold for 30 seconds. It should be comfortable the entire time just like all of the hamstring stretching in this article.

In yoga, they may tell you to “lift your sit bones” to the sky. While this is a great yoga cue, in clinical practice, I’ve found pushing your hips behind your feet works better and is much more protective over other parts of the body. Keeping your feet grounded into the floor should also make you feel more stable, resistant of falling when performing a forward fold.

Sit/ Reach Hamstring Stretch

Next up is the sit and reach stretch. An oldie but goodie, the sit and reach hamstring stretch is sadly performed incorrectly often. As previously noted before, your hamstring only travels from the back of the knee to the sit bone. All you really need is a bend of the hip to stretch your tight hamstring. I’ve included some faults in the correlated picture.

How to stretch your hamstrings in the sit and reach stretch:

  • Sit with only one leg extended (other is bent)
  • With a “proud chest/ proud posture” lean toward your ankle on the straightened leg
  • Keep your back flat
  • Hold the stretch for 30 second, relax for 10 seconds and then repeat.

Door Jamb Stretch

Contract- Relax Supine Hamstring Stretch for Beginners

One way to increase hamstring flexibility is using the contract-relax doorway stretch. It is exactly how it sounds, you contract the hamstring and then relax it in a cyclical fashion. Starting on your back is a great way to work towards your goal of touching your toes when standing.

Can everyone touch their toes at the start of a stretching program? No, it takes time. Dancers don’t become flexible overnight and you won’t either. It’s a long-term thing.

Contract-relax stretching for increasing hamstring flexibility has more research than many other types of stretching styles.

Here’s some tips:

  • When pressing into the wall, attempt to dent the wall with the tip of your heel (30-50% of your full effort)
  • Contract for 10 seconds
  • Relax for 5
  • Slide in closer and do it again
  • Attempt no more than 5 cycles

Each time you’ll get closer to the wall. This one is amazing for near immediate results.

Standing Upper Hamstring Stretch

The standing upper hamstring stretch is amazing for runners who start their run in the morning when the ground is wet. Standing hamstring stretching is similar to the seated “sit and reach” stretch in the mechanics.

We can also combine the standing stretch with a contract-relax style that we previously covered.

  • Finding a tree or park bench place the back of your heel onto the object.
  • Lean in from the hip socket
  • Lightly press your heel into the tree or park bench for 5 seconds with about 25% of your full effort and then relax
  • Move deeper into the hamstring stretch and repeat the contract-relax stretch

Standing Hamstring Stretch

In some situations in life, we can’t get on the ground right? Perhaps, the ground is wet, you’re injured or whatever it may be, standing hamstring stretches are an option.

We covered a few of the standing upper hamstring stretch variation already, but that doesn’t target the lower hamstring. In some people, we need to emphasis the lower hamstring.

Now, we have the standing lower hamstring stretch that I use before nearly every run workout. As with all standing variations, if you have issues with your balance, you may want to perform it next to a wall or chair for assistance.

  • Press the stance leg foot firmly into the ground for balance
  • Tap your other “tip of the heel” on to the ground in front of you to a comfortable distance
  • Press your hip pockets backward, while “bowing to the queen” in front of you
  • Hold for 30 seconds before changing sides

Remember hamstring stretching and the ability to touch your toes is a process. Only go as far as you can without having pain, strain or extreme effort.

Seated Hamstring Stretch

Easy Hamstring Stretch for Athletes

The seated hamstring stretch, via a hip hinge, is a great beginner stretch for those of you who don’t feel comfortable on your feet because of balance. During this stretch, I like to be comfortably seated with feet as support. Staying tall in the spine, rock your weight into your feet, as if you’re “looking over a cliff to the bottom of a canyon.”

You may feel this more in your upper hamstrings, which is normal, Venture into new ranges, yet keep your entire foot grounded to the floor at all times. Believe it or not, your balance will improve by doing this as well!

Leg Swings

Advanced Hamstring Stretch for Athletes

If the previous hamstring stretch for athletes isn’t challenging enough, you many want to start each run, bike or swim with some leg swings for your hamstring stretching warm-up. This is one of my favorite to do before a run, because by the end I feel like my hamstrings are nice and warmed up, ready for the long run.

Here’s some steps:

  • Find a tree, wall or partner
  • Fully ground the stance leg foot into the floor for balance
  • As you begin to build amplitude in the leg swing, kick the leafs every time you pass the ground
  • Brace your belly (like you’re taking a punch) as you change directions

Contract- Relax Stretch

Partner Hamstring Stretching

We previously went over contract-relax stretching for the hamstring on your own, but we can always get more out of the stretch when we have a partner. Use a friend with the same goal of touching their toes or ask your therapist to help. Communication is required when doing this so the person helping out doesn’t harm you.

Lay on your back and have your partner stand over you, cupping your heel in their hand. Remember you’re in control and should be able to tell them when to pause.

  • Start with the leg slightly bent (like a lazy stretch position)
  • Your partner should be supporting your leg, not stretching
  • When you’re ready, “press your heel toward the sky” – your partner is just holding the same starting position while you attempt to straighten your leg
  • Effort is 10 seconds, relax is 10 seconds, repeat for 5 cycles

As with all of the hamstring flexibility exercises, none of these should create leg pain, numbness or back pain. Consult your doctor before starting a stretching or exercise program.

Myofascial Release Of Hamstring

I also use self myofascial release of the hamstrings before my runs. I normally do it before I actually leave the house and drive to my location. I love it!

My hamstrings feel so loose after doing them and the great thing is it only takes a minute or so per leg. Grab a lacrosse ball or baseball and give it a try. Take a look at the picture for more details.

Kicks Stretching The Hamstring

Supine hamstring kicks are great for certain types of hamstring tightness. As mentioned in other sections of this article, your hamstrings could be tight for other reasons. This stretch works well when people are ready for reducing minor neurogenic tightness. If that term doesn’t make sense to you please re-read the “reasons for hamstring tightness” section of this article.

Here are the steps:

  • Lay on your back with your hands supporting one thigh
  • With your ankle bent toward your face, slowly knee the leg into a straightened position
  • Hold for 1 second and then lower
  • Perform 10 times per side

Ankle Stretch Tight Hamstrings

The supine ankle rolls hamstrings stretch is another one that is great for neurogenic hamstring tightness. I have people in my clinic do it only once a day if it works for them because sometimes if you “tickle the dragon” it will wake up and tighten the hamstring again.

Here are the steps:

  • Lay on your back with your hands supporting one thigh
  • With your ankle relaxed, straighten your leg
  • At the top of the motion, perform 10 ankle rolls
  • Perform 10 times per side

Foam Rolling Lower Hamstring

No matter the type of athlete you are, you’d probably benefit from the use of a foam roller to address those nasty “trigger points/ knots” in your hamstring. A foam roller is a cheap and easy way to decrease local sensitivity after a workout or long day.

Foam rolling the hamstring is best performed after runs and lifts because the pressure will temporarily deaden the stretch response of the hamstring muscle. Performing it before a run will actually make you slower.

Performing foam rolling after workouts, will also assist in your recovery so you can run or lift again sooner, plus feel great doing it!

The steps are simple:

  • While on the floor, place the foam roller on a trigger point
  • Use your upper body to modify how much body weight you can tolerate on the area
  • Spend no more than 1 minute per location

What Causes Tight Hamstrings?

Hamstring tightness can come from many events in life, but if I had to pick the top three reasons they would be:

  • Sitting too much
  • Running/ lifting too much
  • Poor posture in life

I know these all sound very different but like I said, your hamstring could be tight for many different reasons. Just like your car not starting one day, it could be from many reasons. Gas, battery, starter and much more.

When sitting, your hamstrings become tight because they’re in a shortened position too long or because of nerve pressure from the low back (too much arch or round of the spine). Nerve pressure has been documented to increase tone (tightness) of the hamstring muscle. Think sciatica…

While running and lifting, the hamstrings are being actively stiffened because of the workload. Without a good hamstring mobility program, this tightness can become extreme.

Bad posture can lead to hamstring tightness the same way that sitting for a long period can.

Why Stretch Your Hamstrings?

Stretching your hamstring, and then apply workload to the hips, on a consistent basis can yield massive improvements in your health.

Here’s just a few improvement you may expect to see:

  • Better posture
  • Less back and nerve pain
  • Reduction of recurrent hamstring strains
  • Less pain with motion that matter (walking, standing up from a chair, sex, travel)

Eccentric Hamstring Strengthening Exercises

Eccentric exercise is the key to retaining the flexibility you gained after a hamstring stretching session. Without adding resistance to the hamstrings on a consistent basis, do not expect your hamstring to stay loose for long.

The reason I created this article was to educate the public that hamstring stretching is great, but useless when not coupled with strength training. This combination approach is why contract-relax stretching works so well.

Use the following exercises to keep your hamstring flexibility.

Eccentric Strength of Upper Hamstring

Romanian Deadlift

High eccentric hamstring strength has been linked to having less hamstring strains. Less hamstring strains lead to less hamstring tightness. Eccentric strength is being strong as the hamstring elongates, decreasing possibility of hamstring tears. This carries over to running.

Throughout running gait, the hamstrings encounter these eccentric loads often and can become strained if they haven’t previously been exposed to forces of that type. Using controlled motion in a gym setting is the safest way to expose the hamstrings to high risk eccentric loading.

The romanian deadlift is a great option for beginning to develop eccentric hamstring strength.

Here are some tips:

  • Ground the feet
  • Slowly push the weight behind your ankles
  • Change weights and challenge your range
  • Reps will range from the 5s to 10s, anything more is too light of a weight

With any hamstring strengthening exercises, you should never feel back pain, extreme stretching or discomfort in the hips. Contact a doctor if you do.

Single Leg Deadlift For Stance Leg Eccentric Hamstring Strengthening

Once we have mastered two legged hinges, such in in the Romanian Deadlift, we can move to single foot variations. I do this with no weight, or less weight, than two foot deadlifts. If you perform this the correct way, you should feel your stance leg glute muscles start to work.

Here are the steps:

  • Ground the stance foot
  • Look over a cliff
  • Have 95% of your weight into the front foot
  • Get sassy in the hip
  • Turn your belt buck into your stance leg pocket
  • Hold the position until your glute is tired

Performing glute strengthening exercises, especially in single leg motions, OFFLOADS the hamstring, which makes it become overworked less often. We are teaching the body to share the workload produced with human movements like sitting, walking, lifting and running. This leads to less spikes in hamstring eccentric loading during movements like running, which lead to repeated hamstring strains and tightness.

 Eccentric Strength of Lower Hamstring

Heel Dig/ Slides

Heel digs are a great way to strengthen the hamstrings is a safe way. It’s the starting exercise I give many injured runners. Isometric, non-motion contractions/ holds, assist in allowing the hamstring to remodel its proteins so we can “lock in” the nice, loose feeling we have after doing hamstring stretches.

An advancement of this exercise is to use furniture sliders to “push the heels” and elongate the knee, yielding another eccentric hamstring strengthening exercise. Training eccentrically will decrease potential hamstring strains.

Here are the steps:

  • Lay on your back
  • Bend the knees and bridge your hips up
  • Hold the position and try to dent the floor with your heels

Tall Rocking Exercise

For Hamstring Strength

Tall rocking hamstring stretches are great and they combine eccentric strength-hinging/ control with a nice stretch. Take a look at the image and give it a try. Think of it like a kneeling version of the Romanian Deadlift.

What If None Of These Hamstring Stretches Or Exercises Worked?

It is possible and common that these don’t stick… why do you think there are so many tight hamstrings out there?!

There’s a missing part that is often not too hard to find, but just like having a dead car, there are a few very simples additions that could solve your issues (gas, key, & put it in park).

Allow me to take you the rest of the way with my hamstring course.

It will fill in all of the missing parts, so you don’t have to dig through another 30 hamstring flexibility articles and waste hours of your life.

It’s simple, affordable and backed by the most current science on hamstrings.

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Tensor Fasciae Latae Pain: 3 Effective Exercises For TFL Muscle [2022] https://www.p2sportscare.com/articles/lower-extremity/tensor-fasciae-latae-pain/ https://www.p2sportscare.com/articles/lower-extremity/tensor-fasciae-latae-pain/#respond Mon, 24 Oct 2022 14:27:03 +0000 https://www.p2sportscare.com/?p=93829

Tensor Fasciae Latae Pain

Symptoms: Tensor fasciae latae pain presents as outer hip pain located at the TFL muscle belly . Pain when lying on the affected side, walking up and downstairs, running, walking, and hiking. Treatable non-surgically within weeks to months with complete recovery probable.

Hi, I’m Sebastian.

This article will share common signs, symptoms, and non-surgical treatments for tensor fasciae latae pain. I’ll also cover some easy home remedies that work very well in the right circumstances!

The 3 home remedies will be exercises shown at the end of the article.

DISCLAIMER

The tensor fasciae latae (TFL muscle) is a hip muscle commonly overactive in many types of athletes. The TFL muscle is part of a group of muscles that tend to become hyperactive, tight, and overused.

Other muscles of the hip region that are also tight in association with tensor fasciae latae tension are the hamstrings, lower spinal erectors, iliopsoas, iliacus (hip flexors), piriformis, and adductor muscles.

Tensor Fasciae Latae Origin and Insertion:The TFL muscle is attached to the IT band at the anterior aspect.. It originates at the pelvis at a location known as the ASIS. It performs various stabilization roles in the pelvis and very little as a primary hip mover.

During a single-leg stance, the tensor fasciae latae function is to stabilize your body in the frontal plane by tensioning the IT band. For this reason, the TFL is called a “fascial tensioner.”

You can see by its small size, it is an accessory muscle in single-leg stance (walking and running), assisting the glute max, hip external rotators, adductors, obliques, and the remainder of the core muscles.

The desire to understand human anatomy, muscles, tendons, and joints is typical in your journey to figure out how to get rid of this problem. Yet, you don’t need to become an expert in human anatomy to eliminate tensor fasciae latae pain.

Understanding what to do and how to do it is vital.

Understanding what is happening in your body is optional.

This article will share some simple solutions that work well for us at Performance Place in Costa Mesa, CA.

Please read this entire article, use the resources/ links I have provided. Recovery could be hiding with a simple exercise or stretch.

Who Gets Tensor Fasciae Latae Pain?

Tensor fasciae latae pain and chronic tightness can happen to anyone at any age. Thought to be a condition of overuse, trigger points tend to occur while performing repetitive activities. Running long distance, HITS training, boot camps, Crossfit METCONs, and even swimming have all been to blame.

Common symptoms first start in the deep gluteal region as a deep ache. It will travel to the front side of the hip and the outer side of the hip. Stiffness in the lower back is commonly associated.

Suppose you are 20-30 years old. In that case, you could be told they have one of the following diagnoses: hip impingement, hip labral tears, hip flexor syndrome, snapping hip syndrome, scar tissue formation, muscle spasms, or early-onset hip degeneration.

If you are over the age of 30, you will more than likely get more diagnoses of degeneration of the hip, osteoarthritis, or trigger points.

As you can tell, the diagnoses are all over the place, which is confusing because you have multiple doctors telling you different diagnoses and different treatment options.

In later sections, we will get into treatments that work exceptionally well for our clients.

Note: Pain, numbness, tingling, or aches that go beyond your knee on the same side is more than likely spine referred.

You do not need to have lower back pain to have spinal referred hip pain.

If you are experiencing these sensations, contact us to help you recover without surgery, medication, or injections.

Tailoring the treatment to your root cause of TFL chronic tightness is essential to get the rapid results you’re looking for.

Causes of TFL Pain

The leading cause of tensor fasciae latae pain is overuse.

Considering WHY it is being overused is where the magic lies.

It’s easy to blame the TFL muscle for working so hard, but if we reverse engineer this process, we will find that the muscular tightness you’re experiencing is nothing more than the squeaky wheel.

Addressing the cause of your tensor fasciae latae trigger point will result in complete recovery. Addressing the squeaky wheel will result in the short-term relief of pain that will not last more than a week in most cases.

Let’s reverse engineer this process.

The TFL muscle is a hip stabilizer. It is NOT a hip mover.

The larger muscles that cross the hip are the prime movers of the hip joint. The muscles that come to mind should be the glute Maximus muscle, the Adductor Magnus, the hamstrings, and the hip flexors/ iliopsoas complex.

