can you pinpoint a time with this pain started?
what exercises do you do on a typical leg day?
Can you describe the pain? sharp burning…dull achy…
[quote]jp_dubya wrote:
can you pinpoint a time with this pain started?
what exercises do you do on a typical leg day?
Can you describe the pain? sharp burning…dull achy…[/quote]
it was about 2 years ago, i don’t know how and when exactly happened but i know i was doing hamstring twice a week
my leg days are different but typical exercises are jump squat and some other variation of squat split, bulgarian, one leg, sissy;lunges, deadlifts, leg curl, bridges or hip trust
Pain is dull. sometimes while lying down i feel a twitch to
BBB, I said I was told I have APT because one trainer at my old gym mentioned but I was never told that by Dr or Chiro (I’ve seen 3 different ones). I just always thought I have a nice curve 
Never had any lower back problems, which I know people with APT have, no?
Also I’m always stretching and doing everything I could find on APT
Here is something I found online and been using for sometime now
Foam Rolling
Glutes, hamstrings, calves, adductors, quads, TFL/ITB, peroneals (additional focus on quads/hip flexors)
Static Stretching/Activation
1A) Psoas or Rectus Femoris Stretch, paired with
(RF) Put one foot on bench behind you, other leg straight. Rotate pelvis backwards. Tighten glutes and put hand on them and squeeze. Bend other leg, and feel stretch on front thigh.
1B) Glute Bridge
Lie with back on floor. Raise knees and keep feet flat on floor next to bum. Squeeze glutes to raise your arse up from the floor. Try not to use hamstrings.
2A) Piriformis Stretch, paired with
Sit up straight on chair. Cross left leg so it is parallel to floor. Lean forward. Repeat with other leg.
2B) Side-Lying Clam
Lie on side with slight bend at hips, 90 degree bend at knees. Extend lower arm upwards so head rests on it and balance with other hand. Keep your heels together and raise your upper knee without moving hips.
Mobility Training
Knee Hugs,
Slow walking with high knees. When knee reaches highest point, grasp with both hands, and hug up and into chest. Raise up on your opposite toe. Focus on maintaining good posture.
Pull-Back Butt Kicks,
Take a step forward, and bring your right leg up behind you. Grasp it with your right hand and pull it into your glutes. Come up onto opposite toes. Don’t lean forward, and don’t let your leg go to the side.
Warrior Lunge with Twist,
Reverse lunge until knee is just above the ground. From the lunge position, twist your torso and reach back over the front leg. Finish by driving off front heel back to start position. Get low, and go back far. Keep chest upright.
Running Butt Kicks,
Run forward. Kick heels to butt. Don’t lean forward too much, or allow legs to move to side. Perform 8 reps each side.
Crossover Overhead Reverse Lunge
Start with feet shoulder width apart, arms by sides. With one leg, stride backwards and behind the other leg, and place that knee on the floor. Attempt to get the leg about 30 degrees away from the centre. Keep your front foot pointing forward. As you move backwards, reach your arms up over your head. Push off the heel of your front foot to return to the start.
See, I don’t think that stuff is going to help.
The normal rationale is that a tight psoas and weak, underactive glutes cause APT. Hence all this psoas stretching and glute stuff in the program Jelena’s been doing.
However, I just don’t see Jelena’s glutes being weak and/or underactive. There’s no way she has pain at the ischial tuberosity from not doing enough single-leg training, or glute training. So I don’t see how that program is going to help her pain. And she says she’s been doing it for some time now, and it hasn’t helped. All that stuff is similar to the tons of glute- and ham-intensive single-leg training she does all the time.
If the psoas is tight because it never gets put through its range of motion (with a sedentary person who sits all the time), then stretching would promptly help. But Jelena stretches it, yet it’s still extremely tight. She could try ART on the psoas and that might help, but there is a reason the brain is holding that muscle contracted, and if stretching is not gonna help, it’s not gonna help. I’ve been in that situation myself.
[quote]Jelena Abbou wrote:
it was about 2 years ago, i don’t know how and when exactly happened but i know i was doing hamstring twice a week
my leg days are different but typical exercises are jump squat and some other variation of squat split, bulgarian, one leg, sissy;lunges, deadlifts, leg curl, bridges or hip trust
Pain is dull. sometimes while lying down i feel a twitch to
[/quote]
This seems like the cause to me. Tons and tons of hip extension and so much emphasis on glutes and hams. Just more training volume than those hamstring tendons can recover from. Especially when dieting for shows. Dieting just sucks for joint recovery IMO. I’m surprised you don’t have issues with your IT band/TFL/hip joint as well. I’ve been doing a bunch of that same single-leg stuff, which is supposed to help me rehab my back, and while my back is doing much better, my IT band/TFL and piriformis are not happy!
