T Nation

Figuring Out What's Wrong, and Fixing It


#1

Hello. I have posted on this subject before but I wanted to post a renewed approach to fixing my immobility/pain.

I have had these symptoms since I started lifting at 20. Its no one thing but a series of problems that I have been trying to narrow down. I recently tried 8 sessions of egoscue movement therapy and while I bought the tower and double pedal, overall I don’t have any noticeable symptom relief. In jan of this year I had goen to sports med clinic and had graston/estim/trigger point therapy done but no success. I then went to a DPT who does Postural Restoration work. Again saw no results after 10 visits, and additionally strained my testicular area on L side, though that could be incidental as I found going heavy on bench aggravated the area as well. Also tried chrio and plain’ol strength training but no results. Though I have gained some insight to what might be going on.

I’m thinking i need to take my own approach to this based on my body’s feedback.

Symptoms:
L hip impingement at 90 degrees, weak glutes, externally rotated leg, weak/asleep obliques and (possibly) iliopsoas, R rotated lumbar( tight when turning torso to the left), anterior tilt on L pelvis, increased L lordosis and flared ribs, knee clicks and doesn’t fully extend, tight calf, poor stability/balance on single leg, L protracted scapula/tight pec minor.
R knee pain/clicking, some hip impingement/external leg rotation (I suspect these are due to general posterior chain weakness but could be wrong)

I should note these symptoms are present in my dad as well, so i’m looking at an inherited rather than acquired condition. I have a T12-L1 herniation and wonder if there are neural issues, though the DPT did not believe so as I did not show symptoms.

I was messing around in the gym today, trying figure out how to target/activate/strengthen these muscle groups. I’m broadly focusin on 3 area that in trouble. L shoulder/hip/abs.
Here is what I have come up with so far:

Hips:
Single leg stiff leg deadlift- L hand holding on for balance, heaviest weight I can handle for 3x10 with good form. Felt in glutes/especially outer glutes and some hamstrings toward end.
Side lying clamshells- against wall with 25lb plate over knee area, 3x10. Felt these in R hips as well funny enough. Went a bit heavy for what I want, ended up doing partials but felt it in glutes.
Glute bridges with pause- dumbbell over hips, squeeze yoga block, 10 sec holds 3x10-20. These are pretty tight at lockout and feel more in R glute until end. Thinking next time to position dumbbell over L hip to offset weight.

Shoulder:
One arm dumbbell row- supported 3x10. Changed arm position from 90-45-0 degrees, trying to get where I could really retract the shoulder blade and hit the rhomboids/traps.
Overhead band pull apart- 3x10-15, medium band. Pull behind neck to traps, trying to activate/strengthen the lower traps, 3-5 second hold.
Facepulls- 3x10-15, cable or band light weight, 3 second hold. These can irritate my L shoulder/coracoid if i’m not careful. Might substitute band external rotation/pull aparts.

Abs: where I am having the most difficulty.
Side crunch- tried supine/knees bent, supine/hips flexed, side lying/rotated, lastly supine/knees bent/weight in R hand. Had trouble feeling L abs, feeling more in R. did alot of reps with a few holds.
Side plank- 3x60secs. Feel these a little in L abs, especially if I rotate forward a little. L QL takes over mostly, which is fine but I also want to his obliques. I have tried a variation with hips flexed/knees bent which is quite intense. That might give me more ab/oblique emphasis.
Hanging knee raise- Tried bringing knees to R shoulder, some holds. Abs were burned out by then, felt lower abs alot but more in R side again. Might invest in ankle weights and load L leg only.
Straight leg raise- supine R knee bent, hold at top, lower slowly. Felt this a little in my L abs but felt it alot in quad/knee/RF. Not a fan of these might leave them out.

Stretches: L pec, R hip flexor/quad, lying R rotation stretch. 1-3 x 1-3mins.