90% of the time, the culprit is the inhibition of the glute max muscle (on one or both sides). In the 2000s, this phenomenon was dubbed “glute amnesia.” Clever right?

Why is the glute max so forgetful? Why does it forget to contract?

To reverse engineering this process, we have to ask ourselves how to get maximum glute max contraction.

Maximum glute contraction occurs when the core/ lumbar spine/ pelvis region has adequate stability or reactive stability. Stability is a relative term.

A stable object (let’s say a stack of Jenga block) is only sturdy till the wind blows. Reacting against external forces (wind) to remain upright is the core stability we need to set the stage of reversing glute amnesia.

Hip joint motion is only as good as the reactive stability it is using for movement.

Consider shooting a cannon from a canoe.

The movement of the canoe as the cannon fires robs the cannonball of distance. Lack of reactive core stability robs you of glute contraction and hip movement. It’s simple physics.

The Mobility, Stability, and Strength Continuum is a simple concept that further explains how the body functions when we reverse engineer tensor fasciae latae pain (as well as other trigger points around the hip).

Simply put, the body is created by a series of alternating mobile and stable joints:

  • Midback – mobile
  • Low back/ core – stable
  • Hip – mobile
  • Knee – stable
  • Ankle – mobile
  • Foot – stable

For this reason, when looking at tensor fasciae latae pain, we may even need to look at thoracic spine mobility to give the core a better ability to keep stable (the canoe).

Here is a Youtube video I made the Mobility, Stability, and Strength Continuum.

Using the Mobility, Stability, and Strength Continuum allows a coach or rehabilitation expert to cleverly design a program to enhance reactive stability where lacking, improve mobility in joints where it has been lost, and then apply strength to the body.

As you can see, it takes more than foam rolling, ART, self-massage, and rest to get rid of tensor fasciae latae pain permanently. While these treatments are great at reducing pain, they do not restore mobility (movement with control), stability, or strength. Weekly treatment should yield long-term results if you ask me!

Where should you start?

While searching the web for the best TFL stretch, may be most people’s instinct, it doesn’t alway yield the best results. A TFL stretch works well for some people, but for many it does not have a lasting effect. If you’re looking for the most effective treatment, having yourself inspected for YOUR reason for TFL spasm is best practice. If you have questions about your specific situation, contact us here.

Yet for you DIYers, I will be showing a few of my favorite exercises for you DIY people using the 5 Step System for tensor fasciae latae pain at Performance Place. Remember, we can coach you virtually if you need help!

Symptoms

Symptoms of tensor fasciae latae pain vary from person to person, based upon their actual diagnosis/ root cause.

Here is a list of what many people experience:

  • Worse with running, walking, or jumping
  • Less pain with strength training over cardio
  • Home HITs training is unbearable
  • Feeling like you have to pound your hip
  • TFL or IT band spasm
  • Adductor muscle trigger points
  • Knots in muscles
  • Pinchy hips
  • Deep glute ache
  • Snapping, clicking, or clunking of the hip
  • Pressure in the lower back
  • Feeling like you need to “pop” your hips or SI joint

You may not be experiencing all of these symptoms, but they are commonly found the longer you have your problem.

Movement compensations tend to create a cascade of associated symptoms that all reversible with the right treatment program and coaching.

Diagnoses

The most common cause of tensor fasciae latae pain in athletes is hip impingement.

We always have to include the rare but possible sinister diagnoses like a tumor, infection, cord compression, and much more.

To learn more about the “Red flags,” go to this website.

Simple Home Remedies

Reduction of tensor fasciae latae pain comes down to finding out three questions (Part the Performance Place 5 Step System):

1 – A correct diagnosis
2 – What makes you feel better?
3 – What are you doing that keeps the pain around?

Note: If you are interested in how we do things to accomplish rapid success at Performance Place, consider getting access to the Performance Place Hip Program.

1 – A correct diagnosis

Establishing a correct working diagnosis tells us a lot about how to melt your TFL spasm away. The best way to develop a correct working diagnosis is not Google search, WebMD, this article, MRIs, X Rays, or Youtube, believe it or not.

A good old fashion medical history and physical examination by an experienced medical expert is best. A trained eye can identify deficiencies in mobility, stability, and strength that you are not aware of.

Stress testing the hip can be performed, which will rule out many of the diagnoses on the list we had above.

Establishing a “working diagnosis” can happen within 30 minutes. A 5-minute meeting with a doctor or a Youtube video will not accomplish this.

MRIs and X-rays help rule out some diagnoses, but they give very little information about developing and implementing a treatment plan. As you may already know, having a diagnosis and treatment plan does not always improve your situation.

The magic is in HOW you do your exercises, not the exercises themselves. A skilled coach, sports chiropractor, physical therapist, orthopedic doctor, athletic trainer, personal trainer, or medical doctor can help coach these exercises for better results.

Just as professional athletes have skills coaches (a pitching coach in baseball), we all need a little help with our movements to improve.

Lastly, don’t fixate on trying to “see” your problem on an image. Images do not tell us that much information on how to help you.

Images can not see your pain.
Pain is a sensation.
Images can not see thoughts or pain.

Establishing a “working” diagnosis is all you need to start testing the low-hanging fruit in your recovery plan.

2 – What makes you feel better?

Figuring out what makes your TFL feel better or worse can give insight into the mechanics that keep triggering it, which we will cover in the next section.

If laying on your belly feels better, do it more!

If sitting feels better, do it more!

If stretching feels better, again, do it more!

Your body knows what it likes, and you may need to do a little more of it.

3 – What are you doing that keeps the pain around?

Flexion pattern

  • Sitting?
  • Driving?
  • Picking up weights?
  • Walking upstairs?

Extension patterns

  • Running?
  • Walking?
  • Walking downstairs?

Specific Activities, Paces, or Durations

  • Running?
  • Jogging only a particular pace?
  • Sprinting a certain distance?

While this may not be an exact science, noting what keeps your TFL in a spasmatic state is worth writing down. It may be worth scaling back on this activity for a week to “reset” your body.

While it’s not what you want to hear, it may be the simplest thing you have ever done. Many of the exercises that help build mobility, stability, and strength needed to reverse engineer this problem may not stick if you keep pissing the area off chronically.

Cooling the TFL down for a week makes it so much easier to coach exercises that help build mobility, stability, and strength.

It’s like working on breathwork while you have a cold; let the body chill out for a week and then proceed. It will make your life way easier!

Non-Surgical Treatment

In my opinion, the best non-surgical treatment for a tight TFL are tensor fasciae latae exercises, or as we call them “active care.”. Active care often needs to be progressed to get you back to the activity you want to do.

Progressive exercises can be tailored to help build support for the motions that trigger your TFL. Think of these exercises as building blocks till you get to the actual activity.

I know all of the “experts,” and your instructor may tell you something else, but hear me out. I’ve been helping runners and lifters with tensor fasciae latae pain in record time for over 12 years now.

I assure you that progressive exercises to build mobility, stability, and strength within regions of the body are the best plan of attack. Custom programming is the best route to go. Proper form can be coached virtual or in person.

Other non-surgical treatments:

Cortisone, Active Release, Rolfing, Adjustments, Prolotherapy, Deep tissue massage; I have tried all of these with many of my dancers with hip pain. None of these treatments work better long-term as a customized mobility, stability, and strength program with good coaching.

Cortisone, Active Release, Rolfing, Chiropractic Adjustments, Prolotherapy, stretching your hip flexor, stretching your hamstrings, and Deep tissue massage are great at reducing pain, but they will not keep it away.

As mentioned before, we need to reverse engineer how you got this way. It did not happen in a day, and it won’t return to normal function in a day either!

Performing the correct exercises and stretches over weeks to months will give you the pain-free hip range of motion that you’ve been looking for.

Challenging corrective exercise is the most effective way.

Corrective exercise can also be a very effective way of reducing pain as well. Allow me to prove it to you.

Here are three simple exercises that you can do as home remedies for chronic TFL and IT band ache.

As a disclaimer, these should not be felt in the TFL at any point. They should feel effortful and painless. Also, know that these DO NOT WORK for everyone. As I mentioned before, your TFL could be in a pissed-off state and not be ready for this type of exercise yet. Here are the best tensor fasciae latae exercises we have found at Performance Place.

Corrective exercises are like medication. If you do the right one in the right situation, you will be amazed at how good it works; you have to keep that feeling with weeks to months of doing the right program.

Note: Some videos may not be live on our Youtube Channel yet. If the video is not live, subscribe and get it when it does.

Recap

If you’re serious about getting over your tensor fasciae latae pain, consider having someone help you. The key is having some with expertise help programming and coach you on what to do.

I wish I could vouch for the skill level of every healthcare provider, physical therapist, chiropractor, acupuncturist, orthopedic, and physiotherapist, but I can’t. We all have different strengths and weaknesses. Myself included.

Off the top of my head, I can estimate that over 90% of clients we have seen with a TFL issue at Performance Place do not need surgery, medications, or injections to return to sport pain-free.

Don’t get talked into doing surgery too soon. You can recover! The human body is remarkably resilient, and it can recover full function on its own with most conditions.

I’m Sebastian at Performance Place Sports Care. We can help virtually or in person. We are in Costa Mesa CA. Rather than tell you how great we are, allow our Google Reviews to speak for themselves.

Our clients have some amazing stories of recovery. Start your recovery story with our help.

Book your first session with us today!

Sebastian
Performance Place®
Virtual & Costa Mesa, CA

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Shoulder Pain-Causes, Symptoms, Treatments https://www.p2sportscare.com/articles/upper-extremity/shoulder-pain-causes-symptoms-treatments/ https://www.p2sportscare.com/articles/upper-extremity/shoulder-pain-causes-symptoms-treatments/#respond Mon, 17 Oct 2022 06:50:54 +0000 https://www.p2sportscare.com/?p=102727

Shoulder Pain Introduction

We know how complicated it can be to find answers. That’s why we’ve compiled all you need to know about shoulder pain in one place. It doesn’t matter if you’re unsure where to start or what symptom-relief exercises will help the most. We have it all here for you – your shoulder pain survival guide.

Spoiler alert:

Before anything else, we want to start by saying that if you feel a sharp pain around your shoulder blade (and let’s assume that you don’t have any broken bones, cancer, or serious injuries), there is no reason to delay because this 4 Step Shoulder Blade Recovery Program can help you with that – 100s of previous shoulder pain sufferers are living, breathing proof that this field-tested pain relief and rehab guide works!

 

You work hard and you deserve to know how to stop that pesky shoulder pain, whether it be at the gym, while gardening or while getting ready for your next big date. The first thing we need to do is determine whether or not the pain is coming from the joint itself (such as an inflamed tendon) or from the surrounding muscles and ligaments. This can be done by taking a look at how much movement is affected, where exactly the pain is located, and whether or not there is swelling present.

When it comes to knowledge about shoulder pain, we’re not about to sugarcoat this for you.

Shoulder pain can really suck. If left unabated, it will occupy your every thought, can disrupt plans and leave you feeling like you’re drowning in an ocean of despair (if a little dramatic). Ouch. 

But you know what a bummer is?

The pain around the shoulder is a complex experience that doesn’t necessarily cease despite the best efforts of pharmaceutical medicine. Chiropractors, physical therapists and physiotherapists, on the other hand, are trained to recognize and treat a wide variety of musculoskeletal conditions—including conditions affecting your shoulders. 

So what causes shoulder pain? And how can you go about treating it?

The answer lies in understanding the anatomy and biomechanics of your shoulder. This will help you pinpoint where your pain is coming from and whether there is anything you can do about it.

Shoulder Anatomy Poster
  • The collarbone (clavicle)
  • The upper arm bone (humerus)
  • And the scapula (shoulder blade)

The head of the humerus fits into the socket of the scapula, and together these two bones provide an extremely large range of motion in this joint. The shoulder joint is a joint with high mobility and low stability.

The shoulder muscles consist of the following muscle groups:

 The 4 Rotator cuff muscles – infraspinatus, subscapularis, supraspinatus, and teres minor.

  • Pectoralis major.
  • Pectoralis minor.
  • The deltoids.
  • Trapezius.
  • The serratus anterior.

What Is Shoulder Pain? A Brief Overview

Shoulder pain is a common complaint that according to population surveys, “affects 18-26% of adults at any point in time, making it one of the most common regional pain syndromes.”

The condition can be characterized by persistent and disabling symptoms which can impede an individual’s day-to-day activities.

Additionally, symptoms can be gradual in onset or sudden, sharp and acute in nature. If it is acute, sudden onset pain it can be suggestive of an injury such as dislocation or fracture rather than inflammation or irritation of tendons and ligaments around your joint (which would cause gradual onset pain).

That’s not all:

Ultimately, the frequent and widespread occurrence of shoulder pain represents an enormous economic and social problem. When the pain caused by shoulder injuries is not treated, there are substantial economic costs involved—disease management and treatment, increased absenteeism from work, and decreased productivity.

Lastly, there are ways to help shoulder pain that don’t involve expensive medical interventions or invasive surgery. If you’re suffering from shoulder blade pain, check out our guide!

And soon you’ll be pain free just like Just like Dawn Harper – she has this to say

What’s amazing is I didn’t have to spend hours and a lot of money to get better. I got myself out of pain by simple movements. I’m an avid runner and fitness enthusiast, so I’m super grateful to be rid of this pain and get back to doing what I love!

Causes of Shoulder Pain

There are three main causes of shoulder pain:

  • Trauma – This can include an injury from sports or work, or an accident. Fractures of the bones of the shoulders, shoulder dislocation, rotator cuff tear, and nerve injury are common examples that can cause pain in the shoulder area.
  • Overuse – This occurs when you use your shoulder joint too much during repetitive movements such as throwing or lifting weights over your head repeatedly over time without proper rest between workouts. This can lead to inflammation and pain in your joints, which may result in tendinitis or bursitis (inflammation of tendons). A common example is Rotator cuff tendinitis, tendonosis or tendonopathy
  • Arthritis – Arthritis is a degenerative condition that causes structural changes in your joints over time, resulting in pain, swelling and stiffness in affected areas.

Other common causes of shoulder pain include:

  • Acromioclavicular (AC) joint disorder.
  • Impingement syndrome.
  • Bone spurs within the area of the shoulder.
  • Frozen shoulder (Stiffness of the muscles, tendons, and ligaments surrounding the shoulder).
  • Pain referred from the neck. Also, other parts of the body as seen in Phrenic nerve palsy, heart attack, stroke, apical lung cancer, splenomegaly, etc.
  • Tumors of bone, muscle, or soft tissue affecting the shoulder joint.
  • Poor posture.

Symptoms Of Shoulder Pain

There are several signs that might indicate you have shoulder pain. They include: 

  • Pain in your upper back or neck.
  • Sharp pain in your shoulder after lifting something heavy.
  • Pain when reaching behind you.
  • Pain when reaching over your head.
  • Limited mobility of the shoulder joint.
  • Swelling in one or both shoulders.
  • Tenderness when pressing on certain areas around your shoulder blade.

 Treatments, Home Remedies For Shoulder Pain

Treatment of pain around the shoulder depends on the cause. Treatment consists of non-surgical measures such as rest, physiotherapy exercises and medications like NSAIDs and analgesics, etc. Surgery may be considered in cases where conservative treatment fails for example a case of trauma.

Analgesics (Painkillers)

These are usually recommended for short-term pain relief. They include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac. In some cases, stronger analgesics may be needed temporarily if there are no other options available or if your pain is particularly severe.

Please note: These medications should not be taken for long periods of time without consulting your doctor first as they may cause side effects with long-term usage. Speaking directly with your medical doctor will assist in establishing if using medication is safe for you.

Physiotherapy Exercises

Exercise is one of the most popular ways to treat shoulder pain. 

The aim of physiotherapy is to achieve a balance between muscle strength and flexibility, joint mobility and stability (the ability of the joint to resist forces that may cause damage). This helps to relieve pain and improve function.

Physiotherapy exercises can be used alone or with other treatments such as medication or injections.

These exercises can be done at home with the help of a physiotherapist or by yourself. Head over here to discover effective exercises that can help get rid of the pain around your shoulder.

Heat Or Cold Therapy

The premise behind heat therapy is that it will loosen the muscles and increase blood flow to the shoulder joint. Heat also increases muscle relaxation, which can help reduce pain. Heat can be applied as a hot pack or with a warm bath or shower.