Those movements are mostly (all?) frontal plane dominant, so it might help to stretch the adductors. When I do one of those mobilizations I mentioned from Cressey/Robertson/Hartman’s Assess & Correct DVD, I feel the pull RIGHT at the tendons where the adductor and hamstrings connect to the joint at the ischial tuberosity.
But if it’s tendonitis/tendonosis, you will also have to stop the training that puts the strain on the tendon for a loooooooooong time. A couple months won’t do it. I’ve had elbow tendonitis that took maybe 9 months before I could pick up a milk carton without pain, or throw a ball.
Andersons,
I agree with some, but disagree with some of what you said.
[quote]andersons wrote:
See, I don’t think that stuff is going to help.
The normal rationale is that a tight psoas and weak, underactive glutes cause APT. Hence all this psoas stretching and glute stuff in the program Jelena’s been doing.[/quote]
Tight psoas and weak/inhibited glutes are not the only restrictions/issues that can contribute to an APT. Tight/restricted Latissimus Dorsi/Thoracolumbar fascia and rectus abdominus/abdominal fascia/linae alba can both contribute to APT. Also, a tight QL, erector spinae, etc. can all contribute as well. You have to look at the fascia associated and the soft tissue quality of all of those muscles as well. Not to mention that Jelena stated that with the hip flexor/psoas/quad stretch, she could feel tightness all the way up to her ribcage. This is definitely indicative of some tight/restricted structures along the anterior hip/abdominal. Trigger points in the QL can also cause referred pain to the location of the ischial tuberosity as well.
I’m not saying 100% that Jelena has weak/inhibited glutes. Nobody would be able to say that without performing an assessment during the exercises. But you can’t base her having strong glutes on a training protocol that she listed on the thread either. The body can compensate to create the wanted motions and she may be performing a lot of hip extension exercises, but may not be fully recruiting her glutes, even if technique is correct. Even with the glute activation drills, if the hamstrings are overdominant during the exercises and/or if the hip flexors/psoas are tight and causing reciprocal inhibition, the glutes won’t fully be activated. If you have the weakened/inhibited glutes, the other hip extensors will take over (hamstrings, posterior fibers of the adductor magnus) and take on the load, which can overload the attachment at the ischial tuberosity. Also, if the body can’t create the necesary motion with hip extension, it can also compensate with overactivity of the QL and move into lumbar extension.
I have worked with a lot of athletes, who the majority have tight hip flexors/psoas. It is very common. They would in no way be considered a “sedentary” population. It isn’t always about being inactive and in a position for an extended period of time, you can also be active and in a position for an extended and repeated period of time. Look at a linebacker or wrestler - they are held in an athletic position for extended periods of time - knees bent, hips back, slight forward bend at the torso. Now I won’t claim to have ever been at a photo shoot for fitness models, though if somebody wants to give me the experience I’d be more than glad to go, but I would assume the photoshoots are relatively long, where the models have to hold repeated positions for extended periods of time. As BBB stated earlier, models will tend to increase lordosis and APT to accentuate their buttocks. I’m sure a lot of poses put them in a position of hip flexion as well. This could be a major contribution to a psoas/hip flexor issue with Jelena.
I agree that increased emphasis on hip extension exercises are likely a cause for the pain. I still believe that it is due to overcompensation from the hamstrings and adductor magnus due to a likely inhibition of the glutes. The glute is a large muscle and can absorb a lot of force if it is fully active. I don’t see it being a tendonopathy of gluteal muscle, but more so from the hamstring or adductor magnus. Issues with IT Band/TFL, etc stemming from single leg work is likely due a poor conditioning of those muscles for the purpose of hip stability during the single leg motions. Also, probaly a poor tissue quality and length/tension ratio.
Also, the dieting is definitely a factor! Dieting (caloric and fluid restriction, decreased nutrient intake, etc) can kill the body’s natural healing and alter its inflammatory response. Decreased hydration = decreased synovial fluid in the joints and dried out tendons.
Most of Jelena’s exercises that she listed are occurring in the sagital plane (squats, deadlifts, lunges, bridges, hip thrusts). She would benefit from adding in some exercises in the frontal plane (side lunges, lateral step ups, etc). I do agree that she should work on her adductor mobility, specifically the adductor magnus which attaches directed at the ischial tuberosity, and definitely double the recommendation to check out Assess and Correct.