Im trying to make a workout with these elements between 3 full body workout days for 6 days a week. My body is imbalanced so I figure my training should be as well.

So for the length of this post, just have alot going on. Trying to stay positive and focused, im 33 now and im pretty fascinated with strength and conditioning so its been frustrating being limited with pain and imbalances.

Thank you for reading. If you have any ideas or advice I’m more than open.


#2

Apparently you’re figured everything out… tho tbh self diagnosing and treating is usually a terrible idea unless you really know what you’re doing. Some of your statements kinda make me doubt that like:

You’ve dropped a big list of problems/symptoms which are rather common and often occur in conjunction with one another. You could go for a trip to China and find people with similar presentations. By your reasoning there’s a so far unrecognized inherited musculoskeletal disorder affecting millions all over the world.

Overlapping lifestyle, psycho-social, environmental and mechanical contributing factors between individuals, resulting in similar presentations is one thing. Family history/genetic predisposition to certain conditions is another thing entirely

That being said I think its best to focus on what is actually causing you problems first and stuff that you are paranoid about/annoys you later. Pain and limitations in activity are the most pressing issues and addressing the contributing factors may resolve some of your other problems spontaneously.

e.g. your knee (pain, clicking and reduced ROM) and your hip impingement

Would recommend professional guidance for these specific issues.

You’re should probably change your mindset. Getting rid of all imbalances is an exercise in futility because a lot about movement is inherently imbalanced e.g. Dominant handedness creates imbalances in almost everyone.

Instead aim for health and function. Dysfunction e.g. painful movements or reduced movement and activity limitations and contributing factors should be addressed and prevented within reason. Being paranoid and worse stressed 24/7 is incredibly bad for your health and GAINS


#3

Ill take your advice under consideration.


#5

I am not really sure where the accusation of being paranoid comes from. Im simply noting the similarities in body type and even gait between me and my dad, as well similar symptoms. His issues are worse due to his job type of lifting and carrying heavy boxes (5 back surgeries).

You may have missed the part where I saw professionals, ive seen several over the years, PT’s, orthopedic doctors, chiro’s and had a trainer who had gotten clients referred to her from eric cressey(different states).

The symptoms i’m listing can be found in a variety of people with pain or limitations, i’m simply stating the ones I notice in myself.
I’m a licensed physical therapist assistant so I have some knowledge of muscoskeletal issues.

If you have any disagreements with my post I’m okay with out, i simply ask you refrain from being derogatory or condescending as that is not helpful.


#6

Was not my intention to attack you. Apologies if it came off so.

Maybe paranoid isn’t the right word and I don’t use it in a negative light . Maybe excessive attention to detail or super body awareness is more palatable lel

Maybe I can be more helpful this time around.

Not sure how physical therapy is practiced wherever you are but there’s more in the tool box then physio specific techniques and corrective exercises.

If that approach hasn’t worked in the past maybe it’ll be useful to attack the problem/s from a different angle. Addressing mechanical and psychosocial contributing factors can often be an effective and permanent solution when used as an adjunct to targeted corrective exercises.

e.g. If an anterior pelvic tilt is built up due to thousands of hours sitting it’d make sense that a lot of time spent doing focused corrective work would be required. Sitting loads is the mechanical contributing factor so what can be done to address that? Standing desks, special chairs, active breaks from sustained postures and rotation of duties come to mind. This is only an example tho

You are in a good position to attempt such interventions because no one knows your life better than you. Identify your contributing factors and address them. As a physical therapist assistant or whatever it should be a walk in the park.

Combine this with what you’re already planning and hopefully we’ll see better outcomes. Hopefully…

You’ve been troubled by your issues for more than a decade with little (?) success in fixing things to your satisfaction even with your and various professional’s skills, knowledge and experience.

It’s a matter of perspective.

You see many problems which require addressing lest they affect your quality of life dedicating significant time and effort in your week (or planning to at least) running a mobility workout 6 days a week.