Cold therapy is used to reduce swelling after an injury. It also has an anti-inflammatory effect by constricting blood vessels in the area of injury, which reduces inflammation and discomfort. Cold packs can be applied directly to the affected area, or you can soak a towel in cold water before wringing it out and applying it as a compress over your shoulder (for example).

Rest

Rest your shoulder as much as possible for up to 3-5 days. Avoid using the injured arm to lift or carry anything. You may be able to use the arm for light activities such as cooking, shopping or other non-weight bearing activities. Many times reducing the activity provoking your shoulder will reduce your shoulder pain quickly.

Posture Correction

One way to relieve and prevent shoulder pain is to correct poor posture habits and strengthen supporting muscles.

For example:

Sit with good posture at work or home: Sit up straight with your feet flat on the floor or on a footrest and your arms relaxed at your sides. Don’t slump forward, cross your arms or clench your fists while you’re working in front of the computer screen or driving your car.

Strengthen upper back muscles: Strengthening these muscles will help stabilize the shoulder joint by giving it more support from above when lifting something heavy overhead or pushing something.

When Does Shoulder Pain Warrants A Visit To The Doctor

From experience many people are able to get long-lasting relief when they use home-based rehab programs. However, there are times when the pain is severe and your doctor will want to diagnose the cause of your pain.

So what are some signs that you need to seek help from a medical professional?

  • When joint instability is observed.
  • If a treatment plan isn’t working after a while then it’s time to see a doctor.
  • If you’re having severe pain accompanied with other symptoms such as fatigue, fever, and pain in other parts of your body.
  • Swelling and red/blue discoloration of the affected area.
  • For intense left shoulder pain, especially if it extends from your chest to the left arm, jaw or neck. And accompanied by shortness of breath, dizziness, or sweating, it’s time to seek emergency care – this might be a sign of a heart attack.

To make sure that you’re safe and do not worsen an existing injury, make sure that you seek help from a medical professional.

A Word On Shoulder Blade Pain 

The word:

Misdiagnoses.

The shoulder blade is an often-misdiagnosed cause of shoulder pain. When you think of shoulder pain, you automatically think of the shoulder joint itself, but the shoulder blade is a common source of discomfort as well.

What we’ve observed after several years of practice is that when you’re feeling shoulder blade pain, your body is trying to tell you that something’s out of alignment. The most common culprits are the mid back, core, and neck.

Put An End To The Misery Of Shoulder Blade Pain Once And For All

We know what it’s like to feel hopeless about your shoulder pain, but we also know how powerful it feels when you start seeing results! That’s why we’ve developed our program so that it’s easy for anyone to follow and tailor it to their needs. 

We’ve worked with thousands of people who have been struggling with shoulder pain, and we can tell you this: they came in feeling hopeless. But they walked out feeling like they had their lives back.

We don’t just work with you on the physical aspects of your shoulder pain; we also help you figure out what’s going on in your life that might be contributing to it. Then, together, we come up with a plan to get rid of the issue for good.

And along the way, we’ve got some great reviews from folks who have turned their lives around with our program.

So, if you are:

  • Struggling with chronic shoulder blade pain.
  • Sick and tired of letting your shoulder blade pain get in the way.
  • Only getting temporary relief from stretching.
  • And ready to put an end to your shoulder blade pain for good.

You’ve made it to the beginning of your journey. Click the link below to get the field-tested program that can help you put an end to your sharp shoulder blade pain.

If there was a way to make all the pain go away without hurting your pocketbook, would you do it? Of course, and you can with this guide!

Get it for 50% off because you made it to the end of this article. Use code 50OFFSHOULDER during checkout.

Claim Now!

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Shoulder Blade Recovery and Why Most Shoulder “Solutions” Don’t Work https://www.p2sportscare.com/articles/upper-extremity/shoulder-blade-pain/ https://www.p2sportscare.com/articles/upper-extremity/shoulder-blade-pain/#respond Tue, 13 Sep 2022 20:51:04 +0000 https://www.p2sportscare.com/?p=71946

Sharp Shoulder Blade Pain

If you’re reading this, it’s safe to bet you’re dealing with a sharp pain under your shoulder blade.

And if you’re like most of my clients – it’s not your first try to fix it.

Unfortunately, there are a lot of remedies out there providing little and temporary relief.

This causes hopelessness. People believe that their shoulder blade pain is a lifelong inconvenience they’ll just have to deal with.

But guess what… your shoulder pain CAN improve!. Most online blogs and remedies just deal with it in the wrong way.

47.6% of shoulder pain cases actually come from the spinal nerve. 

But because they don’t feel pain in their neck or back, most people just treat the shoulder. And for almost half of shoulder blade cases, this will do nothing but cause endless frustration. 

Are you part of that nearly 50% where treating your shoulder doesn’t help?

Your spine may be causing you shoulder pain, EVEN IF YOU FEEL NO PAIN IN YOUR SPINE. 

This is a low risk, high reward approach, and if you’re frustrated with your shoulder blade pain, keep reading. 

This article goes over the right way to deal with shoulder blade pain.

It’s likely that you’ve never heard any of this advice or associated any of these movements with your shoulder blade.

But this system has worked time and time again to relieve shoulder pain in my clients, many of whom are elite athletes. 

Before You Finish…

There are effective first-aid exercises you can do NOW if you are experiencing sharp pains in the rhomboid / shoulder blade area that is not improving by addressing the shoulder.

View our web-based Shoulder Blade Guide if this sounds like you. Especially if you cannot see a sports chiropractor in person or virtually (we can do both).

Note: This article is not medical advice.

Warning: Shortness of breath, chest pain, heart disease associated pain, intense headaches, nausea, vomiting, weakness, change of hearing, speech or vision are reasons for an ER visit.

Shoulder Blade Pain Relief Program

Recovery is simple if we first address the red herring that distracts people from REAL recovery.

And what do I mean by REAL recovery? REAL Recovery means you can return to all of the sports and hobbies that you love.

It’s NOT avoiding them because you feel you’re “getting too old” or are too afraid the pain will return.

Ask yourself… what is REAL recovery to you?

Set a goal and focus on it. Set your goals high.

  •       Play baseball and even pitch?
  •       Rock climb?
  •       Carry your daughter around on your shoulder?

This program is going to get you there.

But first, back to that red herring…

Companies that sell foam rollers, massagers, and trigger point products want you to believe your shoulder blade pain is from a knotted-up muscle.

But they’re wrong.

This idea is meant to make consumers believe they need to roll out their muscle tension on a daily basis.

Not only does this red herring cause short-term relief and eventual frustration when the pain comes back…

It also holds you back from recovery.

Because you’re distracted by the daily routine and short-term relief, you hold yourself back from finding and addressing the root of your shoulder blade pain and eventual long-term relief.

I Want the Truth!

Your shoulder blade pain is not from overuse. It’s not from muscle strains that developed out of thin air…

That constant ache in the middle of your shoulder blades is a symptom of dysfunctional spinal levels – even if you have no neck or back pain. More technically known as non-painful dysfunctional spinal levels.

Dysfunction at the spine creates shoulder blade pain by pinching a nerve as it exits the spine.

A Shoulder Study

The idea that your spine is the cause without actual spinal pain can be hard to grasp. 

Lucky for us in 2019, a study was published exposing the prevalence of spinal referred extremity pain in absence of spinal pain (i.e. no neck or back pain). 

The study’s subjects were originally treated with conservative care to the region of pain without any improvement. Below are the percentages of people who significantly improved via a spinal treatment approach instead…

  • Shoulders – 47.6%
  • Forearm/ Arm – 83.3%
  • Elbow – 44%
  • Wrist/ Hand – 38.5%
  • Hip – 71%
  • Thigh/ Leg – 72.2%
  • Knee – 25.6%
  • Ankle/ Foot – 29.2%

Spinal referred shoulder pain accounted for almost ½ of all shoulder pain in the study. This means that a huge percentage of people are trying to fix their shoulder blade pain by rehabbing their shoulder, while that’s not the real issue at all.

So many people come to me saying they’ve “tried everything” with shoulder blade pain. But 99% of these people have never tried treating their spine – likely the source of the issue.

Below are examples of the most common referred pain patterns that cause shoulder blade pain.

Note that each level of the spine (C5, C6, C7, C8, and so on) has unique differences.

Although these images may not 100% describe your situation, the shoulder blade pain is a starting point before the pain starts to move outward.

Knots and Trigger Points

Could your issue be knots and trigger points?

Sure, and these knots can be reduced with physical therapy, massage, myofascial release, foam rolling and trigger point devices.

These are what we call “compression therapies,” which is great for muscle knots, but not for nerves.

The problem is that many times these “knots” are actually pain referred from non-painful, dysfunctional spinal levels, making these compressive therapies unproductive.

When compressive self treatment doesn’t work, doing decompressive methods tend to excel! This works well with spinal disc injuries and pinched nerves, both of which can refer to the shoulder blade in the absence of neck pain.

These are simple and can be done in your own home. I’ll get into more detail later in the article.

If foam rolling and massage hasn’t worked yet, consider the possibility that your source of pain is not from knotted muscles and muscle tension.

Before you start with the home anti-inflammatory pills, you may just need to give the non-painful, dysfunctional approach a chance.

Personally, I give each treatment method a few weeks to produce a 50% reduction of symptoms. If these results aren’t found, then we simply move on to another method. The logical choice with “midback knots” is to address non-painful, dysfunctional levels of the neck and upper back..

Compressive treatments work… sometimes. Yet there are many areas of the body that do not respond to compression, the spine and nerves are perfect examples

You’ve probably already experienced nerve pressure in your life.

Have you ever hit your funny bone that sends a zinger into your hand?

This is an example of how nerves are sensitive to pressure AND how they can feel so much better after the pressure is taken away.

NOTE: If they are under pressure too long they will actually develop long term damage.

Yes, the burning/ aching sensation under your shoulder blade is not the same sensation as a funny bone experience. But nerves can reveal a variety of sensations that can result from pressure.

  •       Aches
  •       Shooting
  •       Burning
  •       Coldness
  •       Stabbing
  •       Numbness
  •       Creepy crawly flickers of the muscles

You name it and nerve pressure can make you feel it.

Shoulder Blade Pain Treatment

As you can see in the image from the previous section, non-painful, dysfunctional regions of the neck and upper back create a variety of presentation patterns. These odd presentations often account for pec minor tightness, upper trap tension, scalene muscle tightness in combination with the shoulder blade. 

So forget what you’ve heard about foam rolling, massage and removing scar tissue from the muscles around the shoulder blade.

They just want you to buy their products.

They’re telling you that you’ll have to use their tools daily for the rest of your life to keep your symptoms at bay. They directly benefit financially when you believe your deep ache is a trigger point that needs to be rubbed away.

They benefit from the red herring.

So why does foam rolling, massage and trigger point work make you feel better?

Have you noticed the results only last for hours at most?

This is because compressive therapy tricks your nervous system and brain into ignoring the symptoms for a little while. Remember that old trick of stepping on your toe to make your headache go away… relief only lasts as long as your toe still hurts.

Compressive therapy bombards the brain with sensory information that dulls the pain.

If you’ve spent a good chunk of change on weekly massages, trigger point devices or months of successful physical therapy or chiropractic, do not be embarrassed.

Many people do the same thing before they find something that truly works for them.

And to be honest, these treatments aren’t completely useless. They still yield a few hours of pain relief right?

These treatments are amazing at pain “modification.”

They decrease pain momentarily so we can spend time addressing the real problem through MOVEMENT based correction (I’ll get into this more in a moment.)

  • Your body is amazing.

     

  • Your body has the ability to recover inherently built-in through movement.
  • Movement is the body’s natural way to unpinch nerves and loosen up muscles.

It’s easy too. Simply taking a walk (relaxed with some nice arm swing) helps some people’s shoulder blade pain. Crazy right?

Other people have improvement as they start to do yard work. I know it sounds silly, but people have been surviving for centuries without foam rollers.

I’ve even told some people to push their car (in neutral) to rehab their shoulder pain… they think I’m joking, but I’m actually very serious.

Pushing a heavy object (most people just happen to have a car) can be very therapeutic and decrease shoulder blade pain when used in the strength period of their care (discussed below).

Phases of Recovery

Recovery from nerve-based shoulder blade pain comes in these phases:

  1. The First-Aid Period
  2. The Movement Period
  3. The Strength Period

Step 1: First-Aid Of Shoulder Blade Pain

The First-Aid Period (5-10 days)

The first aid period is exactly what it sounds like.

Just like when you get a cut, you need to rinse, clean the wound frequently, and don’t pick the scab as it heals.

With shoulder pain, it’s the same thing. Your tools and methods are just a little different.

  •       Use position of comfort (these can vary)
  •       Off load the nerve every hour for a few minutes while you’re awake
  •       Go for a walk (3 times a day for about 10 minutes per time)

Some movements may create symptoms, so take note and avoid them.

Here’s a video of one of the first aid moves that has worked well for my clients, especially the people who have “psuedo rotator cuff syndrome”/ strains.

It’s called McKenzie Cervical Extension. It’s important to note that it’s a GRADUAL reduction and centralization of symptoms that I look for to validate this as a good first-aid for this person.

The first few may be tender, but as the reps increase it will do one of two things… make it more painful (in the blade) or reduced.

If reduced, great! If not, then we would find another form of first-aid.

Not all first aids are created equal. The whole idea that there’s a “single exercise or treatment” that will work for everyone is complete BS. This specific first-aid is 1 of 6 first aids we include in our guide.

Make notes of observation and patterns that develop. What seems to trigger your symptoms?

In the movement period, we start to re-integrate the triggering movements to become pain-free again.

Pain is a positive feedback loop and will feed itself if you let it.

This phase assists in breaking that loop, so we can exit the symptom cycle.

Step 2: Movement Period For Shoulder Blade Ache

Now we’ll start to explore free ranges of motion – without adding too much of a load challenge.

  •   Walking
  •   Jogging
  •   Arm circles
  •   Leg circles
  •   Movement flow

You shouldn’t overthink this step, just start moving.

If the symptoms return, then change that movement’s range. Perhaps you weren’t ready for that much of THAT MOTION yet.

Don’t worry. You will more than likely be able to regain most of your motion back, if not all of it. Your body is very resilient.

Movement is medicine. Sometimes the medication is too much too soon.

Step 3: Strength Period

This is when the pain is gone. We don’t have the fear that it’ll immediately return. We’ve gained back most, if not all movements of the neck, shoulder and midback.

Oftentimes, the missing link (to gain more symptom-free motion) is the incorporation of some strength and support to the areas moving… the neck, shoulder and midback.

Funny though, in this period most people feel much better, so they tend to shy away from “making it worse.”

But the lack of building strength and support around the spine is the reason WHY many people will have the same issues come back year after year, till they sadly start to tell themselves they are “broken” or “getting old.”

Depressing way of thinking huh?

Getting Back After Recovery

After relief, we’re excited to get back to the things we love. But we still have that fear that the shoulder pain will return.

How can we be sure the neck can move and tolerate activities we love without becoming pinched again?

Simple, the neck moves better/more freely when it’s surrounded by stable areas.

So the key to beating shoulder pain for good is to build the strength of the shoulder blade, anterior neck and deep core. (Notice I said strength, NOT size).

The mid back (thoracic spine) is important as well. It functions less as a point of strength and more of a section of “attention.”

The mid back will strengthen while strengthening the shoulder blade and core. It’s almost like a bonus.

Adding load (resistance) to movements is actually therapeutic.

Sadly, much of the general public thinks of resistance training as ways to lose weight or “get big like Arnold”… yet those are just extreme side effects.

They occur when people “double down,” work really hard and spend more than a few hours a week partaking in weight training. It takes YEARS of hard work to boot.

I encourage you to get with a strength coach and start lifting weights. The weights don’t have to be extreme either. To get therapeutic benefits just make it “a little challenging.”

The Next Step to Recovery

If you only remember three things from this article, let it be this:

You can do this.

Your body is not broken.

You’re not too old.

I hope this article did its job in helping you understand the real cause of your shoulder blade pain and the route to REAL recovery.

But there’s one more thing I want to leave you with.

I see this mistake in my clients again and again… and I think it’s safe to say that it is the biggest mistake people make with shoulder blade pain.

