T Nation

FAI or Something Else...


#1

Hi all, been a viewer of this sight for awhile now, and wanted to post a question. I've been strugglign with lower body training for some time, whenever I squat to parallel, i feel tightness, almost like a bony block in my hip as well as pain going down the front of my thigh into my knee. I used to think I had knee issues untila realized it was morel ike the nerve was getting pinched. I looked up FAI, and believed I had that since my hip Flexion, add, IR are reduced and cause pain in anterior hip if a push it.

However, I dont have other symptoms such as pain from prolonged sitting or from walking. An xray also showed no abnormalities in my hip (though i know i'd need an MRI to get a better picture of whats going on).
I do noticed I have alot of symptoms of pelvic obliquity such as a leg length discrepancy, LB pain and tightness on the afected side. When i squat heeavy on side of the barbell will tilt, same thing when doing a stiff leg deadlift. I'm wondering if I have some sort of hip capsulitis to accaount for the impaired ROM.

I dont have time or money at the moment to see an orthopedist, though I plain to in the future. I just wnated to post and see if anyone else had similar symptoms and what, if anything they were able to do for it.

Mark.


#2

FAI is a bone problem. If it doesn’t show up on an xray, there’s a high likelihood you don’t have FAI, the cam or the pincer kind. You might have an issue with your labrum or some bone spurs maybe. Probably need to get that MRI.


#3

[quote]nkklllll wrote:
FAI is a bone problem. If it doesn’t show up on an xray, there’s a high likelihood you don’t have FAI, the cam or the pincer kind. You might have an issue with your labrum or some bone spurs maybe. Probably need to get that MRI.[/quote]

Yep, FAI is due to bone growth. The only thing I’d add is make sure you saw a hip specialist, not just a general family doctor or a general orthopedic doctor. If someone doesn’t know what to look for I really don’t think FAI will even cross their minds when looking at an x-ray.


#4

I seem to be saying to everyone that posts - that sounds like me! I have a few problems all layered over each other LOL

Here’s my thoughts on your problem (based upon my own experiences).

A sacral torsion / twisted pelvis will result in a leg length discrepancy and can potentially cause all the other symptoms you mention. It can even result in a hip impingement in a similar way that scapular instability can result in a shoulder impingement.

The sacrum is the bone at the bottom of your spine. During normal gait the sacrum tilts and rotates to the right and left. The innominates (wings of the pelvis) and spine move in relation to the sacrum. So when the sacrum side bends and rotates one way the lumber spine does the exact opposite and the thoracic spine does the opposite to the lumber spine. When the sacrum tilts and sidebends one way the innominate on that side goes into inflare, posterior rotation and downslip. The innominate on the other side does the opposite. In this position the leg on one side will temporarily be longer than the other. For various reasons, the sacrum can ‘stick’ at any point (or just be more mobile on one side than the other). If this happens you end up with a twisted, tilted pelvis, an apparent leg length discrepancy and a whole host of other problems - essentially your entire spine, pelvis and legs are ‘stuck’ in the wrong position and muscles are going into overdrive trying to stabilize you.

With all the boney landmarks out of alignment some muscles are stretched too tight (no amount of stretching and foam rolling will loosen them because they’re already over-stretched). Other muscles are loose and in a compromised position where they can’t fire properly. In order to stabilize you your nervous system recruits other muscles to do the job and this can (as well as causing a whole bunch of ROM problems and sore, tight muscles) result in the femur being pulled into the wrong position in the acetabulum. So essentially a hip impingement - but one that will be resolved if you restore correct muscle balance.

This was one of my many issues. The doctors diagnosed it (incorrectly) as hip OA. The ‘hard end feel’ that they said was bone on bone and irreversible has actually been reversed as my sacrum/pelvis leveled out!

It’s not an easy fix. Once your body gets itself locked into this kind of pattern it’s very tricky to persuade it to let go. I’ve had zero success with health professionals (doctors, physios, chiros, osteopaths etc). There are people online that do understand this type of problem though - NeuroKinetic Therapy, Postural Restoration Institute, Eric Dalton etc.

Knowing that you have a sacral torsion doesn’t really solve the problem as a sacral torsion is really just the result of a muscle imbalance. But because of the way in which the body works as a unit (innominates, lumber, thoracic spine all moving in a fixed pattern around the sacrum), knowing what the sacrum is doing gives you a very clear idea of what’s going on with the rest of your body. And this can help you unravel the puzzle.

Of course, I can’t guarantee that you don’t have true structural hip impingement - so be careful. And even if your problems have a soft tissue cause it’s really not a gppd idea to be squatting with bad form as you’ll just compound the problem. Better to back off on weight and height to a rom that you can do perfectly and build up from there.

