T Nation

Squatting Career Over?


#1

I've had an ongoing problem with my left leg over my hip socket (ITB?) It hurts when I squat, lunge and I can't do step-ups. However there is virtually no pain when doing front squats.

I have seen ART doctors in the past but never on a continuous basis. This time I've decided to do whatever it takes so I've been seeing an ART doctor in Columbia,S.C. I just finished my 5th visit. Over the first 4 visits the pain became less and less so I obviously took that as a good sign. I've been pretty diligent in doing my stretches as well. Now between the 4th and 5th visit the doctor had to go to Hawaii to work on competitors in the Ironman event. So I had to skip a week of treatment. During my last 2 leg training sessions the pain came back and it really frustrated me.
My concern is with the freqency of ART treatments. How long should one go before it is concluded that the problem is outside the realm of ART treatment only? Do I seek treatment once a week for the next 6 months? When should I seek a different or complimentary treatment?
As a side note I'll be leaving the state in 2 weeks and that gives me only 2 more treatments with this particular ART doctor.
Well I suppose that is about it. If anyone has gone through something similar or has any idea what I can do to find a solution to this nagging injury please write in. Thank you in advance!


#2

ART = Active Release Technique?
Have you had an MRI?
You said an ongoing problem with your left leg over your hip socket. How did the injury occur?
Is it a muscle, tendon, ligament, nerve?
Lower back injury...ever?


#3

Go see a doctor (MD), preferably one that is a sports medicine specialist (family medicine, physical medicine & rehab, or orthopedic surgeon). Get a diagnosis nailed before trying anything else.

beef


#4

That's too much ART without permanent results. Should take 6 sessions at the max; any more, and it isn't an ART thing or the therapist isn't very good.

-Dan


#5

This is incorrect. I am doing an internship with an ART guy and six sessions is a fairly small number of treatments. Depending on the injury, treatment times can last anywhere from as little as 1 to 3 or as much as three times a week for four or five weeks.

ART is more than just massaging out a knot in your neck, it is about stripping out myofibrosis (scar tissue) and restoring normal stretching/contracting in a muscle (sometimes tendons). If the nature of the injury was a chronic one, the treatment times will take longer than something that was relatively superficial and new like "I tweaked my rhomboid doing bent rows". The problem with your hip sounds like it is more tendonous in nature, therefore dictating more treatments. You haven't given much history about the injury...didn't the ART guy tell you EXACTLY what the problem was? and what sort of timetable the treatment was likely to take?


#6

Not true. ART is simply soft tissue work, while very effective, the extent of the involvment of the tissue, the length of time the problem was developing, and other factros all impact.

the fact that you feel better is a great sign.


#7

Dude, I've got what could be the same thing...going on five years now. Doctors have been worthless. Could be Piriformis Syndrom, Trochanteric Bursitis or ???

For me, stretching hurts, heat helps. Long hikes help. Being very careful not to reagrevate it helps. Heat rubs and patches seem to help a little.

Multiple Doctors, Physical Therapists and Chiropractors were a waste of time. Cortizone injections didn't help.

I hope you do better than me. If you find anything really effective, please let me know.


#8

I'm pretty familiar with ART and other myofascial release techniques - could you explain why it would take 4-5 weeks to take effect? There's no "re-education" involved like there is with straight chiropractic, you're breaking up scar tissue. Once it's gone, it's gone. Why would it take up to 15 treatments to work?

I'm especially dubious of this claim as I know many master's powerlifters and strongmen who've been at their sports for 10-20 or more years building up adhesions who were easily repaired in 3 or 4 sessions.

-Dan


#9

His problem area is a difficult area to treat. If his problem isn't a "joint" problem, but instead a muscle/ligament/tendon problem then the area itself it not the most conducive to quick treatment. Here are some factors (as I read) that seem to cause difficulty:
1. His problem has been chronic, not acute...meaning the longer the problem before seeking continuous treatment, the more stubborn to fix.

  1. Muscles react better to several successive treatments as grouped as closely together as possible. It sounds like he has been doing one per week.

  2. This is probably the biggest factor; he has been continuing his leg workouts while undergoing treatment. While this is not a terrible thing per se, any sort of re-aggravation while undergoing treatment will fall under the category of 2 steps forward, one step back. Just like continuing to bench while you have a hurt shoulder, you are not giving yourself the best chance to heal properly while still subjecting yourself to the same harmful stimulus.