I created a free audio to illustrate to you what the biggest mistake is. It’s something we all instinctively do with shoulder blade pain, and I’ll explain why you should stop. 

Sign up below to receive this free audio!

A Success Story For Pain Under Shoulder Blade

Becky was able to successfully return to full activity (work, yoga and sleep) after suffering from shoulder blade pain like you.

Becky has been a nurse for the past 10 years, working in a hospital 5 days per week.

She’s fully capable of rolling patients over in bed, pushing wheelchairs, and going throughout her day without neck, shoulder blade, or arm pain. She sleeps like the dead at night without the assistance of medication of any kind.

But she didn’t always feel this good…

10 years ago, Becky was in grad school when she started to develop light headaches and muscle tension. 

Most days were mild, just a light throbbing ache around the base of her head. Other days her headache would wrap around her head, towards her eyes and travel downward towards her shoulders. 

She got through most of the day with help of a frequent self massage and bi-weekly chiropractic work to address her muscle tension Her home remedies included weekly anti-inflammatory medication and rolled on a tennis ball.

A few years later, her symptoms began to evolve.

Even though she feels great today, she can still recall the details like it was yesterday.

Most days she was in intense pain from the moment she opened her eyes in the morning. Sleeping was terrible due to the fact that it felt like someone was taking a hand drill and boring a hole into her right arm bone all night, directly through her bicep.

Throughout the day, her pain began to increase and creep down into her midback, upper trap area and to both of her shoulder joints. The pain was so intense at times that she said she would have been “willing to cut her arm off” if it would take the pain away.

She had to stop doing yoga, was unable to sleep at night and considered quitting her job. She continued to use anti-inflammatory medication and tennis ball rolling as home remedies. She was doing this daily now.

She did not have any shortness of breath, yet deep breaths would hurt between her shoulder blades. She did not have chest pain. Searching the Internet brought her to Dr. Google, which said she was simply experiencing intense muscle strains.

Tucking her chin and looking upward at the sky were painful. Looking down to her chest was much better, but still not pain-free. While driving, she could not turn her head to check for cars as she changed lanes. She even bought those little blindspot mirrors so she could safely change lanes.

Sounds intense right? Yet, she was able to overcome it.

What did she do to feel better?

She didn’t get better overnight. She spent months having her neck adjusted, going to physical therapy (ice and muscle stimulation machines) and getting massages with very temporary relief.

Eventually she found a chiropractor specializing in focal soft tissue work to help her release a nerve in her neck and shoulder. After that she began to progressively get better.

A series of thoracic mobility and shoulder blade stability exercises were suggested, along with daily walks at sunset. Using this series of home remedies, she was able to avoid being seen weekly for soft tissue work to release her neck.

Once she found specific exercises that worked for her, she was able to sleep without being woken up by pain. She was even able to return to yoga without any restrictions.

Want to be like Becky?

Sign up for the 12-Week program for the REAL recovery that Becky and many others have experienced.

Click here to get the program:

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Ulnar Nerve- Syndrome, Exercises & Treatment https://www.p2sportscare.com/articles/upper-extremity/ulnar-nerve/ https://www.p2sportscare.com/articles/upper-extremity/ulnar-nerve/#respond Mon, 22 Aug 2022 18:02:08 +0000 https://www.p2sportscare.com/?p=102322 Are you suffering from an ulnar nerve problem? Want to know some ulnar nerve exercises and its treatment remedies? You have come to the right place to get all of your ulnar nerve related queries answered.

When Scott, an avid guitarist, began experiencing numbness and tingling in the 3rd and 4th fingers of his left hand as well as the outside of the forearm, the music-loving RN from Arcata, CA knew he needed to act fast before his guitar days were over.

“I’m very concerned about losing my ability to play. My grip is still strong and I can still play, but I can see this is something I need to address before it gets worse.”

As unnerving as it sounds, conditions affecting the ulnar nerve like cubital tunnel syndrome or Guyon’s canal syndrome can cause long-term damage to a person’s ability to lead a normal daily life.

Just a heads up:

Can’t feel your pinky or ring finger? You deserve to know the truth about ulnar nerve conditions. Sadly, the truth is, that you can’t just Google it or find answers on YouTube. Luckily, this affordable online guide allows you to cut through the BS and find the 5 most common points of nerve entrapment quickly and easily! It includes descriptions of exercises and stretches that will help to reduce the problem and improve your condition. Get the solution to your hand numbness problems now!

If self treatments are not helping you, you need to go to a medical professional for treatment quickly.

Okay, now let’s get back to the basics here

What Is Ulnar Nerve?

The ulnar nerve is one of three significant nerves of the arm which arises from the medial cord of the brachial plexus. Its name is derived from the ulnar bone – one of the two major bones of the forearm that is located on the same side as the little (pinkie) finger.

The ulnar nerve takes a pretty interesting path through the body:

It travels down your neck, through the shoulders, and branches out to your fingers via the wrist, where it is responsible for sensations in the ring and little fingers (4th and 5th fingers), a portion of the palms, and the underside of the forearm.

Sometimes referred to as the “funny bone nerve”, the ulnar nerve helps you feel sensations like touch, pressure, and heat—that’s why when you hit your funny bone against something hard (or even just tap it), pain shoots up your arm and makes you wince!

Ulnar Nerve Entrapment

Unexplained pain, burning, aching, numbness, and tingling in the ring finger, middle finger, and little finger; chances are you suffer from ulnar nerve entrapment.

Ulnar nerve entrapment is a condition where the ulnar nerve becomes compressed or pinched at a point in its course. The most common compression location is believed to be the cubital tunnel at the elbow. Note: Ulnar nerve entrapments do not occur at the carpal tunnel, as it does not pass through this location. This compression or pinching can cause pain and numbness that radiates down your arm and into your hand.

When compression of the nerve occurs at the elbow, it is called cubital tunnel syndrome and if compression occurs at the wrist near your hand, it is known as Guyon’s canal syndrome. Other than these two common spots, the ulnar nerve can also get pinched anywhere between the wrist and elbow or between the elbow and shoulder.

 Entrapment of the ulnar nerve may also be referred to as:

  •     Bicycler’s neuropathy;
  •     Handlebar palsy;
  •     Or Tardy ulnar palsy.

Cubital Tunnel Syndrome – Ulnar Nerve Entrapment at the Elbow

This is a condition that causes pain and tingling in the hand and fingers. It occurs when the ulnar nerve — which runs from your elbow to your pinky finger — becomes compressed or irritated as it passes through a narrow tunnel (the cubital tunnel) on the inside of your elbow.

Causes of Cubital Tunnel Syndrome

Cubital tunnel syndrome is caused by pressure on the ulnar nerve. This pressure can come from overuse, injury, and other problems that affect the elbow, forearm, or shoulder.

Typically, risk factors that cause irritation or compression of the ulnar nerve at the elbow include:

  • Trauma to the nerve itself (for example, falling on an outstretched arm). Most commonly: “Hitting your funny bone” – which results when you smack the inside of your elbow and is no laughing matter. Because an extremely sharp pain will shoot from your elbow to your little finger, causing numbness in the ring finger and the pinky.
  • Overuse of the hand, wrist, and forearm. This can occur with repetitive activities like typing, playing a musical instrument, or using power tools.
  • Arthritis in the elbow joint.
  • Sleeping with your arm hanging over the side of the bed.
  • Compression of the ulnar nerve due to a tumor, cyst, or swelling.
  • It can also happen when you use an awkward position for a long time (like leaning on your elbow or sleeping with your elbow bent for a long time under your head.

Guyon’s Canal Syndrome – Ulnar Nerve Entrapment in the Wrist

Guyon’s canal syndrome is when the ulnar nerve gets trapped as it passes through a tunnel in the wrist called Guyon’s canal.

Causes of Guyon’s Canal Syndrome

The following conditions may cause the compression of the ulnar nerve inside the Guyon’s canal:

  •  Trauma to the wrist such as the fracture of the hamate bone is quite common among golfers and baseball players.
  •  Arthritis in the wrist.
  •  If you’re doing a lot of gripping, typing and twisting, or if you’re regularly using your hands in ways that involve repeated wrist and hand motions, you could be at risk for Guyon’s canal syndrome.
  • When you work with your hand in a position where it is bent down and outward can lead to the compression of the ulnar nerve in the Guyon’s canal.
  •  If you constantly put pressure on the palm of your hand. This happens most often in cyclists and weightlifters because they grip so hard when they are cycling or lifting weights. It can also happen after people use crutches for a long period or after running a jackhammer all day at work.

Symptoms of Ulnar Nerve Entrapment

Do you know when you hit your funny bone?

It’s like this: You’re crushing your ulnar nerve against the medial epicondyle (the protruding bony part of the inside of your elbow) which causes not only the tingling and numbness but also the pain that flashes from your elbow to your ring and little fingers.

But alas, the feeling will go away after a few minutes of rubbing your elbow.

But here’s the thing:

Think of the cubital tunnel syndrome as someone whacking your funny bone over and over again all day long – In other words, if you have cubital tunnel syndrome, your elbow can be a riot of pain.

In general, symptoms of cubital tunnel syndrome include pins-and-needles tingling in the pinky finger or thumb that spreads up into the forearm; numbness; weakness; sharp pain in the elbow area; and difficulty bending or straightening your wrist and fingers. It can also feel like burning or aching in the forearm, ring or pinky finger.

What does it feel like to have Guyon’s canal syndrome?

The most common symptom of Guyon’s canal syndrome is the “feeling of pins and needles in your pinkie and ring fingers”. It’s often noticed when you first wake up—but it doesn’t go away by itself. The symptoms may get worse and develop into a burning pain in your wrist and hand before a gradual loss of sensation in your ring and little fingers. Eventually, if it is left to persist, it would cause the muscles controlled by the ulnar nerve to become weak, and you might also have trouble spreading your fingers wide apart and pinching with your thumbs. In advanced cases, the fingers begin to “claw” creating a phenomenon called Claw Hand.

Treatment Of Ulnar Nerve Entrapment/Hand Numbness 

First off, it’s important to clear the air on:

Passive Care vs. Active Care for Ulnar Nerve Conditions

You may have heard about two types of care when looking for a solution for your hand numbness and other symptoms of the ulnar nerve condition: “active” and “passive.”

Passive care is a temporary solution. It helps to manage the symptoms of hand numbness, ulnar nerve compression, and other common issues. But it’s not a long-term solution.

This type of care involves the things you can do for yourself that require little effort or exertion such as the application of ice/heat, stretches, rest, the use of braces, massage, medications, injections, etc.

But I’m going to be honest with you: passive care is a temporary solution at best.

It can help with the symptoms of hand numbness and ulnar nerve compression, but for more than 50% of my patients, it’s not a long-term solution. 

I think you’re looking for a long-term solution, and I have one for you.

I’ve been in this practice for a while now, and I’ve seen it all: from the most basic cases of hand numbness to the more complex cases of ulnar nerve compression. And what I can tell you is that the only way to make sure your symptoms go away for long periods is with active care. Note: after you experience these symptoms once, there is a high probability they will return one day. When it returns and how severe they feel, it is completely within your control. Active care assists in reducing symptoms and keeping them away for months, years or even decades.

Active care is all about treating the underlying problem, not just treating the symptoms. It can be a long process, but it’s worth it!

Active care is like a chiropractor or physical therapist giving you a toolbox so you can take care of yourself.

Rehabilitation experts get it. You’re busy. You have a lot going on, and when you’re in pain, sometimes all you want to do is focus on getting better and making sure it doesn’t happen again. That’s what active care is all about: they help you achieve lasting recovery, alleviate everyday pains, and also help prevent you from re-aggravating your condition.

Unfortunately, many healthcare providers ignore the importance of this aspect of care. Most are aware of its importance but they lack the time to suggest or coach appropriate stretches and exercises.

I believe that most people are unable to recover from hand numbness if they do not make changes in their daily habits. I have personally seen many patients with hand numbness symptoms return to normal after learning proper sitting techniques. I have also seen patients recover from numbness by learning to “lock on” their shoulder blades to their rib cage.

Thanks to countless hours of hands-on experience, I dare to estimate that poor movements, improper loading of overhead lifts, or sloppy postures account for over 90% of all ulnar nerve problems. Only 10 percent of all ulnar nerve-related problems can be traced to trauma (such as a slip and fall or getting hit in the arm).

Therefore, if we learn how to move properly and avoid bad postures, we will automatically prevent and effectively correct most cases of ulnar neuropathy.

What more?

We’ve found that not everyone responds to passive care corrections.

Some people’s bodies recover more effectively with active care, which is what was covered in this web guide – The Secrets to Resolving Hand Numbness. The guide provides a holistic approach to treating symptoms of ulnar nerve pain, hand numbness, and loss of grip. So, rather than mistreating symptoms with painkillers like ibuprofen, take advantage of non-surgical and drug-free remedies that will get your body back in balance while simultaneously strengthening your muscles, and give yourself the best chance of a full recovery in no time. Discover how we treat ulnar nerve conditions with active care here.

Principles Guiding the Non-Surgical Treatment for Ulnar Nerve Problems 

If your pinky and ring finger are numb there are treatment options that are designed to help you get rid of that numbness and feel great again (even faster than what you’ll imagine).

In most cases treatment for ulnar nerve pain is non-surgical. The goal of nonsurgical treatment is to relieve pressure on the nerve and allow it to heal naturally.

That said, we see people every day who come to us convinced they need an EMG or some other nerve conduction test. However, the current evidence shows you don’t need these tests to alleviate your condition.

With that in mind, the treatment of the ulnar nerve can be broken down into five parts:

  •     Find the site of compression
  •     Decrease local irritation (passively or actively)
  •     Decrease activity creating compression (until under control)
  •     Increase nerve’s ability to slide through
  •     Improve postural control, breathing patterns, movement patterns, etc.

Let’s discuss these points in detail.

  1. Find the site of compression: Think of a nerve as a garden hose. Any kink in the hose will affect the water flow, regardless of its location. When considering ulnar nerve compression, it works much like the garden hose

Remember, there are a few sites on the ulnar nerve that have a high probability of becoming entrapped.

When your hand is numb, the following could be happening:

  •     Entrapment of the ulnar nerve in the neck;
  •     Ulnar nerve entrapment in the shoulder (Brachial plexus region);
  •     Compression of the ulnar nerve at the cubital tunnel at the elbow;
  •     Compression of the ulnar nerve at the Guyon’s tunnel in the wrist.

But here’s the thing:

Symptoms that mimic compression of the ulnar nerve may be caused by a variety of underlying problems, or they may be caused by multiple factors. You should consider these in great detail and if you start to feel panicky about the possibility, it wouldn’t hurt to have a doctor perform a thorough physical examination to assist in the location of the pressure. 

Here are two stories to buttress the point above:

Once I had a patient who complained of numbness and pain in the ring and pinky fingers at night. In the end, the cause turned out to be a tumor in his spine.

The second case…

The young man came in and presented with bilateral (i.e. both sides) numbness and pain in his hands/fingers. This is a sign of possible spinal cord compression.

As you can see, both of these patients are in clear need of a more thorough evaluation and treatment. While they both requested that “can you just treat it,” I recommend that they receive further care from specialists to properly treat their conditions.

It’s sad and scary to read stories like these but it’s important to pay close attention.

There is some good news though.

If they are found early, then they can be corrected to some degree. Ignorance is bliss. It’s only a matter of time before something comes along, and smacks you in the face with a reality check.

The lesson to be drawn is this:

If you’re having symptoms of ulnar nerve damage in your hand, it means something is going on with that nerve! And if you don’t know what it is, you may end up losing muscle function in your hand—and that could be a big problem.

Therefore…

If you’re experiencing pain or numbness in your pinkie and ring fingers, come have it checked. Don’t wait. If you think that something doesn’t feel right, then it probably isn’t. It’s easier to catch problems early than later down the line – if you don’t, you may be in store for a lifetime of frequent medical attention..

And that’s the point of this post – to show you the step-by-step process that I apply with my patients. This process usually reveals certain body regions that are capable of causing or are responsible for their pain.

If, after a complete examination, and the all-clear is given – certain that the cause of your numbness and pain doesn’t have any underlying cause, there are often changes I can make to optimize your health without having to endure any more of those pesky symptoms.