In attempting to correct all these you are using quite a bit of time which could be spent enjoying yourself with family friends or dieting and researching to improve your lifting or just plain relaxing, kinda ironically making life less enjoyable. It’s like this is controlling your life.

Maybe this is not you but personally I’m a little paranoid about my posture for sure. There’s not a moments peace: standing, sitting down, lying in bed etc. Is this negatively affecting my posture? How should I be positioned to minimise this? and so on

If you want to see problems everywhere that’s your perogative but like I said the first time around if you look at what’s causing you pain or limiting your actions activity it’s much simpler, easier to focus on and ultimately resolve.

Good luck


#7

I listened to a Podcast with this dude named John Quint, a Nueromuscular Therapist.

He said, if your glutes are weak, and your hip flexors are tight, the ROM in your hip joint can become restricted. Once this happens, you only use some of the muscle/tissue around the joint. You get more in tune with using some muscle/tissues, while the unused stuff goes unstimulated, gets weaker and is “Downgraded.” There may not be “neural problem,” but you “forget” how to use the correct muscles. So you keep using the wrong muscles, which further limits the ROM in the joint. Which causes you to continue overuse/underuse, which continues to restrict the joint…

Hip doesn’t move correctly, pelvis doesn’t move correctly, but mobility has to come from somewhere so the spine compensates. This causes issues with pelvic tilt, posture, leaning forward, weak mid back, crooked shoulders. Which cause worse posture, worse pelvic tilt, worse glutes, tighter groin, worse hip function…
.
So you MUST fix that hip impingment. Then you have to start training the tissue around the hip joint. Juggernaut Training Systems has an article “The Hip Impingment Solution” with a basic training plan that uses a bunch of the exercises you mentioned.

Here’s Ben Bruno talking about glutes and hip adduction/abduction

Here’s jacked hips, crooked pelvis, twisted spine.
images (7)


#8

That’s the first half on the battle! You still need to work the joint itself, plus train all your muscles to work together. Squats and deadlifts are great for this, but you can’t do those big, heavy, compound lifts with long, long ROMS if you hips and “core” are twisted and unbalanced.

To get around this, I used Isometric Deadlift holds. I set up a barbell with like 85 pounds, just below my knees in the power rack.
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From there, I drove my feet out(spread the floor) and my hips forward(drop your nuts on the bar) until the bar just broke of the pins, and held it at knee-cap level. At first, my knees were in the way, I was leaned forward, all the weight (85 pounds to start) was on my back, my groin was controlling where my knees went, upper back rounded. Overall, shitty position.

But I held the bar right at knee-cap height. During the brief hold, my glutes started working, to “open” my hips, to get my knees out of the way, so I could pull the bar closer to my hips. This allowed me to drop my hips, straighten my back, raise my chest and improve my position.

Holding the “hold” position forced my glutes to work, and made my hips move into more correct position. Holding it put these “tissues” I hadn’t been able to train under tension. Holding the hold meant more Time Under Tension, actually training these muscles and making them stronger.

It was like practice for square hips and better posture.

After a couple months of that, I started doing “regular” Sumo deads out of the power rack, from like mid shin. All glutes/core.

I not totally “fixed” or “normal.” I still have to squat to a box above parallel, and I do my deadlifts out of the power rack. But life is way better. I can ride in a car, or sit on a bar stool without pain. I can put on my socks and tie my shoes. My knees and platellas don’t click or slap. I still kinda twist and curtsy if I have to pick something off the floor. But I’m on the right track! I can train and keep improving.


#9

This video isn’t about rehab, mobility or isometrics, but does talk about getting your knees open and pulling yourself into position.


#10

Thanks for the info. I was reading the hip impingement solution, really good stuff I hadn’t thought of. I’m going to try the isolation hold you described tomorrow.
I honestly have been hesistant about doing high squats and rack pulls as I had this idea that I wasn’t doing them “correctly” for whatever reason but not training these lifts is worse than training them in a shorter ROM. I have also had good results with the high handle trap bar, though of course most gyms don’t have one.