  3. He made no mention of what his form was like...it is odd that he has no pain front squatting, but back squats, lunges and step ups hurt. Is this due to the weight used or are there other factors involved?

  4. Training age has nothing to do with how fast one reacts to treatment. You say you know long time powerlifters who reacted quickly to treatment, but you don't tell us what their injuries were, nor are you able to anylyze the extent of their damage. You only know that they reacted quickly--good for them; they have nothing to do with this particular individual. Superficial muscle layers and smaller muscle groups tend to respond quicker to ART treatment (in the abscence of repeated trauma--read: continuing to train). Deep tissue such as in the hip joint are much more difficult to treat and will almost certainly take a longer time to rehab, heal and regain strength.

Not trying to be contentious here, just that I have been in on clinical evaluations and assisted in treatments for almost a year now, day in and day out. My advice to this guy is to stick with the treatment and rehab as best as possible. All things considered, ART (even on a continuing basis) is a hell of a lot cheaper than surgery or cortizone shots and a lot less damaging to boot.


#10

This is not to mention the fact that we are focusing on only breaking up the scar tissue; there's no mention of re-training the proper movement patterns and allowing the proper muscles to do the work. Check out the Get Your Butt in Gear article series b/c I have a feeling your glutes are seriously dormant.

Stay strong
MR


#11

I asked a question about a similar problem on Elite a while ago. The following is my original question and the response by Michael Hope....

Today I did Good Mornings for the first time in a while and I had a sharp pain near the bottom of my glute or top of my hamstring on the left side. I don't feel anything on the negative or the pause at the bottom but as soon as I begin to lift the weight there is a sharp pain that feels like it is pretty deep. I could feel it even when I was warming up with the bar so I don't think it started today. I tried some light romanian deadlifts and those hurt on the concentric phase too, and I do heavy RDLs alot and I've never felt this. I tried doing full squats and those have no pain at all. I am just coming off a rest week and before that I hadn't done and GMs or RDLs or DLs for over 6 weeks at least. I had been doing mostly full squats although I remember trying some lunges a few week ago and this area felt a little pain with my left leg forward so I might have had this injury for a while and not noticed it. Any ideas what it could be and what I should do?

Josh let me tell you a story and see if this resembles your problem

I am treating a 17 year old football player that has a 7 week history of hamstring strain at the origin. He has pain at the bottom of his butt top of his hamstring like you. His pain is intermittent. He has pain with running, RDL, GM and DL. he stopped the following exercises because of pain. he stopped all lowerbidy training.

On testing he had no pain with resisted hamstring testing. He had pain with prone hip extension, bent knee hip extension and bridging. He had pain with anterior reaches, RDL and GM with no weight. He had no pain with squatting.

I had him perform 30 bridges, 30 prone hip extensions 30 bent knee extensions and 20 GM.

Every rep of every exercise produced pain, but the pain never remained worse. This meant that he has a stable painful problem. He is an inactive lesion. He needed to contract the muscle and stretch it for recovery. preferable with the same movements that created his pain.

His treatment was to repeat the previous exercises 3-4x a week as well as squatting and lunging. He would perform 10 GM with just his body weight 5x a day. The goal was to produce his pain with the GM. The GM was a two fold exercise stretch the problem and contract the tissue

Once bridging and prone hip extension exercise were no longer painful second week. He began stability ball bridging. he added db's for GM. He would pyramid up in weight just to see the pain respone. It was consistent... the exercise produced pain but when the exercise was over his pain stopped(not worse). Still a stable problem. Which means we are not making his condition worse. The plan was to give him enough exercise stimlus to repair the structure but not enough to push him into an active painful condition. He gets worse and remains worse with his exercises.

On his second week I let him run sprints. One day his response was... pain was produced but did not remain worse. Next day was faster shorter sprints this did make him worse for only twenty four hours. No big deal

In his third week he had very little pain with resisted hip extension. The most pain was the GM movement. heavy dumbbells or his body weight gave the same intensity of pain response. At the end of this week he will have been seen for three weeks. He is sprinting with very little pain and does not remain worse. He will play this week

You may find your respone to movements like my young athlete. If this is the case try some of the same exercises. If these baby exercises hurt the big ones will definetly cause pain and inmost cases to much tissue tension.

Rememebr your are not trying to improve your strength just give the muscle the proper stimulues to heal. Squatting can be continued

Sorry for such a long response let me know if this makes sense


WVU ranked 45th and climbing,
Michael Hope


#12

No I have not had an MRI. What would that do to help?