To do it, I’ll have you keep all factors the same, and request that my patients move their body region to a new position and hold it while we observe for changes in numbness/pain.

Here’s what I mean:

  •     From the center, does a tilt of the head to the opposite side increase or decrease symptoms?
  •     From the center, does dropping the chin to the chest increase or decrease symptoms?
  •     What if they just shrugged their shoulders, will it improve or worsen the symptoms?

Do you see what’s going on here?

It’s all about pinpointing the area that has the greatest effect on hand numbness. And that depends on your body because everyone is different and sometimes manipulating the position of a body region is not enough, instead, symptoms might be due to the “stiffening” of a region. If you’re curious about what I mean by that, check out the eBook!

The secret to hand numbness

To be honest, locating the site of nerve pressure can be a real pain in the neck (pun intended). 

That’s why when we work with clients 1-on-1, we don’t just take a quick look at you. We examine your body from head to toe, inside and out.

We go through the paces of medical history, physical examination, and any medical reports (such as X-rays, MRIs, nerve conduction studies, and so on). That may already exist to ensure that we know exactly what’s going on from the beginning so we can deliver the best treatment possible.

And the best part?

You don’t have to get a bunch of tests done before we can help you. If you’re reading this, chances are you don’t need to get an X-ray, MRI, or a nerve conduction study to reduce your nerve pressure.

Bottom line: If you’re looking for nonsurgical treatments for hand numbness and other symptoms that arise from ulnar nerve conditions, comprehensive medical history, and physical examination are the foundations.

  1. Decrease local irritation: This is a way to stop your flare-ups in their tracks.

Let me explain:

If you’re a sufferer of nerve compression, you probably know what triggers your symptoms – most people do. You need to get honest about what those triggers are so we can avoid them. That means taking a look at all of your habits and figuring out which ones might be causing your symptoms.

While it’s not always easy to do, especially if you have a job that requires it, or an activity that seems like it’s just a part of your life, then you might have to put in a little more effort – avoiding those motions may be the best course of action.

I want you to look at it this way:

You’re not a bad person. Sometimes our bodies are just like, “Hey, the way you did that was stupid. Let’s punish you with pain.” So if you’ve ever been told to avoid an activity, don’t let that freak you out. You can do it.

In that vein, we’re not going to beat around the bush: we need you to do some homework.

With all that’s on your plate, it can be hard to take the time to look at your lifestyle and figure out what’s causing your flare-ups. But if you don’t, how will you know what to change?

Here’s what to do:

Identify the precise components of each activity, and find the exact cause for the flare-up. This would allow the nerve time to “relax,” thus the less stressed it’ll be. 

  1. Decrease activity creating compression (until under control): We all know that the “hobbies” we pick up in our free time are meant to be fun and relaxing. But some hobbies need tweaking, and they aren’t just limited to sports and exercise.

When you’re a tennis player, your ulnar nerve may become triggered by all the balls you hit. And when you’re a baseball player, it’s not uncommon for your elbow to be jammed into the ground every time you make a diving catch. But these aren’t the only hobbies that can cause ulnar nerve compression. Volleyball, swimming—any activity where you have to hold your arms above your head can cause ulnar nerve compression. Additionally, writers, woodworkers, and typists are also susceptible to the compression of the ulnar nerve.

So what do you do?

While in the previous point we tilted more towards avoidance of certain activities we know that the truth of the matter is for some individuals especially athletes and hobbyists that’s not quite possible. The whole point here is to “decrease.”

Takeaway: It’s important to remember that any activity that typically increases your ulnar nerve symptoms should be decreased to some degree (at least for a short period of time while healing begins).

  1. Increase the nerve’s ability to slide through (moving the nerve): After the irritation is gone, we can start to get the nerve to glide freely.

It’s time to get moving!

Movement is the key to keeping your body healthy. When your body moves properly, it’s like a dream – the chances of experiencing pinching, crushing, aches, or numbness are significantly reduced or eliminated!

At Performance Place, we add nerve sliding (gliding) exercises when appropriate These nerve gliding exercises are isolated in nature giving them the effectiveness to help your nerve slide through a stuck section of your neck or back. It’s like getting a car unstuck from mud; the more you can move, the better it will be!

Curious as to which exercises? We’ll get to that later.

  1. Improve Postural Control, Breathing Patterns, Movement Patterns, etc.: If you’re reading this, it means you survived the last section. And if you survived the last section, that means you get what I’m talking about: “movement” is one way to decrease nerve compression.

Do you know what’s better than moving? Moving better. And when it comes to avoiding nerve compression, learning how to “move better” is sacrosanct.

However, I am not going to sugarcoat it: moving better isn’t something everyone can do without 1-on-1 coaching. It’s a process, just like learning any new subject or discipline. So hang in there and start at the beginning.

The good news is that you’ve already made a major step in the right direction by reading this article. You know what you want, and you’re ready to put in the work to get there.

In essence:

  •     Adjust your sleep positions;
  •     Try passive mobilization of the midback to decrease hand numbness;
  •     Mobilization/adjustment of the neck (Cervical spine) by a professional;
  •     Myofascial release of the upper trap, scalene, & levator muscles;
  •     Spending 5 minutes a day (broken up into 1-minute bits) blowing up a balloon with deep forceful exhales.

But here’s the kicker:

You need to learn the right way to do it, and you need someone – a professional to guide you through the process. If you want to see positive results regarding your ulnar nerve issues, don’t go it alone – because the secret to success is getting the right help. 

So let’s make a pact: get the guide to end your ulnar nerve symptoms like hand numbness today and we’ll keep each other accountable, support each other through difficult days, and celebrate our successes together!

And that brings us to the all-important subject of ulnar nerve exercise:

How to Exercise Your Way to Ulnar Nerve Healing

You know what they say: “If you want to make a change, you have to be willing to do the work.”

And that’s true—but it’s also important to remember that sometimes all the work in the world isn’t enough if you’re doing it wrong.

So in this section, we’ll be taking a look at the Passive, or “quick-fix” exercises you can perform at home to help you reduce ulnar nerve pain, and some other symptoms of ulnar nerve conditions while speeding up your recovery 

Important Note:

Top 5 Ulnar Nerve Passive Care Exercise to Reduce Hand Numbness Fast

Ulnar Nerve Exercise #1: Passive mobilization of the midback

The goal of this exercise is to reduce the amount of sticking points you have in the neck, where the nerves exit.

Now one of the simplest ways to achieve this is to use a foam roller. Here’s how to do it:

  •     Lay the foam roller on the ground and then lay your body on top of it so that your spine is perpendicular to how you will lie down.
  •     Lie down on the foam roller (backward), and then roll your body onto it using it as a fulcrum. Keep your ribs depressed while doing this.
  •     Do this for at least a minute for each region that needs mobilization.

When you foam roll, you’re passively improving your midback mobility. But unless you actively teach your body how to control the movement and control it in the presence of gravity, that mobility won’t stick.

You need education and training—the same kind of education and training you can access in the active care guide to get rid of hand numbness effectively.

Watch the video below for a detailed rundown of my favorite passive ulnar nerve exercises – they’ve worked for many, and I am confident you’ll get the results you seek too! Check it out:

Conclusion: You Can Resolve Hand Numbness For Good!

Wrapping up this post, I’ve covered some important aspects of hand numbness and ulnar nerve symptoms. And you know that hand numbness and ulnar nerve symptoms are not something to mess around with. You also know that they can be resolved.

One of the best ways to do this is by finding and getting in touch with us at Performance Place and we will be able to help you identify the cause of your symptoms and treat them with the right combination of therapies, exercises, and medications.

 It even gets better:

You start your recovery journey with this easy-to-read and engaging web guide. The 5 most common points of entrapment are clearly detailed, along with stretches and exercises that will allow you to alleviate this problem once and for all. No longer will your hands feel terrible, or restrict how you move around your day-to-day life.

If you found this article helpful, please share it with others!

As always, we’re here if you have questions about anything related to ulnar nerve symptoms or hand numbness! Just send us a message using the form on our site and we’ll get back to you as soonest!

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Infraspinatus Strain Treatments, Therapy and Hope! https://www.p2sportscare.com/articles/upper-extremity/infraspinatus-strain/ https://www.p2sportscare.com/articles/upper-extremity/infraspinatus-strain/#respond Mon, 08 Aug 2022 08:06:03 +0000 https://www.p2sportscare.com/?p=72040

This is a complete guide to the infraspinatus tear/ strain.

If you want to know what your treatment options are for an infraspinatus strain, you’ll enjoy the actionable tips in this new article.

In other words, you won’t be reading outdated suggestions that don’t work!

Note: read the disclaimer and always see a doctor first. If you need some help virtually (or in-person) the “Locally World Famous Chiropractors®” at Performance Place Sports Care are ready to work with you!

Let’s dive right in.

What Is The Infraspinatus Muscle?

The Infraspinatus muscle is one of the four rotator cuff muscles of the shoulder, with the primary function of stabilization of the glenohumeral (GH)l joint.

The muscle resides in a section of the shoulder blade called the fossa of the scapula and is innervated by the suprascapular nerve. The infraspinatus muscle-tendon is attached to the greater tubercle of the humerus bone.

Infraspinatus pain often presents as pain on the front side of the shoulder. Infraspinatus muscle and tendon pain began often without trauma, dubbed as an “overuse” injury.

Compression of the suprascapular nerve (or its contributing spinal nerve roots) can create tension and “strains” in the muscle. It will feel like a tight muscle that can’t be stretched out. The contributing spinal nerve roots that may be compressed, creating trigger points are C6 and C7.

C6 and C7 spinal nerve roots can also create associated symptoms of:

  • Tricep ache
  • Winging of the shoulder blade
  • Weakness in a pushup or bench press
  • Neck tension
  • Tight pectoral muscles (more commonly the pectoralis minor)
  • Sternal pain (without fatigue or shallow breathing – could be something else serious)
  • Upper trapezius tightness
  • Pain between shoulder blades (medial border)

While many of our clients end up having suprascapular nerve compression causing their infraspinatus pain, it is possible to have a local muscle/ tendon complex tear.

Before we go on to the topics of local strains, please do not overlook the possibility of nerve pressure causing your infraspinatus “strain.”

Here is a YouTube video we made about shoulder blade pain that can work with infraspinatus pain too. Enjoy!

 

Even when MRIs show degeneration or tears to the infraspinatus tendon, the nerve could be the root of the pain. Tears and degeneration do not always hurt, especially if overuse in origin.

The infraspinatus is the second most commonly torn muscle/tendon in the shoulder.

While it can be extremely disabling, it doesn’t have to be the reason you stop doing what you love.

The funny thing about rotator cuff injuries is that they’re commonly not painful.

That’s right. They are found via MRI and MSK Ultrasound in pain-FREE athletes all the time. Without going into too much detail, we have to consider why…

Are they just lucky? Nope!

Oftentimes, if we improve an athlete’s movement, we can also decrease infraspinatus pain and prevent future injury.

How?

By addressing the root reasons for glenohumeral joint dysfunction (shoulder joint) in the first place.

If you’re wondering who’s writing this section of the article…here I am!

I’m Dr. Sebastian Gonzales. I’m the head doc at Performance Place® Sports Care in Southern CA. Throughout this article I’ll be guiding you through the best collection of information on how to resolve infraspinatus pain on the Internet.

 

EXPECTATIONS WHEN YOU
COME SEE US IN COSTA MESA:

 

MORE THAN 50% IMPROVEMENT WITHIN 4-6 SESSIONS
Most Cases

 

MORE RELIEF WITH LESS RISK 
We Only Use High Reward/Low Risk Treatments

 

NO RIDICULOUS LONG-TERM TREATMENT PLANS

MORE ATTENTION WITH A SKILLED GUIDE 
Even Though our Costa Mesa Chiropractor are Not A "Real Doctor" 🙂

 

MORE THAN A TYPICAL COSTA MESA CHIROPRACTOR 
No Bone Cracking Required To Feel Good

 

NO QUACKERY
Dr. Gonzales & Costantino Only Uses Current Evidence-Informed Methods

 

CLICK HERE TO BOOK YOUR APPOINTMENT WITH A COSTA MESA CHIROPRACTOR

 

It’s funny, after writing this article, I started to receive more emails from people just like you asking for a list of my favorite rehab exercises for an their infraspintus. For months I replied directly, because I love to help people overcome their aches and pains but it wasn’t sustainable for me… so I finally sat down to list out my 9 favorite exercise videos on how to quickly rehab an infraspintus issue.

You can access them here. If you’re looking to bypass, 4 more hours of reading and digging around through random Youtube videos buy the mini guide. I did all the work for you.

Now onto the article for those of you who enjoy reading.

Part 1: How To Rehab Infraspinatus Tendon Pain

Here’s the order of importance when it comes to infraspinatus pain (and shoulder pain in general). If we don’t correct dysfunction in this order, then we will not improve the shoulder. Period.

  1. Core and High Intra-Abdominal Pressure
  2. Thoracic and Cervical (neck) Mobility
  3. Shoulder Blade Stability
  4. Glenohumeral joint Motion
Infraspinatus Pain

I’ve seen many shoulder cases and this process works. Sorry I couldn’t resist using the Overhead Beer Goblet Squat on my birthday as an example.

I can remember one patient specifically, a weightlifter who had been seeing a massage therapist for months and was still unable to lift a 45-pound barbell over his head without pain.

By using this method, I was able to improve his infraspinatus pain within minutes by improving his shoulder blade stability. And by improving it, I mean he was so excited, he hugged me. True story!

I’m not trying to toot my own horn, but I just want to bring to attention how quickly an infraspinatus injury can resolve if we are addressing the right things at the right times.

This is an example of a functional issue…not a structural issue. This can happen regardless of where the pain is.

Here’s an exercise I like to give to many people that I see with shoulder pain. Granted, it won’t work for everyone, but it helps many. It’s called a Turkish Get up (Extension to Low Sweep).

If you would like to see more, we do have a course coming out.

Where is the infraspinatus?

Anatomically speaking, the infraspinatus is found on the back, originating inferiorly along the spine of the shoulder blade (also known as the scapula) extending out and inserting onto the humeral head where it turns into a tendon. Just beneath the tendon, the infraspinatus bursa cushions it. Infraspinatus is part of the rotator cuff muscle group of the shoulder, and a infraspinatus tear (also known as a strain) can be the cause of pain within the shoulder joint.

There are three other muscles that make up the rotator cuff along with infraspinatus. They are:

  • Supraspinatus
  • Teres Minor
  • Subscapularis

When we are considering shoulder pain, there are other structures that need to be ruled out as the painful source:

  • Posterior joint capsule of the shoulder
  • The glenoid labrum
  • Subscapularis

Here’s a video we made years ago called “Infraspinatus Strain Pain Treatment Video.” It’s an oldie, but a goodie.

Part 2: Function Of The Infraspinatus And Who Tears It

More about the function of the Infraspinatus and who gets a strain of the Infraspinatus

The main function of infraspinatus is external rotation and stabilization of the shoulder joint along with elevation and depression of the shoulder. The first muscle susceptible to a tear within the rotator cuff muscles is the supraspinatus and infraspinatus is the second.

An infraspinatus tear is generally due to an overuse injury that stresses the shoulder joint and leads to both instability and joint laxity. Baseball and volleyball players are known to have this injury due to the demands made on the shoulder with constant overhead motion.

But it’s not just athletes that suffer with infraspinatus tears. Other repetitive stress motion injuries of this muscle and tendon can occur simply from driving with the arm held stretched out/extended on top of the steering wheel or from reaching back persistently with a computer mouse.

What kind of pain does an infraspinatus tear cause?

There are a few different symptoms that are possible:

  • Pain radiating into the neck and upper back areas and down into biceps
  • Inability to raise the arm above head because of stiffness and feeling numb
  • Weakness in the shoulder
  • Discomfort with sleep when rolling onto side
Sebastian Gonzales DC

Chapter 3: Examination Of An Infraspinatus Strain

If you haven’t been to the doctor yet, you could be wondering why all of the odd “press into my hand” testing. This is a video series of some of the common tests you will see when you go in for a proper exam of the shoulder.

Together, these tests will guide your doctor to the correct diagnosis. Each video is very quick and at the end of each, I will tell you what each one is testing for.