I disagree with that long of a timeframe to take time off. If I ever told any person (athlete, figure model, everyday person) to stop doing an activity that was directly responsible for their income and livelyhood, they would laugh and walk away. Would it help to take the time off? Yes. But you can work around it and still do what you need to do to for your profession. I doubt a timeframe of over a couple months is very possible for Jelena to stop training her lower extremities to allow this tendonopathy to heal. Take small time frames off when available, alter workouts, and address imbalances/weaknesses.
[quote]LevelHeaded wrote:
I’m not saying 100% that Jelena has weak/inhibited glutes. Nobody would be able to say that without performing an assessment during the exercises. But you can’t base her having strong glutes on a training protocol that she listed on the thread either. The body can compensate to create the wanted motions and she may be performing a lot of hip extension exercises, but may not be fully recruiting her glutes, even if technique is correct. Even with the glute activation drills, if the hamstrings are overdominant during the exercises and/or if the hip flexors/psoas are tight and causing reciprocal inhibition, the glutes won’t fully be activated. If you have the weakened/inhibited glutes, the other hip extensors will take over (hamstrings, posterior fibers of the adductor magnus) and take on the load, which can overload the attachment at the ischial tuberosity. Also, if the body can’t create the necesary motion with hip extension, it can also compensate with overactivity of the QL and move into lumbar extension.[/quote]
I am basing my best guess about Jelena’s glute function (and yes, it’s just a guess) not only on her training program, but on the obvious muscle development. I don’t see how you can develop glutes like that without recruiting them pretty well.
It just seems to me that if she is getting lumbar extension instead of hip extension, she wouldn’t have the glute development she has, and she would be much more likely to have the much more common pain areas of the lower back. Her pain area is quite unusual; I’ve never heard anyone else complain of pain there, and it’s not easy to find information on it, suggesting it’s not common.
I did not say that tight psoas is ONLY a sedentary population problem; I said that IF it results from lack of range of motion, then stretching fixes it easily. But there are other causes, NOT easily corrected by stretching it.
And my point is, she IS stretching it, and it’s NOT getting better.
I just believe that if stretching doesn’t work, it’s not going to work. I’ve had tight muscles that did not respond to normal stretching, but I eventually found some magic bullet movement (which usually involves CONTRACTING some small deep muscle elsewhere) that convinces the nervous system to let go of the chronic tension.
I myself have had an extremely tight psoas that would NOT respond to stretching. However, currently, it’s only normally tight and does respond well to stretching. So obviously I am not opposed to stretching it, I just believe that sometimes it will NOT let go no matter how much you stretch it, so you have to look for another solution.
Well, I never suggested that Jelena might have gluteal tendonopathy, I said “more training volume than those hamstring tendons can recover from.”
(I’m the one with the IT band/TFL issues from single-leg work. Initially I had poor hip stability, but the BETTER it got, the tighter that IT band got. But I don’t want to hijack Jelena’s thread with my issues, there’s zero overlap with Jelena’s.)
So you think that if Jelena recruited more glutes and less hams while doing hip extension movements, her issues would resolve. Your approach seems great for athletes whose goal would be strength or volume tolerance of a movement like hip extension, so get balanced muscle tension and recruitment around the joints in the movement pattern.
But based on what I know about Jelena, that’s not her goal. If my impression/recollection is correct, Jelena was intentionally trying to bring up hamstrings, hence the training volume and frequency. And if she didn’t want to bring up quads or glutes at the same time, she’s TRYING to emphasize hams over glutes and quads. My memory isn’t what it used to be, but I’m basing this on having read Jelena’s contest prep thread a few years back, and stuff she has posted on FA. I remember she said she doesn’t squat much because of too much glute development.
So what you see as poor recruitment pattern, I see as bodybuilding-style training, intentionally trying to bring up hams. You say she’ll have to learn to move differently, while I’m saying, she’ll have to lay off the hams if their tendons can’t handle the volume/frequency of training.
(For BBers reading this, I KNOW that Jelena’s training is not the same as what male BBers might do for hams, I just mean bodybuilding-style as in having the goal of developing one muscle group more than others.)
Yup, I really feel it in my joints while in dieting, even when staying as hydrated as possible. And dieting for figure comp as Jelena has done repeatedly is, well, awful just reading about it.
Yup, you’re right, I’m lazy about learning the terms for things, should have looked up that term first but hoped the concept was clear.
I was guessing that Jelena might not want to do a lot of lateral lunges and step ups because her vastus lateralis is already very developed. But I thought that adductor mobilizations are worth a try since the adductor magnus attaches at that same spot. Sometimes, lengthening and/or contracting 2 muscle groups together in a way that you don’t normally do makes everything better.
I have a bookshelf of stuff, but recently bought Assess & Correct and think it’s great. I honestly think just about all lifters should buy it, and then this forum would see far less action.
