Tight Hips

Had a new guy start in my Meditative Yoga class at Northwest Community Hospital Wellness Center.  Spotted the usual difficulty with keeping still during opening breath work in Sukasana (sitting crosslegged).  Figured either anxiety sufferer or leg problems.  He came up after and turned out to have a hip problem.  Guys usually have big muscles and poor flexibility.  The short-cut in figuring which machines to use or barbell movements to rely on is do what is most popular in the mags or just go down the machine line and hit one body part at a time.  Problem with applying general body region movements or machines is you have to be in posession of an "average" body.  In my sports medicine clinic, even between twins I find differences in knee alignment, foot arches, posture, muscular thickness, pain tolerance.  So applying general guidlines to and individual person is a formula for failure due to non-sustainability. 

What also is a "curve ball" in developing a personal exercise/movement routine=what are the end goals.  Cross training for running, shoulder development for looks, bounding height for dunking, flexibility for mixed martial arts, power for contact sports.....this is where it is so important to get a "second opinion" on applying an exerciser routine to your life.  I don't mean with a sportsmedicine doc, I highly value to ingenuity of exercise physiologists in figuring risks, strengths to embrace, weaknesses to address and lifestyles that would limit a long term sustainable life change.  So this is where my tight hip/50+ year old yoga student has entered into the "melee" of personal fitness programs.  For the short 8 weeks of having him come for guidance, I can at least help him in planning a continued exercise/overload program.  If we can use 3 easy poses of yoga as a staple or preexercise warm up, over time he should be able to gain progressive lengthening to a very contracted hip capsule.  Keep up with the basics no matter how deep he gets into other sports/activities and one day he'll have the flexibility of a highschool gymnast. 

Problem with hips is most americans view the groin and hips as very private.  The figurative concept of hiding from sight always translates to physiologic function.  Although a painful image, think of a sexually abused kid dreading the gyne office PAP smear when she gets into her 30's.  The psychology of injury always limits the form and function.  One of the reasons I save hip poses for the end of class is for the first 45 minutes, I not only get students to warm up body temperature but they also have worked on breath and relaxation so any psychological worries are not as distracting compared to before class.  If all distractions (I mean psychological ones like "my hip is about to break" or "feels like the muscle is going to tear" or "shoulder is about to come out!") are calmly removed from the forefront of one's attention, it will usually be able to apply exercise/overload.  Getting to the point where the hip is tight in the movement but not terribly painful....then holding at that point, concentrating on breath, and when guided-slowing coming out of the pose with control.  When I was captain for my school Track and Field team, I would lead warm up and remember bouncing the joint in the 1980's to provide warm up, flexibility, and stretching-usually on cold ground!.  (How wrong I was!!!)  The slow entrance into range of motion, gradual addition of torque and length, and relaxed breath will usually convince the muscle group to release it's contracted state after minutes.  Some will note after a long hold the sudden realization that the knee is now touching the floor in pigeon pose or the forehead is on the knees in forward fold.  (Others it takes a few months)

Here is a video link to a few poses that I showed my student and helped him to adapt (via use of yoga blocks and blankets) for daily repetition/ritual. 

Of note is it took me 2 years to attain pigeon pose equal on both right and left.  I suffered a hamstring tear going around the back stretch 110yards in a 440yard medley for state championship and coach said he heard a pop from across the field.  Cost the team 1st place and always held that in the back of my mind (and the back of my hip)...and that was 1979!

Mommy Wrist

Something about the having a baby is just beautiful, ask any mom.  Then there's the fragmented sleep, weight gain, transition back to running a house and working......and wrist problems.  Carpal Tunnel has been so published/talked about in the last 20 years that anyone will be able to figure out if their symptoms are similar and find conservative treatment to start online. 

I had a patient come in referred by ob/gyn.  Second time around mom with wrist pain that was "different".  Started about 6th week after leaving the birthing center and has been persistent since.  Mom is now 3 months out and suffering.   Tried to use the brace from walgreens for carpal tunnel with no help.  Pain grabs her with certain movements and now is interfering with sleep.  No history of this before and no trauma.  Still breast feeding but planning to wean off and return to work in about a month.  (Incentive to get the wrist pain resolved since she uses a computer 8 hours a day)

There are a few things I watch out for in anyone complaining about joint pain.  First is always broken bone or tumor.  Luckily with the wrist, small joint, easy to evaluate.  Then I think in mechanical terms and locate the area of pain/dysfunction.  Finally look above, below and referred.  In rare cases the pain will come from soft tissue like infection, other tissue, blood vessel or metabolic problems.  If I can't find a good solution or patient has tried everything, time to add traditional chinese medicine  and break out the needles to "move stuck energy" until conventional modalities start to work. 

If the pain is evaluated early, usually history gives the diagnosis (physical exam and testing backs up the dx).  If the pain has been "lived with" for a long time, the presentation can be different as the average person will compensate and may not remember the new symptoms vs the old symptoms.  Detective work ensues (experience and listening) and chipping away at confusing red herrings starts until the true problem reveals itself.

In this case, I ruled out scaphoid fracture (very important bone in the wrist that if ignored, leads to chronic disability) and went straight for the gusto-finkelsteins test.  BINGO! reproduced pain exactly.  This is notorius for moms as they reach to pick up 3-4month old (baby has good head stability by then) and lift up play face to face.  Gave a specific splint for thumb immobilization, advil (only antiinflammatory ok with breast feeding moms).  Also suggested facilitating healing with diet control (no dairy or wheat), turmeric and magnesium (ok with baby) topical treatment (helicrysium, tea tree, traumeel, ice massage) and acupuncture as back up if not better in 3 weeks.   If all else fails, steroid injection into the sheath of the tendon will help, and shouldnt effect breast mild production.  By then occupational/physical therapy will problably be necessary.