Part 4: Infraspinatus Strain Symptoms & Treatments

How can an Infraspinatus Strain present and how can it be treated?

When observing the shoulder motion, the patient may experience pain throughout the full range of motion. Commonly known as the “arc of pain”, this is a positive indicator of a tear. Muscle weakness will develop secondary to the shoulder pain and you may also observe abnormal motion of the scapula.

If a tear is diagnosed, there will very likely be scar tissue built up along the tendon and around the infraspinatus bursa causing a catching or grinding motion of the shoulder. The degree of a rotator cuff tear is difficult to determine without imaging. The degree of pain does not always correlate with the severity of the tear; some patients may present with decreased range of motion and a great amount of pain while others may have no pain yet still have limited range of motion.

The first imaging test to look at is an x-ray. While it won’t be able to show any soft tissue damage, it is helpful in ruling out other conditions. An x-ray will tell you if there is any joint degeneration, impingement from an osseous (bony) structure, or arthritis in the joint.

Infraspinatus Tear

Treatment is based on the severity of the tear and its impact on the patient’s activities and ability to function.

Possible treatments for an infraspinatus tear may include:

  • RICE (rest, ice, compress, elevate)
  • Surgery based on the severity of the tear to reattach the muscle tendon
  • Steroid injections
  • Non-Steroidal Anti-Inflammatory medications
  • Addressing the scar tissue formation in the shoulder joint
  • Stretching
  • Rehabilitative strengthening exercises

The last two treatments are very important and should be a part of any treatment regimen for an infraspinatous tear. Without proper rehabilitative strengthening exercise for the shoulder and treatments to address the scar tissue, more disabling conditions such as frozen shoulder can occur.

Before beginning any strengthening protocol, the muscles should be warmed up properly. This can easily be done with stretching such as the doorway stretch or the “threading the needle” yoga pose.

There are a couple of specific exercises to strengthen the muscles associated with an infraspinatus tear:

  • Resistance band- external rotation motion
  • Face pulls
  • Side Planks

Approximately 6 to 8 weeks of treatment will be needed, depending on the severity of the injury, in order to both decrease the pain and strengthen the muscles.

How Can We Help You?

How does the Performance Place treat a Infraspinatus Strain?

At Performance Place® Sports Care, we approach injuries in a conservative manner that will give the patient the most weighted benefits. Our providers are board certified chiropractors and certified in full body Active Release Technique. Dr Gonzales is a certified Sports Chiropractic Physician and Musculoskeletal Sonographer.

We examine the patient and determine the most efficient and quickest treatment plan for each based on our evaluation. Our goal is to not only to get the athlete back out on the field doing what they love to do, but to also enhance their athletic performance in the process. We perform treatments that address the scar tissue that has built up from micro-tears in the tissue due to overuse or previous injuries as well as develop and implement a program to strengthen and train the muscles to be used functionally.

Infraspinatus Tear

Most all of our patients feel results within a few treatments. Decreased pain, increased range of motion, strength, and balance are all gained through our comprehensive approach. We then move into the second phase of treatment with strength and conditioning training, which is the most important aspect of the treatment and is designed to prevent future injuries.

In summary, to address an infraspinatus tear:

  • We will address the scar tissue of the primarily involved muscle in addition to any associated muscle or bursa.
  • We teach proper warmup and stretching of the shoulders.
  • Lastly, we will strengthen and condition the shoulder to prevent future injury (sport-specific functional training)

Check our online scheduler to book an appointment today

Works Cited

Majority written by Dr Tabassum Ali DC

Itoi, Eiji. “Abstract.” National Center for Biotechnology Information. U.S. National Library of Medicine, 01 Dec. 2013. Web. 01 Apr. 2013. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607722/>.

Infrapsinatus muscle. Digital image. N.p., n.d. Web. 02 Apr. 2013. <http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/infraspinatus/atlasImage>.

“Rotator Cuff Tear.” Rotator Cuff Tear. Seacoast Orthopedics & Sports Medicine, n.d. Web. 02 Apr. 2013.

Hadim, Mehdi. “How to Deal with Shoulder Injuries: The Infraspinatus | StrongLifts StrongLifts.” StrongLifts RSS. Sandbender, 12 Feb. 2008. Web. 02 Apr. 2013.

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12 Truths About Sports Hernias Your Doctor Didn’t Tell You https://www.p2sportscare.com/articles/lower-extremity/sports-hernia/ https://www.p2sportscare.com/articles/lower-extremity/sports-hernia/#respond Thu, 04 Aug 2022 09:10:51 +0000 https://www.p2sportscare.com/?p=71965

Sports Hernia

You just struck GOLD with this article.

This article will include the best information about sports hernias, treatments, rehab, and surgical interventions. I wrote this article originally in 2016 (updated in 2018) to compiled the most up to date research-based information for people suffering from sports hernias, all in one place.

To accelerate your recovery, I’ve created a video guide you can preview above.

As we get into some of the treatments available for a sports hernias, it’s always important to ask yourself WHY your groin became irritated in the first place.

Aside from direct trauma, most groin injuries issues are a painful yet regular adaptation to load.

Pain is just an alarm.

Most symptoms are just an alarm that you need to “re-calibrate” how your body absorbs load in human motion.

Building up the support systems for the groin will allow re-calibration to occur, and the abdominal wall will begin to heal itself.

 

Why are the fascias and tendons of your groin overused and painful?

People use treatments that address pain, swelling, scar tissue, and tenderness as simple ways to modify pain, similar to taking pain medication.

Pain modification is great, but only when coupled with re-calibration of your body weight during athletic motions that frequently re-injure the deconditioned athlete with a deconditioned groin.

Similar to your iPhone (when re-calibrating GPS), groin pain is the body asking to redistribute load. In this case, away from the groin.

Re-calibration is simple to do, yet most athletes require a little guidance in finding their way… hence the reason I made Volume 1 of My Sports Hernia Course.

It should be your starting point to re-calibrating your groin’s loading strategy.

The course is the most efficient way for me to guide you to the rehab exercise videos you’re looking for (ethical guidelines in the medical world restrict doctors from recommending direct care without examination).

I included some videos of methods we use in the clinic with high success in this article as a way of “unveiling the curtain.”

I want you to see that recovery from a groin issue is not magic and closer than you think.

The videos in this article are great and work sometimes but not all of the time. In my 10+ years of practice, I started to learn more effective corrective exercises to accelerate recovery for my clients.

Many of the videos in this article will work BUT to be honest, the newer stuff works FASTER.

I started to compile video references in this PDF for my patients to use as “refreshers.” You can access them through Volume 1 of my Sports Hernia Course as well.

For those of you who are not sure about the program but want to learn more, I just created this eBook to help “Demystify” the sports hernia… since there is not thing about it on the Internet.

It’s called Understanding Sports Hernias: Unveiling The Mystery Behind Groin Pain in Athletes. Here is a link

 

What’s a realistic recovery timeline for groin pain?

Most people I see with inner groin pain follow this rough spread of recovery times (every case is unique):

  • 1/2 tend to regain their ability to run, change direction, jump and squat within a 30 minute intervention
  • 1/4 tend to have a slower recovery, yet are cleared to resistance train, do agility drills, and sprint work performed as “pain-free reps.”
  • The last group is usually more chronic and has neglected their symptoms for months/ years. Regardless, they are typically cleared to resistance train, do core work, and walk long distances.

Enjoy the article, happy recovery, and if you’re in Southern CA, come in to see me to accelerate the process! Make an appointment.

Dr. Sebastian Gonzales DC, DACBSP®, CSCS – Head Clinician Performance Place Sports Care, Huntington Beach, CA

Sports Hernia Truths 1-3

 

Sports Hernia Truth #1

Sports Hernia’s Often Occurs In Sports With Cutting, Pivoting, Kicking And Sharp Turns.
  • Soccer
  • Football
  • Tennis
  • Rugby

Poor movement quality in sports with quick changes in direction can overload the tissues in the groin and eventually can lead to a small painful tear over time. Improving the support for the groin, the hips and core, are required for high movement quality.

Sports Hernia Truth #2

Sports hernias have a slow onset, which means it is not traumatic.
  • Nobody has to hit you.
  • You don’t have to fall.
  • You don’t have to hear a pop.
  • It occurs slowly, meaning it is very preventable.

Sports Hernia Truth #3

Pain is one-sided (unilateral) around the groin/pubic bone.

The pubic bone is the bone at the very bottom section of the abdominal area. Many muscles of the pelvis and abdominal area attach here. Pain is usually only on one side, so if you have pain on both sides you could have another injury type.

Sports Hernia Truth 4-6

 

Sports Hernia Truth #4

Pain can radiate to the upper thigh.

“Referred pain” happens with many different types of conditions. Even injury to an organ like the heart can create radiation of pain. Sports hernias refer to the front of the thigh and into the quad muscles.

Sports Hernia Truth #5

The pain associated with a sports hernia is “hard to pinpoint.”

Not being able to find the source of pain is extremely common and a very characteristic symptom of a sports hernia. If you cannot locate the apex of the injury yourself, you should investigate the possibility of a sports hernia.

Sports Hernia Truth #6

Scrotum pain or tightness can also occur in some cases.

Obviously, this is just for the guys. I have heard athletes say it feels “tight” or “numb” even into the ball sack. Other conditions can also yield tightness into the scrotum, but this is a classic one found in athletes with sports hernias. Don’t ignore this one.

Sports Hernia Truths 7-9

 

Sports Hernia Truth #7

Other AKAs for a Sports hernia are:
  • Sportsman’s Hernia
  • Athletic Pubalgia
  • Gilmore’s Groin

Sports Hernia Truth #8

Top 4 diagnosis it can be confused with are:
  • Adductor Longus Dysfunction
  • Osteitis Pubis
  • Hip Joint Pathology
  • Hernia

If you genuinely want to know your correct diagnosis, you’ll need some advanced imaging. I go through that in more detail later in this article.

Sports Hernia Truth #9

Dynamic Musculoskeletal Ultrasound (MSUS) can confirm the diagnosis.

An ultrasound is one of the best ways to know precisely the injury you have. I know that might surprise you, but it assists us in recommending the right treatment plan for you.

Sports Hernia Truths 10-12

 

Sports Hernia Truth #10

Rehab can be slow, frustrating and even unsuccessful. Bummer huh? That’s the nature of the beast if you have a TRUE sports hernia.

Rehab can be very slow but the great news is if you rehab and it is a fast recovery you probably had something else, what I would classify as a “pseudo-sports hernia.”

You could have had hip impingement, hip flexor tendonitis, light nerve impingement, a spinal disc issue and much more.

To figure out exactly why my patient are experiencing groin pain, it requires about an hour and half of conversation, testing and trail/ error corrective exercise recommendations. In my experience, less than 1/4 of the self diagnosed “sports hernia” cases are actually a sports hernia.

Even more of a reason to confirm your diagnosis!

Sports Hernia Truth #11

Rehab may include:
  • 6-8 weeks modified play
  • Pain Modifying Modalities (ice, heat, electrical stimulation, etc)
  • Sports Massage/ Deep Tissue Work
  • Core Endurance Exercises
  • Breathing Exercise For Intra-Abdominal Pressure “Recalibration”
  • Progressive Hip Strengthening
  • Hip Mobility Exercises
  • Correction And Gradual Loading Of Movement Patterns (squats, deadlift, push, pull, carry)
  • Unilateral Training With An Anti-Rotational Consideration
  • Graded Exposure To Sports Specific Movements
  • Gradual Return To Play With At-Home Progressive Rehabilitation

Sports Hernia Truth #12

Surgery is suggested if rehab is unsuccessful.

The great news is surgery can be extremely successful but I would caution to not jump in too fast.

A successful sports hernia surgery would be an unsuccessful surgery on a hip labrum or other conditions that could also be causing your pain. Read the rest of the article to find out how we can confirm a sports hernia…

Sports Hernia Rehab Program (Actual Results)

The key with a sports hernia rehab program is to rebuild the other areas of the abdominal region to better support the strained area.

In a span of 8 weeks, you can rehab a sports hernia injury with our online program:

SPORTS HERNIA REHAB COURSE – GUIDED PROGRAM WITH VIDEOS

Here’s Why You Shouldn’t Wait to Start Your Recovery

It took Charles Moody 14 months of frustration and discomfort with his Sports Hernia injury until he found this guide, and just 8 weeks to start feeling better.

I found amazing results with this program! Honestly, it is the only rehab that has worked for me beyond resting (which eventually didn’t work), and I had tried everything available to me.

I am a track and field athlete and I compete in the decathlon. I was practicing the hurdles one day in December 2019 and at the end of practice I noticed my groin was unusually sore. It slowly became worse and eventually led me to see a doctor. I was diagnosed with a sports hernia in February 2020 and was told with physical therapy and rest I should recover within 4-6 months. One good thing about the pandemic is that I had time to recover without missing any competition, but after about 2 months I hit a plateau in terms of recovery. I did 2 months of physical therapy and eventually didn’t notice any improvements. In November/December 2021 I finally decided to just rest, instead of trying to still do tolerable activity. By the beginning of January I noticed a slight improvement, but I could still tell the groin discomfort was there. As I was in a last-ditch google search effort I found your program which was a beacon of hope.

I was attracted to the program due to the non-conventional methods of recovery. The breathing and emphasis on being mindful during the exercises is unique and I find it helpful. I feel this is something mainstream exercise and athletics lacks.

I no longer feel pain with putting on my socks or sneezing. If I squeeze my adductors really hard my right groin still feels different, but there isn’t pain like before. I am trying to “add to my bank account and not make withdrawls”. It’s hard because when I feel better I want to test it but I am refraining for at least these 8 weeks. I am still hopeful to make a full recovery so I can sprint and jump again. This program has been the game-changer for me; I wish I could see what would have happened if I started it earlier on in the injury process.

Charles Moody

What Is A Sports Hernia?

A sports hernia is tearing of the transversalis fascia of the lower abdominal or groin region. A common misconception is that a sports hernia is the same as a traditional hernia. The mechanism of injury is rapid twisting and change of direction within sports, such as football, basketball, soccer and hockey.

The term “sports hernia” is becoming mainstream with more professional athletes being diagnosed. The following are just to name a few:

  • Torii Hunter
  • Tom Brady
  • Ryan Getzlaf
  • Julio Jones
  • Jeremy Shockey

If you follow any of these professional athletes, they all seem to have the same thing in common: Lingering groin pain.If you play fantasy hockey, this is a major headache since it seems so minor, but it can land a player on Injury Reserve on a moment’s notice. In real life, it is a very frustrating condition to say the least. It is hard to pinpoint, goes away with rest and comes back after activity, but is hardly painful enough to make you want to stop. It lingers and is always on your mind.  And if you’re looking for my step-by-step sports hernia rehab video course here it is.

One the best definitions of Sport hernias is the following by Harmon:

Sports Hernia Infographic

“The phenomena of chronic activity–related groin pain that is unresponsive to conservative therapy and significantly improves with surgical repair.”

This is sports hernias have behaved in a clinical setting historically. It is not uncommon for a sports hernia to be unrecognized for months and even years. Unlike your typical sports injury, most sports medicine offices have only seen a handful of cases. It’s just not on most doctors’ radar.

The purpose of this article is not only to bring awareness about sports hernias, but also to educate the reasons why a sports hernia may not respond to physical therapy or corrective exercises

Logically we may come to the assumption that the sports hernia diagnosis may be wrong if it’s not responding to a good physical therapy program.

Sadly many people have the same frustrating story.

They have seen a doctor who ruled out a hip labral tear, hip impingement and an inguinal hernia. They conducted an ultrasound to “see” the sports hernia, but it is inconclusive. Or perhaps they have had an MRI that shows nothing.

Now what?

There are a few situations that can mimic a sports hernia, even after all of the other diagnoses have been ruled out.

  • Ilioinguinal nerve compression
  • Genital branch of the Genitofemoral nerve compression

Both of these nerves originate from the upper lumbar spine, which could be the root of the whole situation. We will get to how we can treat this later in the article. For those of you who can’t wait, watch this Youtube video I did as a self test for this situation.

For those of you who want to learn about true sports hernias, it’s all in this article. I got it all!

Sports Hernia

Will you find quick fixes in this article for sports hernia rehab?

Nope. There is no quick fix for this condition, and if someone is trying to sell you one, they are blowing smoke up your you-know-what.

