Daily Mobility Exercises by Dr. Kelly Starrett Forums General Hamstring/Posterior Thigh Pain when Hip Hinging

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    • #70898
      Xiomara RomeroXiomara Romero

      Posts: 5

      I have been having some pain for the last month and
      a half. When I try to bend from my hips, I get a lot of pain in the
      back of my legs. I thought it was sciatic, but smashing and stretching
      my piriformis and gluteal region doesn’t lead to any improvement
      whatsoever. Nor does attacking the hamstrings directly. At first it
      was in the right leg, but for the past 1-2 weeks it is in both. I am
      99% sure are caused by faulty movement patterns and some imbalances,
      because every once in awhile, my movement patterns will click, and I can
      bend over without any pain… it feels as if all the right muscles down
      the change are doing their part.

      I train a lot, and have been trying to correct my posture for over a
      year, but my proprioception and kinesthetic awareness is low. I have
      always tried to build coordination but it is so difficult when I
      constantly overthink and overanalyze whether what I am doing is wrong. I
      have tried to address my issues with lots of SMR and activation, but
      nothing seems to improve.  I’ve been trying to hit the calves a lot now too, just in case faulty foot mechanics are the issue.  I have been seeing an NMT, who in the
      beginning noticed a hiked right hip leading to a functionally shorter
      right leg; however, in recent weeks I have been beginning to think he
      can’t really see everything that is going on.

      I attached a video of me trying to hip hinge if it helps, and I point to
      the general areas where I feel the pain. Sorry about doing it in
      jeans, but I was at work.


    • #74490
      AvatarNathan Richer

      In the video, it is hard to tell but it looks like your pelvis is not completing its rotation and “getting left behind” as the rest of your spine continues bending, as you are hip hinging to 90 deg.  If you have been lifting (say deadlifting or KB swings) in this manner, it is possible you now have issues in your discs which may cause the pain down your legs when you bend – as you bend over, it is possible that the discs get squeezed out because of the spinal joints, touching the nerves there and causing pain.

      You may want to see a good PT and have your back and discs examined. The other thing I would do is really look at your hinging mechanics.  
      Practice hip hinging with a pole. Put the pole on your back and you should touch at 3 points: back of head, mid back bet shoulder blades, and between your butt cheeks. In order to touch at the 3 points, you absolutely must have good posture. Now try to hip hinge without losing contact at any of the 3 points.  How far can you bend over.I’m guessing that you won’t be able to make it all the way down.  Use the pole as a guide for what you have to turn on in your bracing as you hinge.  Use this drill as a way to reinforce proper hinging mechanics and what to keep braced when you do the movement.  Bend over only as much as you can hold the pole touching in the 3 points, then come back up. Try to bend over a little more each time you practice but do not go beyond if you lose contact at any one point. 
      I would have a pole handy at work or around the house and just pick it up and do some reps every time you walk by the pole. The more you practice good mechanics, the faster your body will adapt.
      Some other things to consider:
      1. Are you resetting your femurs into the back of the sockets? If they have moved forward because of our 21st century lifestyles, you should work on banded distractions to get those moved back into the sockets. If your femurs are not in the right place in the hip sockets, your body knows this and will freeze up your muscles to protect itself. If the hams get frozen because of this, then they will keep the pelvis from rotating properly at the end ranges of motion. This could be contributing to the problem, which led to a spinal problem.
      2. Check your stance. Try hip hinging with a wider stance, potentially feet just a bit wider than shoulder width. Does that help get your hips down further? Closer stances can be tougher if you are not as mobilized.
      3. When you hip hinge, pull strongly with your hip flexors: psoas, abs, quads, rectus femoris, etc. Pull yourself down into the hinged position strongly like you’re clamshelling your upper body shut with the top of your legs.  The firing of these muscles signals their counterparts on the other side to elongate, versus staying tight and resisting.  It also encourages proper hinging mechanics.
      4. As always, brace 20% in the torso and 20% in the glutes BEFORE you start the hinge. Always organize yourself properly before you start any lift.  Maintain the bracing in the torso (you’ll have to let go slowly on the glutes to let them elongate) the whole way down. You most likely have issues maintaining proper bracing through the whole range of the hinging motion.
      You might want to stay away from weights until you get checked out by a PT.  If you feel pain AT ALL in anything you do, you should back off and stop. Never work through pain like this – if you blow out a disc, that would set you back more than you would want. It’s not worth it.
      Good luck!
    • #74506
      Xiomara RomeroXiomara Romero

      Thanks David!  I really hope I haven’t messed up a disc.  A lot of the reason I think my movement pattern is messed is because of what you mention in #1 and #4.  I think I’m constantly in extension, because (a) poor proprioception and difficulty differentiating between lumbar and thoracic articulations and (b) my low kinesthetic awareness makes me think that overextension is good posture, and I’ve somehow retrained my brain to think that being overextended both in the lumbar and thoracic region is my neutral spine, and would actually be neutral feels like slouching.  When I try to get into an organized position (squeeze glutes, pull ribs down, tighten belly, and screw shoulders and head back), I think the pulling the ribs down part might actually require me to bend forward at the waist a little bit. I definitely feel a good stretch in my lower back when I do that, as if it’s been incredibly tight… but i don’t want to overflex my lumbar spine, so I’m never sure.  If I allow myself to try to bend over without trying to keep an arch in my back, the pain is diminished a lot, and I think I may have a good hinge again.   I just could never tell if I was bending at the hips or at the waist when I would do this, and would be afraid of doing it wrong.  Yet like I said, doing it this way reproduces less pain.

      I do have a pole at my house and at work.  The only problem is that I realize I can get the 3 points of contact in multiple ways, and one of is still overarching my back.  Are there any videos on here that give some good queing in terms of the whole organized position?  I’m having some trouble differentiating between #2 pull ribs down and #3 get belly tight.