These articles will be of interest:

http://www.posturalrestoration.com/resources/dyn/files/1061719zbab24a88/fn/Soccer_Hip_Impingement_as_it_Relates_to_Postural_Restoration-_Part_One.pdf


#5

susani, this sounds exactly like what I have!
It makes sense as I have very litle trunk rotation on the affected side as well as terrible stability; bulgarian squats and stepups are a disaster for me to do.
A chiro had mentioned my sacrum felt locked but didnt elaborate on what it meant at all so i didnt think much of it (i thought the problem was in my knees at the time.)
What modalities did you use to help with it? did you use exercises or see a manual therapist?

Thanks

Mark.


#6

Mark - for me it’s NOT been an easy fix and whist I’m getting steady and constant improvement I’m not 100% yet.

Mine came about from years of one-sided karate practice. In retrospect, I can see that some twisting had been developing for perhaps 15 years, but it was non-symptomatic so I didn’t really think anything of it. Then one day everything seized up overnight. In addition to the sacral torsion I also have a very common problem of tight chest, low back and hip flexors coupled with weak and inactive glutes, abs and traps. So lots of issues with me - all down to a lifetime of bad habits that I see many others repeating and thinking they’re getting away with!

I had zero success with doctors, physios etc. All would be quite optimistic in the beginning but when they failed to get results they’d insist it was hip OA and do their damnedest to scare me into becoming a couch potato. The trouble is, I think it’s always going to take time to fix something like this and the work needed doesn’t fit into their treatment model so they’re always destined to fail.

So many people have similar issues. I keep meaning to get everything I’ve learned recorded on a website so I can just refer people there!

I think the first step is probably to try and figure out how exactly your sacrum is ‘stuck’. If it were going to ‘unstick’ your chiro would have done that so, like me, it seems your sacrum is ‘stuck’ because muscles throughout your body have got themselves into a faulty firing pattern. Knowing how it’s stuck will give you lots of clues as to where to start resetting all those muscles.

You may be able to figure this out from this little step by step guide if it’s quite badly out of alignment (if it’s subtle it’ll be hard to tell). You’ll need to get someone to help you.

  1. Get your helper to look at the little lumps (or dimples depending on how much fat you have! LOL) at the base of your spine. This is the base (top) of the sacrum. Is one ‘lump’ lower than the other? Test this lying face down and standing up.

  2. Is one of the ‘lumps’ deeper set than the other? Your helper will need to put their fingers on the ‘lumps’ and feel if one is closer to the surface.

If in step one the right side is lower then your sacrum is leaning to the RIGHT.

If in step two the right side is closer to the surface then your sacrum is rotating RIGHT.

That’s what I have and it’s known as a RIGHT ON RIGHT SACRAL TORSION.

It can be pretty much any combination - right on left, left on left and so on.

There is one final step, but see how you get on with that first.

Once you know what kind of sacral torsion you have there are corrective exercises you can do. They probably won’t fix the problem, but they will help. Then you just need to come up with a plan of attack for getting all the muscles working as they should. It’s a slow process (has been for me at least), but the good news is you can continue to train very hard provided you make a few adaptations. The goal is to have your training become part of the fix.


#7

Thanks again susani this has been helpful. I dont anticipate this being an instant fix but im going to improve it as much as I can.
I’ve ditched squats since they were upsetting my low back, honestly i’ve never felt stable doing them, even holding the bar on my back, now I know why!
I’m doing high handle trap lifts and mid shin rack pulls with no major problems. I’ve also got a morning routine i try to do every day.
I perform front/side planks as well as reverse crunches to correct my pelvic titlt. I do glute bridges, focusing on squeezing and activatingthe gluts and keeping the abs tight. I also do single leg standing balance on the symptomatic leg to try and build stability.

I’ve been searchin sacral torsion exercises, i’ve found these links that might be helpful.

http://www.whiplash101.com/2010/01/si-joint-self-corrections/

http://erikdalton.com/media/published-articles/short-leg-syndrome-part-1/


#8

I particularly like Eric Dalton’s stuff - that helped me a lot. He has a video on sacral torsion somewhere if you search for it and I think that’s helpful.

But really you need to know what type of sacral torsion you have. One quick and dirty thing to try is to lie on your back, arms stretched out on the floor and knees bent so feet are on the floor. Let your knees drop to one side (keeping upper back and arms flat on the floor) and turn your head to look the opposite way. Ideally you want the outer edge of your thighs to touch the floor. Note how it feels and how far you get. Then repeat on the other side. If you’re tighter dropping knees to left then your sacrum is rotated to the right. Tighter to the right then your sacrum is rotated to the left.