Is there a way to decrease the pain related to sports hernias?

Yes. Proper rehab and avoidance of activity for a certain period of time will assist greatly, but this will not always stop it from coming back. Pain is the first thing to go and last thing to come. Do not be fooled when you become pain-free by resting it. Pain is only one measure of improvement in your rehab.

Strength, core muscle endurance, change of direction, balance and power (just to name a few) are important, since you obviously desire to play your sport again. If you wanted to be a couch potato, you would be feeling better in no time. Watching Sports Center doesn’t require any movement.

Why is this article so long?

There is a lot of information on sports hernias available to you on the web. However, much of the information is spread out all over the internet and hard for athletes to digest due to complicated terminology. This article lays out the foundational terminology you will need to understand what options you have with your injury. We will go over anatomy, biomechanics, rehab, surgery, and even the fun facts. The information I am using is from the last ten years of medical research, up until 2021. We will be making updates overtime when something new is found as well. So link to this page and share with friends. This is the best source for information on sports hernias you will find.

[eBook] Understanding Sports Hernias: Unveiling The Mystery Behind Groin Pain in Athletes

Sale!

$17.00

Description of this eBook

There is a lack of information on the internet about sports hernias. Let’s demystify the sports hernia together!

There are a lot of reasons you may be experiencing lower abdominal pain, groin pain, hip stiffness, genital tightness and adductor tightness. There are many reasons for lower back or SI joint stiffness or pain as well. A sports hernia is only one reason.

Sports hernias can be a perplexing condition for both athletes and medical professionals alike. Despite being a common source of groin pain, there is a surprising lack of information about sports hernias on the internet.

In this ebook, we will explore the nature of sports hernias, their misnomer, differential diagnoses for similar symptoms, the recovery process, treatment options, and the role of various factors such as core stability and breathing mechanics.

Why is there such a lack of information about sports hernias on the internet?

The scarcity of information about sports hernias on the internet can be attributed to various factors.

Firstly, the term "sports hernia" itself is a misnomer, leading to confusion and difficulty in accurate diagnosis.

Secondly, the symptoms of a sports hernia can overlap with other conditions, making it challenging to distinguish and classify.

Thirdly, even in research publications the term sports hernia is used interchangeably with abdominal hernias.

Lastly, the evolving understanding of sports hernias within the medical community may contribute to the lack of consolidated information.

Common Names (or Aliases?) for Sports Hernias

  • Sportsman’s Hernia
  • Athletic Pubalgia
  • Gilmore’s Groin

How Do You Know If You Have A Sports Hernia?

  • Typical athlete characteristics:
  • Male, age mid-20s
  • Common sports: soccer, hockey, tennis, football, field hockey players
  • Motions involved: cutting, pivoting, kicking and sharp turns
  • Gradual onset

Anatomy of a Sports Hernia

Bones of the Groin Region

  • Ilium
  • Ischium
  • Pubis
  • Sacrum
  • Coccyx
  • Femur
Bones Sports Hernia

Joints of the Groin

  • Public Symphysis
  • Femoroacetabular Joint
  • Sacroiliac Joint

Cartilage of the Groin Region

  • Public Symphysis
  • Acetabular Labrum
  • Hip Articular Cartilage
  • Sacroiliac Joint Articular Cartilage
  • Triradiate Cartilage Complex

Ligaments of the Groin Region

  • Inguinal Ligament

Muscles that attach in Groin Region

  • Adductor Longus
  • Transversalis Fascia
  • Rectus Abdominis
  • Internal Oblique
  • External Oblique
  • Iliopsoas
  • Rectus Femoris
  • Pectineus
  • Adductor Brevis
  • Adductor Magnus
  • Gracilis
  • Tenor Fasciae Latae
  • Piriformis
  • Gluteus Medius
  • Gluteus Maximus
  • Biceps Femoris
  • Semitendinosus
  • Semimembranosus
Muscles groin

How A Sports Hernia Develops

Chronic groin pain typically happens over time, which is why with sports hernias, we do not hear many stories of feeling a “pop” or a specific moment of injury. It is thought to be the result of “overuse” mechanics stemming from a combination of poor strength and endurance, lack of dynamic control from the hip and core muscles, movement pattern abnormalities and discoordination of motion in the groin area.

There is a lot going on in the groin area. There are a lot of muscles, tendons and fascia pulling in different directions. Many of these muscles and tendons attach to the pubic bone, which is the location of pain. These contracting structures need to coordinate together for any athletic motion, such as a skating motion of a hockey player or the kicking motion of a soccer player

This is also known as the injury prevention model.

Over 100 research articles on sports hernias point to the “overuse” model as being a probable cause of the injury 13, which also means it is preventable.

We believe it is a secondary level injury.

Repeated shear force coming from the hip adductor pulling against a weakened groin region (internal oblique and transversalis fascia) lead to a sports hernia.

 

“So you’re saying strengthen the core muscles?

Not exactly. The core muscles are important but it’s better to think of the area as a “complex.” Everything works together. This includes the hip. Your core muscles include your internal oblique, external oblique, multifidus, quadratus lumborum, rectus abdominis, diaphragm and transversus abdominis to name a few. Hip range of motion has been found to be associated with chronic groin pain and injury to above named abdominal structures. 4,14,15

 

“So we need to stretch the hip?”

Maybe, but more so, just remember that your sports hernia was not an accident. It was not bad luck, because it is a preventable injury. We can test hip range of motion and strength. We can look at how well or poorly you move. How well you squat, lunge, and change directions on the field. These can all be tested in physical therapy or a rehabilitation clinic.

Sports hernias, like most “overuse” sports injuries, are in theory preventable if we correct your “problem areas” before the injury begins.

Entheseopathies (inflammation of the tendinous attachment to the bone) can also be found in many groin pain patients. This means this is not a “new” condition. It happens over a period of time and taking preventative steps should not be neglected. Muscles and tendons that attach to the public bone become overused and stress due to poor function of the rest of the core and hip regions.

Prevention is thought to be possible by using the trained eye of a physical therapist, sports chiropractor or strength coach to address non-painful movement dysfunctions before they become painful conditions. We call this protocol “prehab.”

Sports Hernia Symptoms

  • Unilateral groin pain that can radiate to the area between the genitals and anus or the upper inner thigh
  • Pain radiating to the scrotum and testicles
  • Seems like an inguinal hernia without the mass

Other Possible Diagnoses

Want to know if you have a sports hernia for sure?

It’s tougher than you would think.

As of 2016, when this article was originally written, we still didn’t know exactly how to test for a sports hernia with an orthopedic test. Orthopedic tests can be as simple as a muscle test or moving a joint in a doctor’s office.

Now we have a better idea of the regions to test, as well as a better way of ruling out other conditions that could make rehabilitation more complicated. In this Youtube video, I share my exam for a sports hernia.

Testing for sports hernias can require more than one test to diagnose, and oftentimes, require an image to be taken. The area of injury is so dense with structures which could be the pain generator, it is hard to isolate each via orthopedic or muscle testing.

For groin pain, we have to consider these diagnoses:

  1. Hip impingement
  2. Hip Flexor Syndrome
  3. Ilioinguinal nerve compression
  4. Genital branch of the genitofemoral nerve compression
  5. Adductor Longus dysfunction
  6. Osteitis pubis
  7. Sports Hernia (aka sportsman’s hernia)
  8. Hip labral tear
  9. Hip arthritis
  10. Inguinal Hernia

Imaging A Sports Hernia

These tests can assist greatly in ruling out some of the other possible conditions. Still, they do not always confirm a sports hernia. Some imaging options are listed below with the pros and cons of the imaging type:

Plain radiograph (x-rays)

Computed Tomography Scan (CT Scan)

Magnetic Resonance Imaging (MRI)

Magnetic Resonance Arthrogram (MR Arthrogram)

Musculoskeletal Ultrasound (MSMU or MSKUS)

Plain radiograph (x-rays)

X-ray is the typical beginning step in the imaging series for a variety of reasons. X-rays are great at assessing the cortical surface of the bones (the shell) and the alignment of the bony structures. They can reveal suspicion of soft tissue damage. Still, they only reveal a small fraction of what other types of imaging can see. For a complete assessment of the region’s muscles, tendons, ligaments, fascia, cartilages, and other structures, we need to use images better equipped to key in on the specific densities of each.

In groin pain cases, x-ray is great at confirming findings such as:

  • Pubic symphysis widening and erosions
  • Local fractures
  • Bone disease
  • Healing of possible stress fractures

Computed Tomography Scan (CT Scan)

CT scans are beneficial for in-depth evaluation of bone injuries. A CT scan will show everything an x-ray does but in more detail. Why do we not start with the CT in the first place then? Cost is one factor. In the medical field, we do make every attempt to keep the cost as low as possible for each patient. Imaging can be one of the most costly things done in the process of diagnosing the cause of your groin pain.

Second, the machinery to create the image is expensive and much more complex than an x-ray. An X-ray will reveal useful findings, and you will get one done much faster than a CT. Third is the issue of radiation exposure. Radiation is one of the significant hang-ups of using CT scans. Too much radiation exposure is not good. When x-rays were first invented, they were helpful for some skin conditions and used as a treatment for them.

Long story short, we found decades later that was a bad idea. Now, there are restrictions on how much radiation is allowed for each patient to have in a year. Some estimates say CT scans have around 100 times more radiation exposure than x-rays but don’t quote me on that exact number. For groin pain, CT scans can be useful in seeing:

  • Stress Reactions (note: they differ from stress fractures)
  • Inflammatory processes

Magnetic Resonance Imaging (Sports Hernia MRI)

A sports hernia MRI is very useful in the evaluation of the soft tissue in the groin area. Using it it can look at the muscle tendons as they attach to the pubic bone. Using MRI, we are also better at predicting recovery time if there is a positive finding MRIs can also help to narrow down a more precise treatment plan. With this type of image, we can really start to understand the nature of your groin pain: is it simple or more complex? A sports hernia MRI can assist us in ruling out some aspects of the injury and confirming others.

MRI can assist us in confirming:

  • Muscle strains
  • Stress reactions
  • Labral tears
  • Osteitis pubis
  • Iliopsoas bursitis
  • True hernias
  • Occult stress fractures

Some negatives about using a sports hernia MRI are cost and speed of obtaining the procedure. Cash is king, and if you are ready and willing to shell out some big bucks to know more about your injury, you can have the image performed today.

Notice you do not see the two big secret diagnoses I started the article with on this list. Having an MRI can be also useless for seeing compression of the Ilioinguinal nerve and the genital branch of the genitofemoral nerve. Confirming these two come with a hands on evaluation.

 

Do you need other types of imaging?

Probably not. X-rays and CT scans are fantastic at bony evaluation, but a sports hernia MRI is very good at the evaluation of the soft tissues that aren’t clear on those types of imaging, and it’s pretty darn good at the evaluation of bone as well. If you have been waiting for an insurance company to approve an MRI, I would not hold your breath. In some cases, it can be fast, but in others, it can take months. Months of downtime, uncertainty, and pain are considerable downsides to waiting on your insurance to cover an MRI.

  • Are you willing to wait this long?
  • How badly do you want to know about your groin pain?
  • How badly do you want to play again this year?

Again, if you want a sports hernia MRI, just pay the money. If the most significant barrier to your happiness and sanity is money, just spend it. It will be money well spent.

 

Is a sports hernia MRI the most cost-effective type of imaging for a sports hernia?

Not really. So, don’t think I am pressing you to pay for an MRI. Musculoskeletal Ultrasound is a fraction of the cost and very diagnostic. However, a timely image can cost money. Again, just allocate the money from other luxuries like cell phones, movies, dinner, and drinks so that you can have direction in your rehab. I have had to have the hard talk about priorities with many patients.

  • What do you value most in life?
  • Your health or your belongings?

Sorry, we got off-topic. Let’s get back to the imaging!

Magnetic Resonance Arthrogram (MR Arthrogram)

MR Arthrogram is the gold standard for the evaluation of the internal structures of the hip. If we ordered this type of image, we would be looking for a possible hip labral tear. Pain can refer from the hip/labrum and create the presentation of a sports hernia. The correct diagnosis would assist in formulating a treatment plan or possibly recommending surgery.

Labral tears and sports hernia injuries require very different surgeries. If a surgeon corrects the wrong thing, you will leave the surgery with the same pain that brought you there to start. An MR Arthrogram is more expensive than a standard MRI because we are working with contrast dye now. The dye inflates the joint spaces and creates a great visualization of the internal structures of the hip joint.

 

Does this mean an MR Arthrogram can confirm a sports hernia?

No. But, it can rule out a major injury that presents like a sports hernia.

Sports Hernia Musculoskeletal Ultrasound (MSUS or MSKUS)

Last, but not least, is the Musculoskeletal Ultrasound. It is a newer technology in comparison to the previous ones we’ve discussed. One important thing to point out is that it is the most cost-effective, best bang-for-your-buck type of image for groin pain. Still, it cannot see any bony damage that might be there as well. What can it see?

  • Muscle strains
  • Hip joint effusion (helpful in ruling in a possible labral tear)
  • Osteitis pubis
  • Iliopsoas bursitis
  • True hernias
  • Stress fractures

Here’s an Ultrasound of a Sports Hernia. There was a high school soccer player who had experienced groin pain for the past six months. Pain was on the left pubic bone. She said it came and went with her activity level. The imaging reports stated, “Athletic pubalgia strongly suggested.” Note the apparent difference to the pubic bone on the left side (first image) vs. the right (the second image). This abnormality is at the adductor tendon insertion and appears to have been going on for a long time. It was not a new injury at all!

Note on the obvious difference to the pubic bone on the left side (first image) vs the non-painful side (the second image). This abnormality is at the insertion of the adductor tendon and seems to have been going on for a long time. This was not a new injury at all.

“What I would recommend as a comprehensive study package for groin pain would be: 1)an x-ray series, to rule out bony injury, and 2)MSUS to rule in any soft tissue damage, including a sports hernia.”

Sebastian Gonzales DC, DACBSP®, CSCS, RMSK®

What I would recommend as a comprehensive study package for groin pain would be an x-ray series, to rule out bony injury, and MSUS to rule in any soft tissue damage including a sports hernia. Yet again you won’t be able to see the Ilioinguinal nerve and the genital branch of the genitofemoral nerve. Confirming these two come with a hands on evaluation. You should just let us do that for you. 🙂

Musculoskeletal Ultrasound is the only image of the bunch that is a dynamic assessment study, meaning that we can see a sports hernia in action. As the patient actively strains, the ultrasound probe sees real-time bulging and ballooning of the inguinal canal. It can also see posterior inguinal wall deficiency. However, the education and experience of the person performing the exam is a significant variable. MSUS is very user-dependent, and you must find someone qualified to perform the examination.

 

Don’t know how to find someone qualified?

Ask around. Finding an excellent musculoskeletal ultrasonographer is tough, and primary education in sonography school is usually not enough to perform the exam. However, schools are beginning to add musculoskeletal examination into the curriculum.

Two great people in Southern California who I respect very much are Dr. Michael Meng, in the San Diego area, and Michael Jablon in Beverly Hills.

Sports Hernias Treatment & Rehab

Over my years successfully treating and rehabilitating players with groin pain, we have only found 3 true sports hernia cases CONFIRMED with an ultrasound. The funny thing is that we have hundreds of people come in every year with the diagnosis of a sports hernia.

In this section allow me to share the process that works for us at Performance Place. At any point if you feel motivated to work with us 1-on-1, just reach out via this contact form. We also have an online program that shows some steps we take.

I’d rather share what is working versus what has not been working but published research over the years.

Step 1: Cool it down

  • Frogs pose

I know it sounds general but it tends to address the groin pain from various angles. If it was from the nerve compression I mentioned, this may help by opening some holes in the spine. It should generally feel like “no-effort or pain” in this position.

Next we go to skin rolling created by Justin Dean and Phillip Snell as Dermal Traction Method. Here is a video that shows how we use it for groin pain.

Step 2: Glute Primers

We like to use the low diagonal sit exercise that we show here. We have lots of other ways to do this if this exercise is too complicated to do. It should not be painful.

Step 3: Core muscle stiffness – Isometric

We normally do this only in the situation that we have had success with the other steps. If this was a true sports hernia, we may not want to load the belly wall too much just yet based upon the severity of symptoms.