You’re right that no one wants to take time off. And although it’s a big goal of mine never to develop another bad case of tendonitis ever again, I’d certainly be interested in how to fix it faster and while still training.
But once again, I thought that Jelena does not want any more glute or quad development but is trying to isolate hams. If that’s the case, she wouldn’t necessarily want to alter training if it would simply work her glutes or quads more. And she already has exceptional muscle development of glutes and quads, so I figure how can more work for those muscles help? You don’t get exceptional muscle development without doing a ton of work that recruits the muscle. That’s why I came up with, reduce (or temporarily eliminate) hamstring hip extension stuff till those tendons heal. She has had this pain for 2 years.
So to sum up, my reasoning was as follows. Jelena has exceptional glute and quad development, and has stated she doesn’t want them to grow any more, and glutes grow too much with bilateral training like heavy squats. But she has this hamstring emphasis particularly on the upper portion with hip extension, does a ton of hip extension movements for hams, and has pain right where the hamstring tendons attach there. . .maybe she’ll have to give those tendons a break. (Also, she said resting did improve her pain in the past.) The adductor magnus attaches there too, and she doesn’t do much for that, probably because VL is already so developed, so maybe mobilizations that lengthen the adductor magnus as well as the hamstrings will help reduce the tension on the tendons there.
I could be wrong though.
Great points Andersons. Didn’t realize the lagging hamstring issue from a hypertrophy standpoint and never thought of training it in that aspect. But still, for health purposes and injury prevention, I wouldn’t recommend altering recruitment patterns to target specific muscle hypertrophy. I admit that I am very unfamiliar with bodybuilding style training, as most of my experience has come from a performance background, but I would assume that there are better exercises or variations to perform to specifically target the hamstrings. Corrective exercises do not have to be hypertrophic in nature either. Corrective exercises can also just be restoring/teaching proper sequencing and firing of muscles as well.
I agree that stretching isn’t always the answer. You have to take into consideration soft tissue quality as well. If the tissue isn’t pliable due to fascial restrictions, scar tissue, etc., then all the stretching in the world won’t help anything. Also, if there is a synergist or antagonist that is overpowering or if there is a pathology occurring and the body is guarding becasue of that, the nervous system won’t always let specific muscles go.
I do agree that she needs to address the adductor magnus and even if that isn’t the source, it should help with all around hip mobility.
thank you all so much. i’m learning a lot from you guys.
just wanna add I’m doing side lunges to and side steps they are just hard for me, i’m feeling it in my hip flexor. also i use add/abductor machines to.
and I notice worse pain is when doing deadlifts but if I do straight leg deadlifts then there is no pain.
leg curls are ok as long as i go all the way down, when i do fist 1/3 of a movement is most painful
seated leg curls are painful to
let me ask you this if I was to take off and not do any legs, what about cardio?
[quote]Jelena Abbou wrote:
thank you all so much. i’m learning a lot from you guys.
just wanna add I’m doing side lunges to and side steps they are just hard for me, i’m feeling it in my hip flexor. also i use add/abductor machines to.
and I notice worse pain is when doing deadlifts but if I do straight leg deadlifts then there is no pain.
leg curls are ok as long as i go all the way down, when i do fist 1/3 of a movement is most painful
seated leg curls are painful to
let me ask you this if I was to take off and not do any legs, what about cardio?
[/quote]
Is it the hip flexor of the leg that is bending that is painful during the side lunges/step ups? If it is, that is generally a case for soft tissue restrictions for the hip flexor and adductors. It also may be more of an adductor issue, rather than a hip flexor issue. Do you feel the pain is directly below your ASIS (boney prominence on the front of your hip) or is it more medial to that?
During the exercises, concentrate on sitting back during the side lunges. During side step ups, step forwards a bit for the leg performing the step up. If the leg is too far back/underneath you, you end up almost impinging the hip flexor and adductors.
The deadlift situation you described really throws me a curveball. I will have to think about that and see if anything comes to me. The hamstring curls being painful is expected. As for cardio, it would have to be a try it out and see type approach. You can try, but there really is no telling if it will bother the area, especially considering you already said that cardio and walking fast have irritated it in the past. But it could just be that those activities irritated it in conjunction with the lower extremity lifting exercises. Only way to find out for sure is to try it and see.
in side lunge pain of bending leg is in the butt and straight leg your right pain is at adductor and also more medial to ASIS
on side step pain in on working leg right at hip flexor if step is pretty high
i to was confused about deadlfits
It is hard to specifically determine what the underlying issue is due to all of the excess pain associated with the injury. I think you would greatly benefit from mobility work to your hips, specifically adductors and hip flexors. Also, some soft tissue and fascial work on your adductors, hip flexors, abdominals, and superior hamstrings/gluteal complex.