I have no idea if the origination of this pain is stemming from a muscle, tendon or ligament.

How did it occur? It just started hurting one day when I was doing some staionary bike work.


#13

The therapist is accredited in upper and lower extremities of ART. And also the biomechanics certification of the ART program. He seems to be quite knowledgable.


#14

Thank you very much for the imput.

Yes I have only been going once a week. He is based in Columbia, S.C. and I'm in Charelston, S.C. It's a good 2 hour ride for a visit and with work considerations it is nearly impossible to go more than that however, I'll be getting a week off soon. Would you recommend making 3 appointments in a row if I can?

I suppose your example of 1 step up 2 steps back can be cerdible if it is my squating technique that is helping to sabatoge my healing progress. Do you think I should stop doing legs for awhile? I'm pretty desperate to try anything.

Once again thanks!


#15

Thank you for your imput Mike. I'll check out the article tonight after work.

The doctor did mention that my adductors are getting bound up.

He also advised me to have my technique on the leg exercises I do checked out and videotaped if possible.
But I have no idea who to go to for that kinda stuff since I'm very leary about most personal trainers.

Any recommendations would be greatly appreciated.


#16

I think that Dorso's reply above was great. Yes, I do think that it would be worth it to do a few quick consecutive treatments if possible (I understand the distance issue, this makes it very difficult). Your problem is very familiar to me because for the last 4-5 weeks I have been in contact with a young powerlifter (20 yo) with almost exactly the same problem. His issue was an aggravated rectus femoris tendon, due to an increased squat load preparing for an upcoming meet.

Treatment started out 3x per week for two weeks and then weaned down after he showed improvement. He has been coming in every couple of weeks for "tune ups" and probably only has 1-2 more visits before being completely clear. His issue was causing some pretty serious pain and he is obviously not about to give up his sport, thus dictating the aggressive treatment plan. Treatment protocols also included ART to the surrounding areas (because many synergistic muscles will compensate for poor hip mechanics)--gluteal muscles, quads and psoas.

We are now emphasizing lots of stretching performed on his own and anylization of his techniqe...I gave him some advice (I work with athletes as a strength coach--I hesitate to call myself a trainer as I am not exactly a "feel the burn" kind of guy). My advice was just as indicated above; ROM squatting movement with increased weight/depth with adjustments to form as needed. He has quite a bit of mid back/low back tightness which translates to his pelvis going into a pretty severe tuck at the bottom of his squat and thus impinging on the hip joint.

Something to point out...he has great flexibility when checked, but that all changes once he has a load on his back. Soooo, just because you can touch your toes and twist/turn without pain isn't necessarily an indication that your mechanics don't suffer under load! Good luck!


#17

The hip pain I used to feel during hip extension is gone now (see my above post) although I haven't done any heavy deads/GMs/RDLs yet so I don't know if those would aggrivate it again. I have been doing mostly front squats/cleans/unilateral stuff and all is mostly well.

However. I now a strange pain in my hip when shifting weight onto my left side (the one injured). Literally, if I stand with my weight on my right leg than shift it to my left there is a sharp, moderate pain that only lasts a second. There is no pain walking, running, going up stairs, or doing front squats, cleans or light RDLS. Does anyone (Mike Robertson) have an idea what this could be? It developed after the previous pain, that I felt during hip extension, had gone mostly away.

Also, what kind of specialist should I see abou this. I am about to get new health insurance and I want to work it backward based on who I want to see about this. I am more concerned about diagnosis than treatment.


#18

ZEP

I would definitely get in to see an Orthopedic Dr. There are several good ones in Charleston. I would recommend you see a Dr. John Graham (team Ortho for C of C) or Dr. Kenny Caldwell(team Ortho for The Citadel).

Get some X-rays done and possiblily and MRI to see if there is any damage to your labrum and/or any ligamentous damage in the hip joint. Sometimes you can get pain referred to different sites.

Has anyone ever checked you for a leg length discrepency (one leg shorter than the other)? If you do have a leg length discrepency, this could cause you chronic pain in your hip. If so, it could be remedied with a simple heel lift placed in your shoes.

If you are an older individual, you may be looking at some arthritic changes taking place in that particular hip, but that can only be determined throught x-rays and MRI.

Are you stretching your Hamstrings, hip flexors, piriformis, ITB, gastroc and soleus muscles? If so, how much and how often?