A Hip Impingement Case Solved by Deep Soft Tissue Work

Hey everyone, it's your co-host, Sebastian, with the Restoring Human Movement Podcast. Thanks for joining the Movement Movement. Again, we've been doing some shorter shows recently to get you guys some good information out quicker, but we do have long format shows coming on various different topics like postpartum problems, sports hernias, hip issues, knee ones, plantar prasitis, and so on. So stay tuned, make sure you subscribe to the show for those. We're going to cover today a groin injury with somebody that I worked with, sorry, that I cared for, not that I actually went to work with, and the success story that they had actually when they stopped seeing me.

And it was an interesting learning point for me, and I still use some of the lessons that I learned from that case today. And so I wanted to share with you guys to see maybe if you guys had the same experience, but also to, just to help you think outside the box on injuries like this one. Now, this injury was, it was diagnosed as hip impingement, but some people diagnosed it as a sports hernia. It was an area in the front part of the groin on this individual. This was a female about, let's go middle age, although we can't tell what middle age is anymore, and she was having problems doing things like ab workouts and ab wheel rollouts and so on, which is a really common scenario for people with this type of problem.

Now, was it a sports hernia or a hip impingement? It's TBD. We don't really know because there was no imaging to really tell us one way or another. I remember the exam, to me, looked a little bit more like hip impingement, but either way, how to manage it doesn't really, I'm not going to say it doesn't change necessarily, but they're very similar types of injuries and similar mechanics. By the way, if you guys are looking for some free information on hip impingement, we do have a hip webinar that's going to be free in the link description for the podcast. And also, there's a book that I wrote on sports hernias, which is pretty intensive.

We call it the Six Step Sports Hernia Recovery Plan, and that one is also going to be in there too. So please take advantage of those. You guys are interested in more than we're going to cover in this podcast. So this person, so usually I give them, I usually give people some timelines. I tell them like within typically about three to four weeks, they should be feeling a lot better, but not perfect. And so this is what I call the typical healing timeline. If you guys have been a client of ours before, you may have seen a graph that we send out people in an email just so they can understand timelines for different types of tissues, because they're all a little bit different.

Things that are a little bit more avascular or don't have as much blood supply have slower healing times. The ones that have higher blood supply, such as my hamstring tear, have better healing timelines. And so this one, sorry, we got construction out here, but I'm going to take a drive in my car and get you guys the information ASAP. Now, the healing timeline, at least for this gentleman, I predicted as about three to four weeks again. This timeline, although it is going to sound kind of short to most of you, is pretty appropriate for most people with hip impingement or sports hernias. I remember I had a lady that I'd spoken to about this, and she basically called BS.

And she says, no, I've had this thing for like six months. There's no way it's going to heal in three to four weeks. And I said, well, so why is that seem so extreme? And she told me all the reasons why. And then she, we did talk about her, her friend after that. And she said that, well, my friend had a hip replacement and right afterwards, he had like very minimal hip pain. And then, you know, most of his intense pain was gone within the matter of just a week. And I said, so how does it sound unreasonable to just take pressure off of the symptomatic tissue and let it heal and then have about three to four weeks where it feels a lot better?

You know, it's kind of like, it's the same scenario, it's just a different protocol. So usually three to four weeks is about the timeline. And so long story short, I was striking out with this person. And I was trying all the typical stuff that we do that you'll probably see in some of the videos that we have on YouTube or in those free resources that I mentioned. Interabdominal pressure breathing is a very common one that we do. Also, we end up doing something called McKenzie hip extension protocol for people with hip impingement, which is a really common one that works. It works very, very fast with a lot of people.

For other people of older age, sometimes doing stuff like letting their posterior tilt or like letting their, getting their anterior tilt to stop with their pelvis is a big part. So we have them lay on like a big Swiss ball. And so just laying there and decompressing the pinch point for hip impingement is a thing. And for a sporternia that helps build interabdominal pressure too. So there's a lot of bonuses to some of these really simple things that we have people do. And so I tried a bunch of these things with them and limited success. We tried corrective exercises such as side planks, glute facilitation.

We even went beyond the standard things like clamshells, which is what most people get. And in my opinion, they get it way too long. There's got to be more glute max activation. So we did single leg hinging. We did various different types of flares on coaching on a single leg hinge with or without weight. And we tried versions of regressed planks even to see if we can get the abdominal wall to activate really well that would limit the anterior tilt associated to not only hip impingement, mechanical hip impingement most of the time, but also with things like sporternias, like the very similar mechanics.