The ‘treatment’ (I won’t say fix as I doubt it’ll fix anything on it’s own) is to work on stretching it the tight way. Get someone to help you - they should hold your opposite shoulder down and apply pressure to push your knee down as far as it’s happy to go. Then they provide resistance and you push back against that resistance (so pushing your knee AWAY from the floor) for a few seconds. Then relax and your helper pushes down a bit further - it should be willing to go further. Repeat this a few times each day and it should help with the untwisting. I’ll find you a more specific correction that works very well, but you will need to figure out what kind of torsion you have.

The source of my problem turned out to be that my right psoas had shut down. That caused my glutes on that side to shut down too. A whole bunch of other muscles locked down tight to stabilise me and my right hip essentially stopped moving all together. So I’ve been walking around with out the major muscles (psoas and glutes) on one side working! I think most adults have somewhat inactive psoas muscles so I’d definitely include a bit of psoas and glute activation as there’s a very good chance it’s involved.

I’ll look out some good resources for you later that I think will help you figure out in more detail what’s happening with you. I tried loads of stuff (and loads and loads of expensive experts!) and most didn’t work. But you mustn’t give up as it really is just a matter of chipping away at it until you find the source of the problem. Sometimes you just have to resolve some of the minor issues before the real problem shows itself so find a training program that helps your symptoms but lets you train hard. It’ll almost certainly be a while before you’re fixed properly and you don’t want to be loosing fitness during that time. Single legged squats and deadlifts might work while you’re unbalanced like this as with only one leg on the ground there’s not the torque/strain on your spine.

Work on thoracic mobility too - almost certainly you’re locked up there too and one end won’t let go until the other end does!


#9

its pretty crazy how many things you menion that I have as well. My sacrum is defenitely rotated left as I can’t hardly get my lef knee to fall to the right. On the affected side my glute feels “sluggish” as if I have to work harder to get it activated. The same chiro who told me bouthe sacrum also mentioned my psoas was tight, when she palpated it it was quite tender, so everything your describing I can relate.

Aside fro mthe glute activation work, I’m also doing standing psoas exercise with the left leg on a chair, raising my knee past parallel for a few secodns then back down. Its actually pretty hard to do without compensating.

As far as training, single leg work is a no go because my stability is so bad on my left side it can aggrivate my knee. I dont think its a vestibular issue but a muscular one since my right leg isnt much of a problem. I’ve been doing deadlifts from mid shin and above, so far its not caused any pain though i’m being careful to not tweak my back. And yep my left upper body is tight as well so im working on that alot too.


#10

It really does sound like the same problem as me, but my bad side is my right side.

I’ve tried activating my glutes for years but it didn’t really get me anywhere. Right glutes are atrophied and only recently starting to build back up despite loads of work.

The key for me was getting the psoas activated. I used to think it was just tight, but stretching it made it worse! The exercise where you put your foot on a chair and lift to activate the psoas - that didn’t work for me either. I’d tilt my pelvis so that I could use my rec fem etc to lift my knee.

Here’s an alternative approach to psoas activation that you might have more luck with - it’ll help with awareness of the muscle. It’s not (for me) a quick fix, but it gets things moving in the right direction.

Lie on your back on the floor. Knees bent. Feet flat on floor. Place you hands on your belly - beneath your belly button. Imagine there is a pully under you left hand, and a long chord running from the pully to your knee. The chord is very loose. Imagine the pully turning and tightening up the slack - when the chord is tight gently lift you foot an inch or two off the ground. This should help you to use the psoas to lift your leg. Do it frequently. Add to the difficulty by putting a bit of weight on your knee. Progress to doing it standing up with your foot on a chair - once you learn to use your psoas the compensation should stop. In time you should be able to use that visualisation to get the psoas firing all the time.

The difficulty is that when the psoas switches off everything else goes into overdrive to stabilise you which pulls everything out of position meaning you don’t have the range of motion to use the psoas correctly. Also, the weak psoas will be in a shortened, spasm’d state to protect itself. It can’t let itself take a big load because it knows it’s not strong enough. For example, still when I walk my psoas is too short to allow my hip to extend. So on a long walk I (sub-conciously) tend to disengage my psoas and rotate my pelvis back to make up for lack of hip extension. Re-enforcing the problem. But how do I avoid it? So I think you need to think in terms of chipping away at it. Gradually clawing back functionality rather than a quick fix.

I’ll find some links to some corrective exercises that might help. I’ll post again later.


#11

I’ve been working quite a bit on the psoas activation which has definetly helped, i can actually palpate it now when I left the leg. I found an exercise I can hit hard without anyp roblems, the single leg press. It lets me work each leg without the stability issues and allows me to hammer my legs. If you havent given it a shot, I’d suggest trying it out.