Added work on seperation of the fascia between the hamstrings/adductors and hamstrings/IT Band may be a great benefit too. A lot of times, the fascia of the hamstring/adductors form adhessions between each other, as well as the fascia of the hamstring/IT Band. The advice I have given is more of an all around approach with some minor focus on specific areas, but I feel that by doing that, you can either improve symptoms greatly and/or narrow down what the exact problem is.
During the side step ups, do you keep your foot up on the box or do you step down and step up each time? If you step down/step up each time, is the pain at the hip flexor during the raising of that leg or during the execution of the step up? I would try to keep your torso more upright, as this will open up your hips more and decrease the pressure being places on your hip flexor. That, along with soft tissue work, should help with decreasing the hip flexor pain during the exercise.
Also, have you assess your Hip IR and Hip ER ROMs? Generally, females do not have as much of an issue with Hip IR as they already have wider hips and an increased genu valgum at the knees. It still is possible for a female to need to work on Hip IR though, but I wouldn’t recommend blindly performing Hip IR stretches without assess if you need it or not.
The deadlift issue is still stumping me a bit. When do you feel the pain during the deadlifts? Concentric portion of the lift? Eccentric? At the bottom during setup?
Not to be counter-productive, but shouldn’t a thread about Jelena’s butt have at least one picture? Official T-Nation rules. You may now return to your regularly scheduled programming.
During side step ups I keep my foot on the box the whole time
Never had done I/E hip rotation test, but looking from youtube videos I’m worse on ER
When i do deadlifts (knees slightly bent) I pick up db or bar from the rack and when start going down I feel pain right away
Yeah, that deadlift issue might mess up my theory…
How do you perform straight-leg deadlift (SLDL)? Do you push your butt and hips back to get at the glute-ham tie-in, or does your torso go forward (more lower back intensive)?
How do you feel in the following stretch that extends the hip and flexes the knee at the same time? Set up in a lunge position for a typical hip flexor stretch behind something you can grab for balance. Grab the ankle of the back leg, to flex the knee as you brace the core and tense the glutes while driving the hip forward into a mild hip flexor stretch.
One thing I noticed when re-reading through the thread, and this is a very minor point, but you stated in one of your first posts on the thread that you roll on the medicine ball, baseball, and foam roller after leg workouts and cardio. I would try to do the SMR/foam rolling before the workouts and see if that helps free up the muscles and spasm and decrease the pain. I have a specific way to foam roll to target the posterior fibers of the adductors and want to make a video of it but just have not had time. Once I get it, I will be sure to load it up as an example.
Also, after looking at the first of the 2 pictures posted, you can see a heavy lordosis occurring. Does show a great arch and helps accentuate your assets, but also shows a probably dysfunction occurring at your hips.
my pain at the ischial tuberosity exposed itself when doing the kettlebell exercise “windmill” but only on one side. When coming out of the bottom, it just felt like a knife in my ass. I also tested with limited ROM in thoracic rotation. what has helped somewhat is practice kicking my hip out on that side. I am doing more ab strap work but just letting my legs hang. I am only focusing on rolling my pelvis posterior. This is hard for me. prolly because of my anterior pelvic tilt. I also use the mobility drill the brettzel.
[quote]andersons wrote:
Yeah, that deadlift issue might mess up my theory…
How do you perform straight-leg deadlift (SLDL)? Do you push your butt and hips back to get at the glute-ham tie-in, or does your torso go forward (more lower back intensive)?
How do you feel in the following stretch that extends the hip and flexes the knee at the same time? Set up in a lunge position for a typical hip flexor stretch behind something you can grab for balance. Grab the ankle of the back leg, to flex the knee as you brace the core and tense the glutes while driving the hip forward into a mild hip flexor stretch.[/quote]
I do push my butt back in SLDL
On that stretch I feel great quad and hip flexor stretch
hi again
just a little update. i went to physical therapy and doing exercises that i’ve got but it’s not really getting any better. also started wearing inserts in my shoes, since therapist said i’m making a pancake when i run, so i needed arch support.
exercises he gave me are: bird dog, bridges (feet flat, on my toes, and on heels), side planks, some ab work , fire hydrant.
also i stopped doing legs for last month…but that didn’t make it any better. i’m getting back into it and just do what doesn’t hurt
he thinks it’s tendenitis and that i need an MRI and good anti-inflammatory. not really excited getting either
Entertain 2 ideas:
Trochanteric bursitis
Bilateral SI Joint dysfunction
beef