Step 4: Hip Strengthening

Split squats tend to work very well in this situation. Depth and weights used may need to change. I will not be showing this on this article since if you are in this situation you have no reason to go advanced steps without the baby steps.

Find the easy wins first. When you cool it down and then build things up in a strategic way good things happen. The reason why many people have a flare up once they start to play again is because they have never really been challenged in their physical therapy or rehabilitation program. The body is not fragile and it will adapt to what you throw at it.

Rehab may include:

  • 6-8 weeks modified play
  • Pain Modifying Modalities (ice, heat, electrical stimulation, etc.)
  • Sports Massage/ Deep Tissue Work
  • Neurodynamics
  • Lumbar Disc Treatments
  • Core Endurance Exercises
  • Breathing Exercise For Intra-Abdominal Pressure “Re-calibration”
  • Progressive Hip Strengthening
  • Hip Mobility Exercises
  • Correction And Gradual Loading Of Movement Patterns (squats, deadlift, push, pull, carry)
  • Unilateral Training With An Anti-Rotational Consideration
  • Graded Exposure To Sports Specific Movements
  • Gradual Return To Play With At-Home Progressive Rehabilitation
MRI Arthrogram Groin

Do I agree with these sports hernia treatment & rehab styles?

Not 100%. My personal opinion after reading about the consistent failure of “traditional sports hernia therapy,” I can’t help but think… what’s missing, which is why I search for stuff that works

Hear me out; there’s a ton of research on how to rehab a disc injury (as well as many other types of torso/ groin conditions), so most rehab experts have great results with these types of cases. I personally feel very confident that if a disc injury or sciatica case came into my facility that I can help his person, at least a strong majority of the time.

How long it takes to return to full function is dependent upon the person and the severity of the condition, but regardless, I KNOW if I can help this person beyond reasonable doubt.

 

Why can’t we say this about hernia treatment & rehab?

I think it’s because we are just addressing the symptoms of another issue. I can say with much confidence that these happen because there’s a lack of proper function of the “supporting cast” in the abdominal region (and ball/socket joints) based on my experience treating other abdominal, torso, or pelvic floor injuries.

You may be thinking a sports hernia is groin pain, so my theory doesn’t apply. If you feel this way, go back and read the section about what a sports hernia is and come right back…

With an oblique strain, we resolve this by allowing the oblique to remodel (mother nature’s work) and build endurance in the supporting regions: intra-abdominal pressure (think a bike inner tube within the belly), co-contraction of all of the abdominal and back muscles, diaphragm, pelvic floor and adequate deceleration of the hip via the muscles of the hip. With a rotation intolerant spinal condition, like a lumbar spine pinched nerve or a disc injury, it’s the same thing. We’ve found reduced diaphragm motion in people with chronic low back pain (Kolar et al. 2012). Research has also started to investigate the correlation between poor hip rotation and sports hernia occurrence. A lack of hip internal rotation often correlates with having a sports hernia (Rambani et al., 2015).

 

Why would rotation of the hip matter?

With a sports hernia being a rotational/ extension-based injury, we need to have our rotation & extension come from somewhere, right?
Perhaps the region where it’s intended to?

The hip sounds like a good option to me (as well as sections of the thoracic spine). The hip, being a ball and socket joint, is prime for the job, so the fascia of the groin/ torso region doesn’t have to become torn up.

 

How can we increase hip rotation to decrease symptoms of a sports hernia?

Great question.

The range of motion of the hip is linked to having a stiff torso (McGill 2017). When we’re able to stiffen our torso (inflate the bike tire, co-contract all of the torso’s muscles and the ones that cross from the shoulder), then our hip range of motion improves! AND our ability to generate power from the hip improves too!

Amazing right?!

So you can’t just sit there and stretch when you’re watching Lost! You have to pay a bit more attention to the quality of torso stiffness that will improve your hip internal rotation. Then MAYBE you’ll get to play sometime this year! That’s the theory I base my rehab around, and I haven’t had to send a single groin pain case to surgery yet (at least of the people who followed through with my rehab recommendations).

I’d be lying if I told you that current level one research supported my rehab for sports hernias. Still, the theory is supported for hip impingement, low back pain, adductor strains, glute strains, hamstring strains, sore backs, sciatica, and much more. Since the research is starting to venture into figuring out WHY the transversalis fascia tears in the first place, they have to investigate hip and mid-back rotational deficits and postural endurance within the torso… so I’d like to think they will validate my concepts soon. However, the practices of Dynamic Neuromuscular Stabilization and perhaps Karl Lewit, and many active care sports physical therapist and chiropractors will probably be on board with me here.

I’ve been asked by many people, via email, to share my programming, and I was hesitant for many years, but I finally decided to do so. I was hesitant because the research was lagging (it takes time and funding), and I was pretty scared to share with my fellow docs.

I wish I could say I was the smartest person I know, but I’m not. I feel like I’m learning more and more about how to help people with many different conditions daily, but I guess I’ll share what I’ve found to work well so far. You can find the video rehab course here.

 

Wonder when you could return to your sport? How long does a sports hernia to heal?

Typically, 12-16 weeks after the start of your care, as long as you continue to be pain free, is a good time frame to attempt activity. It also depends on if you’ve kept some conditioning up. Just because the groin feels better doesn’t mean you’re conditioned to play the sport.

Want to know what rehab exercises we use? We use a variety of rehab exercises to promote muscular balance of the hip and the trunk. Again, the main goal is torso stiffness with the ability to SLOW rotation (anti-rotate) from the hip and the mid-back (amongst other parts of the body). Remember, the body is a single unit. Some people may use the term muscular balance.

What do I mean by muscular balance? Muscular balance refers to the functionality of the muscles, not just muscle size. Are they all working together synergistically? Can they properly propel you forward when you’re changing directions during your sport? To progress you properly to that point, we often have to start with the basics. I read a tremendous technical description of what our goals are in a study recently:

“The rehabilitation emphasis should be placed on resolving core strength, endurance, coordination and extensibility deficiencies and imbalances at the hip and abdominal muscles and on dynamically stabilizing the pelvic ring.” 13

Notice we don’t see a lot of stretching in this quote. We need to focus on improving function from many different angles and not just stretching, so don’t run for the foam roller too quickly. Here are our progressions:

  • Isometric to Concentric/Eccentric (safe contractions to less safe)
  • Non-loaded to Loaded (i.e., floor exercises then advance to standing, no weight to weighted)
  • Endurance to Strength to Power
  • Two feet to one foot
  • Stable footing to unstable footing

Here are a few of our exercises: TIP: Don’t understand these terms? Listen to this podcast

Here are a few of our exercises we use when indicated, but if you want our step by step for the first eight weeks, you can buy it HERE. Notice that all of the exercises require some type of abdominal/ torso effort. Without building stabilization from the center first, the hip range of motion won’t carry over to the field or daily movement.

Hip Adduction

Remember the Thigh Master? Perhaps they weren’t too far off for sports hernia prevention. But this is an open-chain exercise, meaning your foot is not on the ground. When the foot is on the ground, and we are using ground contact to move us, everything changes. Hence, the squats, deadlifts, and lunges become so important later in sports hernia rehab.

A simple adduction exercise to start with is an isometric one, like a plank. Side-lying hip adduction is a gravity loaded motion we will often use to begin someone. Here’s how you do it:

  1. Lay on your side with the affected side on the ground
  2. Split your legs and bring the bottom leg forward just enough so the top leg is not on top of it
  3. Obtain a stable trunk with proper breathing and bracing methods
  4. Bring the bottom leg toward the ceiling to a comfortable position
  5. Hold this position for 5 seconds
  6. Lower the leg to the ground
  7. Repeat
Hip Adduction Exercise

Multiplanar Trunk Stabilization

Here is one of the basic exercises we use for multiplanar trunk stabilization. You may have heard of it. It’s called Birddog. The Birddog exercise is fantastic for strengthening and stabilizing the trunk and the hips simultaneously. We often test before we recommend this exercise. If the client is weak in this pattern, we need to strengthen it.

This exercise is for the rehab of several conditions, including low back pain, hip impingement, and knee pain, to name a few. BUT it is also used to create power in athletic movements. I know it is not the power to move itself, but creating a rigid trunk is necessary to transfer power from the legs to the rest of the body.

Here is how we do it:

  1. Hands and knees. They should be right below your shoulder and hip sockets
  2. Exhale and dress the rib cage as in the Lewit Exercise queues. This is a stable trunk exercise. Find this stable trunk and stick it
  3. Slide the leg out. Lead with the heel and drive it through the wall behind you. Note: You’re making yourself “long.” Don’t raise your heel to the ceiling.
  4. Contract the glutes and hold the leg parallel to the ground
  5. Slide the opposing arm out, making yourself long. Thumb up.
  6. Hold this position for 5-10 seconds and slowly switch sides.

We recommend doing this for at least a minute or two. Some things we use to get the form right are balancing a cup of water or a stick on your back. I like the water method. It really slows people down and makes them pay attention to maintaining a “stable trunk” throughout the exercise.

Multiplanar Trunk Stabilization

Step Back Lunges

Step back lunges are a great way to add a lunge pattern to a rehab program safely. Even if you have knee issues, these exercises expose the knee to less impact than walking lunges. Do them with or without weight. We often use kettlebells and barbells in a front rack position.

  1. Obtain a stable trunk with proper breathing and bracing methods
  2. Step back as far as you can
  3. Bring the back knee towards the ground, but don’t contact the ground
  4. With a tall chest, the front knee should bend as well and be positioned just above the ball of the front foot.
  5. At the bottom, you should pause for 2 seconds to make sure you are stable
  6. Drive up using the front leg’s gluts.
  7. Alternate legs
Step Back Lunge

Proprioception Exercises

Proprioception exercise can vary greatly. Rather than write about a specific example, it is best to watch this video.

Change of Direction/Plyometric

This is similar to an ACL prevention course, which we also have on our paid courses, so I cannot give that out here, but there are some sources on YouTube you can use as an idea. This training should take place later in your rehab, so you have time to research a bit before you get here. Know all of the other parts first, and then take our course to learn about change of direction training. We have found conservative care of sports hernias is not exactly a standardized process as of yet.

We feel we have an idea of the necessities for an athlete to work on and improve based upon the structures involved in this injury. Currently, studies giving guidance for evidence-based rehab are lacking. 3,6,7,9

Want to know what we do in our facility for sports hernia rehab? We have the first eight weeks of our rehab process with step-by-step videos available for purchase.

Sports Hernia Surgery Success Rates

Surgery success rates for sports hernias can vary, just as any other surgery. Let’s compare some of the success rates of the two types of sports hernia surgeries: Open and Laparoscopic.

 

Open Sports Hernia Surgery

The average success rate for open repair is around 92.8% (SD 9.9). 8 35% of open procedures require mesh. 13 83.3% of open surgery athletes are required to be relatively inactive for the first four weeks after surgery.

After these first four weeks, they are allowed to walk in pools and do light stretching. At six weeks, they are allowed a full return to play and are at total activity within six months. 11

 

Laparoscopic Sports Hernia Surgery

The average success rate for a laparoscopic repair is around 96.0% (SD 4.5). 8 100% of laparoscopic procedures require mesh usage. 13 87% of laparoscopic surgery athletes can return to play partially within four weeks and fully return within six weeks. They had no recurrence of the injury from a symptomatic standpoint at follow-up 12.1 months later. 1

Post Surgical Rehab

This is what open repair rehab looks like: 5

Week 1:

  • Isometric abdominal and hip exercise
  • Walking 5min/day

Week 2:

  • Active hip exercise
  • Transverse and oblique core exercise
  • Stationary bike

Week 3:

  • Mobility work
  • Resistance hip exercises
  • Transverse and oblique core exercise
  • Jogging
  • Swimming

Week 4:

  • Running forward
  • Increased load on core exercise
  • Upper-body resistance training

Week 5:

  • Sprinting
  • Change of direction drills
  • Sports specific drills (kicking and ball handling)
  • Increase the load on core work again
  • Return to play lightly

Week 6:

  • Unrestricted exercise
  • Full return to play

 

This is what laparoscopic repair rehab looks like: 12

Week 1:

  • Walking 5min/hr

Week 2:

  • Power walking (20 – 50 min.)
  • Stationary bike intervals (4×10 min at 80-90 rpm)
  • Isometric abdominal training
  • Step-ups, speed training and lunges
  • Aquatic training

Week 3- 5:

  • Resistance training
  • Normal activities if pain-free

Week 6:

    • Unrestricted exercise
    • Full return to play
Rehab Sports Hernia

Does a sports hernia have a lump?

Sports hernias don’t create a visible lump, as it is an injury to deep soft tissues of the abdominal wall. Umbilical, direct, and indirect hernias will present with a lump if it is large enough. Diagnosis requires a medical examination and possible ultrasound imaging to confirm structural compromise.

Can I run with a sports hernia?

Running straight at slower paces may not be painful, yet increasing speed and changing directions may improve symptoms. Complete avoidance of ambulation is not advised, nor is complete bed rest. Too much inactivity will decondition the rest of your body and make a return to total activity more challenging. Walking may be the easiest way to keep your body from becoming deconditioned.

How do I know if I have a sports hernia or a pulled groin?

A physical examination of the spine, hip, and abdominal wall will yield a working diagnosis. Investigating all of these regions is essential to rule in and out other possible reasons for groin and abdominal pain.

Works Cited

  1. Ahumada LA, Ashruf S, Espinosa-de-los-Monteros A, et al. Athletic pubalgia: Definition and surgical treatment. Ann Plast Surg 2005;55:393–6.
  1. Emery, Carolyn A., Willem Meeuwisse H., and John Powell W. “Groin and Abdominal Strain Injuries in the National Hockey League.” Clinical Journal of Sport Medicine3 (1999): 151-56. Web.
  1. Farber AJ, Wilckens JH. Sports hernia: Diagnosis and therapeutic approach. J Am Acad Surg 2007;15:507–14.
  1. Harmon KG. Evaluation of groin pain in athletes. Curr Sports Med Reports 2007;6:354–61.
  1. Hemingway AE, Herrington L, Blower AL. Changes in muscle strength and pain in response to surgical repair of posterior abdominal wall disruption followed by rehabilitation. Br J Sports Med 2003;37:54–8.
  1. Holmich P, Uhrskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for long-standing adductor- related groin pain in athletes: Randomised trial. Lancet 1999;353:439–43.
  1. Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a ‘‘clinical entity approach’’: A prospective study of 207 patients. Br J Sports Med 2007;41:247–52.
  1. Meyers WC, Lanfranco A, Castellanos A. Surgical management of chronic lower abdominal and groin pain in high-performance athletes. Curr Sports Med Reports 2002;1:301–5.
  1. Nam A, Brody F. Management and therapy for sports hernia. Am Coll Surg 2008;206:154–64
  1. Paluska SA. An overview of hip injuries in running. Sports Med 2005;35:991–1014.
  1. Srinivasan A, Schuricht A. Long-term follow-up of laparoscopic preperitoneal hernia repair in professional athletes. J Laparoendoscop Adv Surg Tech 2002;12:101–6.
  1. Van Veen RN, de Baat P, Heijboer MP, et al. Successful endoscopic treatment of chronic groin pain in athletes. Surg Endosc 2007;21:189–93.
  1. Caudill, P., J. Nyland, C. Smith, J. Yerasimides, and J. Lach. “Sports Hernias: A Systematic Literature Review.” British Journal of Sports Medicine12 (2007): 954-64. Web.
  1. Verrall GM, Hamilton IA, Slavotinek JP, et al. Hip joint range of motion reduction in sports-related chronic groin injury diagnoses as pubic bone stress injury. J Sci Med Sport 2005;8:77–84.
  1. Verrall GM, Slavotinek JP, Barnes PG, et al. Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport 2007;10:463–6.

Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):352-62. Rambani, Rohit. “Loss of Range of Motion of the Hip Joint: a Hypothesis for Etiology of Sports Hernia.” Muscles, Ligaments and Tendons Journal, 2015, doi:10.11138/mltj/2015.5.1.029. McGill, Stuart. “Core Stability: “Fascial Raking” to Stimulate Abdominal Wall Activation for Ultimate Performance.” Http://www.dragondoor.com/pdf/331.pdf. N.p., n.d. Web. 2 Jan. 2017.

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