#11

I feel the same way, my ugly high squat and rack deadlift aren’t exactly “correct,” but isolation lifts don’t seem to train the same coordination and posture as even partial Big lifts.


#12

I tried the rack pulls, did a semi sumo style, was able to feel it in my glutes but also more on the R side, including my low back/erectors. Find myself scraping the bar against my shins on the last few reps, think I just need to practice the movement more. Also tried lever deadlifts. To do these go to a tbar setup and grab the end of the barbell with both hands and lift like a deadlift. I kept myself as upright as possible to use it more like a squat, it actually felt really good with no pain, I kept the reps moderate. I did feel it more on the R leg/quads which I notice with every leg exercise I do. I need to start foam rolling the R side and get it to calm down, it constantly wants to do all the work.


#13

Lever deadlifts as a Squat motion sounds smart. I need to try those out. Anything to keep upright!

Scraping the shins on deadlift means you’re pulling the bar close, that’s a good sign. For me, it was important to push my feet Out to get pressure off my lower back and to keep from leaning over.

Don’t forget hamstring curls and back raises(with Glute/Ham emphasis) to “counteract” or “balance” all that quad involvement.


#14

I currently have surgery scheduled for December 20th to repair a torn labrum caused by hip impingement. My pain started in February or March of this year. Like you, I visited several doctors who took different approaches to treat my problem. Unfortunately, no one knew the actual cause of the pain so I was just treating the symptoms without success. I finally had an MRI and visited a hip specialist. I got to have another MRI with contrast to clear things up and confirm that my labrum is torn.

Through this process I learned a lot about cause and effect. I’m pretty confident I know the cause now, but let me share some of the effects.

My left QL is tight, my left IT band is tight, and I’ve experienced pain in my knee as a result. I have multiple tight muscles that cross my hips such as the psoas on both sides (in different positions) in addition to the aforementioned muscles.

The MRI revealed muscle atrophy in the affected area of which I wasn’t aware.

The reason I share all this is to show you that you can experience multiple symptoms as a result of one problem. The longer you have the problem, the more symptoms you will notice because the body is using the wrong things to complete activities.

My impingement is caused by a small deformity on the head of my femur. My best long-term solution is to have the surgery and let the doctor shave down the deformity and reattach the labrum.

As @FlatsFarmer stated above, fix the problem. Go direct to the source.

On a side note, I wish I could like @FlatsFarmer’s response more than once because it is spot-on. Great stuff!


#15

Hi JMaier31, im sorry to hear about your issues, it really sucks having issues popping up and not knowing whats going on or how to treat it. Does your doctor think the deformity is the cause of the atrophy and associated dysfunctions?
Also curious if you have stability issues on the affected hip(difficulty with single leg standing or exercises).


#16

I think the deformity caused the impingement and eventually the tear to the labrum. I think the symptoms/pain are the result of my body trying to protect the injury. The pain led to weakness and I think that’s what caused the atrophy. I never noticed it but it was noted on the MRI report.

I think I’m out of balance now. If you put two scales under my feet during a squat then I bet there’d be a difference between the sides. My left side has always been stronger but I’m not sure if that’s still the case. I ran a mile today and my gait felt a bit off.

I’ve never had any issues with this in the past and I’m not experiencing anything now. I always include single leg work in my programming to make sure the smaller muscles get some attention.


#17

Some videos

A great explanation/visual of Pelvic Tilt, and tight Psoas.

Hip Joint info, and some moves

Slightly different presentation of info, different moves


#18

Thanks Flats! I need to get some bands like that as my gym only has tubes with handles at the end.


#19

Heres an interesting video I came across about how muscle imbalance can create impingement.


Squat Problem, Right Hip Dips Down