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And The Hip Bonez Connected To the . . .
By
Victoria L. Magown, CMTPT, LMT and
George S. Pellegrino, LMT, CMTPT
The American Heritage Dictionary defines the word hub as “the
center of activity”. If we think of our body as our own personal
universe, our hips, or more specifically, our pelvis can be defined
as the center of our bodies’ universe.
The pelvis is the foundation of the spine, that is, the base upon
which the spine rests. This base for the spine can affect the rest
of your torso all the way up to the head. It also plays an important
role as an anchor for many muscles of the lower limbs. When
the pelvis becomes dysfunctional, besides causing low back and hip
pain, it can cause pain and dysfunction of your shoulders, neck and
head. (See “Follow the Leader”)
When evaluated for pelvic dysfunction, we find a particular
group of muscles are almost always involved. This group of muscles
crosses the joints of the hips and when myofascial
 trigger
points develop in any of them, dysfunction occurs. These muscles
include the quadratus lumborum (Illustration A and referred to as
the QL), rectus femoris (Illustration B) and rectus abdominis (Illustration
C).
A myofascial trigger point is a hypersensitive spot in a muscle
that when stimulated, usually produces pain referred in a predictable
pattern away from the trigger point. These points also trigger contractions
in muscles that are called taut bands. These triggered taut bands
cause the dysfunction of the pelvic joints. When trigger points
are activated in these muscles, both the muscles and the joints need
to be treated.
Trigger points in the QL can be activated during a slip and fall
or a motor vehicle accident at speeds as slow as 5 mph. Injury
to this muscle doesn’t even require landing as the result of a fall
to activate trigger points, a near fall is sufficient.
When trigger points are activated in the QL, it can shorten as
the result of contracture on one side more than the other.
This pulls the back of the hip up on that side and rotates the front
of the hip down on the same side. At this point, noticeable
pain begins. Since the rectus femoris is attached to the front of
the hip, when the front of the hip is rotated downward, this muscle
develop points that trigger causing continued hip dysfunction and
frequently knee pain (Illustration B).
Trigger points in the rectus abdominis can also become activated
during a motor vehicle accident by virtue of the impact from the
seatbelt (Illustration C). Since it is attached to the pubic bone
in the front of the pelvis, when the pelvis becomes dysfunctional,
this muscle is involved. When the rectus abdominis develops
trigger points, pain is referred across the low back. It can
also cause all the symptoms of a bladder infection without any positive
laboratory findings.
If you have low back, hip, buttock and/or knee pain, you could
perform this simple test. Lie flat on your back and have a
friend sit at your side facing you. Have them place the palm
of the hands on the “bump” (Anterior Superior Iliac Spine) that marks
the front of the hips. Now, they place the thumbs just under
that “bump” (ASIS). If one “bump” (ASIS) is lower (closer to
your knee) than the other, that hip bone is said to be anteriorly
(downward) rotated.
At MyoRehab both the muscles and joints are treated. Once we have
eliminated the points that trigger the pain and taut bands, the joints
of the pelvis can be coaxed back to their neutral, functional position.
With a specific home exercise program, the involved muscles are retrained
and pain relief becomes permanent.
For many of our patients, Myofascial Trigger Point Therapy solves
the misery of many failed attempts to decrease/eliminate low back,
hip, buttock and often, knee pain.
Are your hip bonz connected to pain at the hip, buttock or knee?
Give us a call at MyoRehab.
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