There's an anterior tilt and then there's lumbar spine extension, usually incorporated in both. The only difference would be is usually with a sporternia, there's a hip adduction part. So like the knee is going to go to the side, such as like a kicking motion coupled with that. So they're similar but different, right? So I was really struggling and I went to tissue work. I went to adjusting of the hip. There's a bunch of things that I tried. Now, I was seeing this person for about, I think it was like five, six weeks. We had a session every week, which is pretty standard for us if we're having trouble with the case.

And each time, usually after the first week, we're looking to see if there's been any change of any type. And I'm not looking for perfect, but we usually see after the first week, people are 25% better somehow, some way. For example, they can walk further when previously they couldn't walk a minute. Now they can walk five to ten minutes. Like that's pretty substantial, even though they may still have some pain. Doing something like rolling over in bed may get better. Getting into a car, like really easy, we call activities of daily living, can get better within a course of a week, but they generally won't be perfect.

So if we don't find that, we usually do like an internal audit system. And so when we ask the person the second time, how are things going? And they say, oh, it's just worse. We're not taking extra guesses at things, but we reexamine to figure out, like, is there something that we missed? And do we need to implement a better strategy moving forward? So like I mentioned before, those simple things that we tried, stuff like intra-abdominal pressure coaching or hip extension protocols, like we would find out which one is the most beneficial and which corrective exercises couple with that when doing the physical exam.

We don't really need an image for it, but the physical exam usually gives a really nice bit of insight of how to proceed forward. And so each time that we find that there's a non-responder over the course of a week, we see, number one, did the person do the exercises at home? Because no matter what we do in office on one day, it doesn't change anything. Usually it means that the person needs to increase the dosage they're doing at home. Imagine a medication the doctor gives you at the office and says, take these at home. Like, you need to do those at home to prove that that theory of treatment doesn't work either.

So if the person's been doing those things at home and there's no change, we need to reevaluate, do we need to do something different? And so I think I did that about three times with them, four times possibly, because each time they weren't getting better, which is very atypical. We really strive for short timelines here at Performance Place, and it's unacceptable to have, like, no change over the course of a month, for the most part. There are cases where there are exceptions because there's other aspects to that case, but for the most part, it's a lot quicker. Now, they eventually canceled an appointment, and they didn't return for the following week, and so I called them and asked them what's going on.

And I was really surprised. They said, I'm better. I said, really? So what do you think made you better? And they said, well, there's nothing that you did. And I said, okay, so what helped you? Because I'm interested, right? And so they said, I went to this massage therapist that someone suggested, and they just dug really deep into my glute medius area. It was, in this case, it was, I mean, it was so intense that I could barely take it. And they were working in there for, like, five to ten minutes, and they did a couple other spots around the hip, like, kind of around the TFL and around, like, the upper groin muscles.

And so he said, I haven't had any problems in, like, three, four days, and so I was going to wait to see if I needed your help still. And I said, great, that's cool. Just keep me informed. Most of the time, people who feel better don't keep us informed, rightfully so. You know, you forget pain is a good reminder to call back or not or ask for help. But I always wonder, and I know Dawne Costantino and Mandy always wonder, too, how does this book end? Like, how is that person doing? Did they get back to activity? Are they doing ab work now? Have they gone and surpassed that? Have they changed their goals and they hiked a mountain?

So we're really interested because, like, we do care, but also it helps us understand the progressions of successful treatments, unsuccessful treatments, of how people are doing, and it helps us really with future people. And so I didn't hear back from them, and then I ended up calling them two years later, and I said, you know, do you remember me? I'm Sebastian, I tried to help you with your hip or your groin. Can I ask you how you're doing? And they said, I'm still good. I said, no way. I said, did you do anything else? Like, have you done anything else maintenance-wise? And they said, no, I just did that one session with that massage therapist, and I cannot believe that I'm still feeling good.

I'm back to full activity. I'm working out. I haven't had any problems whatsoever, and that's kind of the whole story. And I said, that is so interesting. And so after we hung up, I dug into some of the anatomical research and maybe things that are related, you know. And I was speaking with an intern just the other day, and we were talking about all these different soft tissue methodologies and, you know, which one's better and, like, how are they different and what are they doing and stuff like that. And I remember something that someone told me about diets and how every diet will have its differences, but also there's commonalities.

Like, when you look at Atkins versus keto versus vegan, like, they all really don't eat stuff from packages, right? They all increase water intake, and they all reduce refined sugars. And so there's a lot of commonalities. Obviously, there's ones that are different, like eat vegetables, don't eat vegetables. The vegetable is the devil. Vegetables are, you know, like, the best. So there's obvious differences, but there's a lot of commonalities. And then so when you look at soft tissue techniques, there's also a lot of commonalities. Personally, I came from the discipline. I learned active release technique.

I'm going to say it was over 15 years ago now. It was before I even got out of grad school that I was already in some of the workshops there. And I had worked in a clinic where all we really did was active release. And it was by a doctor named Ron Higuera at the time. And everybody loved him. And he was really good at what he did. And he mainly just, like, I can remember the treatment protocols that we did most of the time. It was very similar for most people. And that's not a bad thing. It's just that people with areas and problems in certain areas also may have commonalities, right? I remember for the lower extremity, he would do a lot of sacrotuberous ligament.

There'd be a lot of piriformis. There'd be a lot of psoas. And there would be a lot of low back stuff, like low back paraspinalis and quadratus laborum. When you get down into the foot, it was, like, flexorholysis longus, which is the muscle that goes to the big toe. There was a lot of hamstrings. The upper extremity, there was a lot of upper trap, rhomboid, scalenes, cervical paraspinalis muscles. I mean, there was a bunch of commonalities. I mean, obviously, there was variance. And I remember, like, he would say, come on in here. Like, let's see this one protocol. Like, this one's different.

And it was definitely a different one. And it's funny from, you go to these active release seminars, and they will teach you in one module, like upper extremity. There's, like, over 100 protocols. But, like, when you end up going back to work, you do kind of like five of them, right, for most people. And then you get a little bit more specific. And then you blend them and make them your own, which is, you know, everybody, that's what everybody does with most techniques. And so I was talking to the intern, and they said, you know, what are the differences between them? I said, you know what? The areas where you're pressing with something like fascia manipulation or acupressure, I said, they're very similar to some of the areas in other soft tissue techniques.

And it's funny, they're the ones that people tend to point out the most, and they're the ones that become tied on a lot of people. And so they say that, like, acupressure, it might, by the way, my knowledge of it is fairly low. So anyone who does know more than me out there, just feel free to email and correct me. My impression is it follows meridian lines, kind of like acupuncture needle points. So it's, like, where the meridian lines are. I think fascia manipulation, it's where the intersection of those meridian lines are, which is where fascial points intersect, too. And this happens to be the area where a lot of the active release protocols are targeted, as well.

And so I'm bringing this up here because the tissue work that this person had done really helped them, which was actually one of those points. And the other points that they mentioned was the same points. And so I took it upon myself to, when a case got harder, after maybe three sessions and weren't having any change, I would do this. And I found that when their hip range of motion was limited in flexion and internal rotation, which is knee towards chest and across body, usually that actually got a little bit better in a lot of cases. In some of them, when they had hip arthritis, it didn't change.

But hip impingement, it did. So there's a lot of cases where it did actually change. I remember we did one, too, where I did the sacred tuberous ligament. And it changed hip rotation, too. I was amazed. And it was, I started to incorporate it a little bit earlier now. And whenever we do telehealth cases, and if that person's not responding after a couple times, I just send them to someone local, and I mention these points. And I don't want to do the person's job for them. But I do think maybe directing them to those areas and asking for a little bit of TLC is not a bad idea. And hopefully they get any tissue restrictions that they have addressed, because that could be a big factor, too, as you learn by the story.

So, anyways, I hope that story was helpful to you guys. And if you want to learn more about how we take care of our clients, we do have those free resources in the link description. But also, too, we do have something called the Discovery Session, which currently it's $29 for 30 minutes. So, it's very affordable. It's our way of figuring out and sorting out cases that we can actually take, because we turn cases away all the time. We can tell by just talking to you a little bit that it's not a right fit. You want to make sure that you actually find the care that you need to get better. So, I hope this podcast was helpful to everybody.

And if you would thumbs up and subscribe, it would mean the world to me. That's the only way I know that this is a helpful podcast, is when you thumbs up it and we get reviews. All right, everybody. Well, take care. I'll talk to you later.