      I really hope I haven’t messed up a disc.  Do you know of any reputable physios in the LA area?  Someone who’s really familiar with lifting and sports would probably be my best bet.

    • #74507
      AvatarNathan Richer

      some things to take a look at:

      I took Gokhale Method http://www.gokhalemethod.com. It is not geared towards athletes but it was excellent. It is missing some essential elements but there were some really good things i learned too. There may be someone teaching in LA.
      Foundation Training http://www.foundationtraining.com/ has some good stuff. I did not take their class though.
      Craig Liebensen at LA Sports and Spine is very good: http://www.craigliebenson.com/lasportsspine/. I am sure his staff is also excellent.
      Dr. Jeffrey Tucker is also good: http://drjeffreytucker.com/. 
      it turns out that proper lumbar spine is less than most people think, even clinicians. We’ve now resorted to hanging on our spinal bones and thinking that is good posture. It’s not. You’ll wear down the spinal joints over time if you do a lot of athletic stuff.  Yes at first, you’ll feel like you’re bending over at the ribs. This is because you’ve been used to another position for the ribs bent further back.  So bend down slightly at the ribs and brace; but now you have to make sure your head/neck is still upright. Often when you bend over at the ribs, the head/neck can’t get back up. Watch for that and work on t-spine mobility with a Gemini or double taped lacrosse balls.
      If you feel tight in the low back, work the QLs with a larger ball like Supernova or Yoga Tune Up Alpha ball. not sure if you’re a MWOD PRO member, but check these out:
      definitely worth paying 7.99/mo to get a PRO account. lots of great tidbits every day in DailyRx.
      Yes you are right. the one problem with the pole is that you can still touch 3 points and be overextended and while standing. however i do not think you can touch overextended while you bend over though…
      it took me about 4 months after taking Gokhale to burn in 24/7 good posture. It took 24/7 attention all day long. I also had to add in proper abdominal breathing and bracing while breathing.  It also took a lot of mobility work on the spine as well as hips to get good posture mechanics. I also had to work on the shoulders because they had drifted forward in typical 21st century lifestyle fashion. I still put my attention on all these things whenever I workout and especially out of the gym. So yes it can take a long time but the results are worth it.
    • #74511
      Xiomara RomeroXiomara Romero

      Thank you so much!  You definitely know your stuff.  I’m going to get a subscription to mwod pro to check out those videos.  And the Gokhale method is something I definitely would love to do; however, it’s pretty expensive.  There’s a free workshop coming up on May 10, and I signed up, but I don’t know how much they’re willing to share for free.

      I was bummed, I felt like I was making so much progress throughout the past couple of days, but when I went into the gym today I couldn’t get anything going.  I felt tight everwhere, and oddly enough, i was feeling pain down the left thigh and its lateral knee, but the right seemed to be fine overall (the right was the one that was initially hurting for a month).  I felt crooked as well, and the typical stretches as well as the banded stuff in this video:
      Episode 262: Hip Flexion Case Study and Mob Rx part 2

      didn’t seem to help.  I didn’t have time to do any SMR beforehand, but since stretching didn’t alleviate anything whatsoever, my outlook is pretty grim.  I’m prone to spending tons of time SMR just going through the pain part, but never really getting much improvement out of it.

      I think now I’m paranoid about if I’m overflexing my lumbar spine, because I can’t tell if i’m maintaining a natural lumbar curve or or slouching over.  Getting organized was really hard today, and I just couldn’t seem to get it right this time.  It seemed easier the past couple of days, but either my mind wasn’t making the connections to my abs well enough for a good brace, or I was just firing the wrong muscles again. 

    • #74512
      AvatarNathan Richer

      If you feel pain, the body may seek to protect itself by tightening up and not letting you do something dumb to yourself. The body is smarter than we think LOL.

      If you do feel pain on a given day, I would go home. You should work with a good clinician (like some of those I recommended) to get pain free, then comes the rehab from pain free to proper function.
      yes it is possible that you were doing well and then had an off day, or it could be that your back problem just flared up again due to something on that day.  Use gentle smashing to loosen up your tight hams and back; don’t really dig into it. I would also use ice to lower the inflammation on your discs, which can help alleviate the resulting pain if the discs are not bulging out so much into the nerve bundles. 
      I’ll probably get flamed for suggesting ice as this is an anti-ice community. However, I am a believer that ice is good for some things and not others, and it’s not as black and white.  In this case, it works great.
      I also think that it is sometimes very hard to figure out for yourself, on your own, what a good organized position looks and feels like. Getting help would be a good idea.  If you feel so inclined, you can probably take a trip to see Theresa Larson at MovementRx in San Diego – she’s part of the MWOD team. There may be other good movement/mobility folks closer though, although I tend to go see the experts whenever i can.
    • #74518
      Xiomara RomeroXiomara Romero

      Thanks again!  I think my problems are caused a lot by what you said
      about my “pelvis not completing its rotation and “‘getting left
      behind.'”  I’m beginning to notice that trying to flex my lumbar spine or round my back is providing me with some more stability… as long as i can maintain anything else.  I noticed my left leg, which has been more stable due a pelvic rotation, was able to step up better because hip flexion wasn’t blocked.  But putting my right leg on the bench, I think the femur is running into the hip; he talks about this in


      and a few other videos.

      So if I round my back more, this would allow the pelvis to complete the rotation and the femur can clear the hip.  Of course this is a tense and scary thought, because we are constantly told to not round our backs… but I think if I’m stuck in extension, then going to neutral will feel like rounding my back.  It’s also a matter of glute activation I think as well.  Unfortunately, I’ve spent months doing glute activation, obsessing over correct form, and still not getting the mind-muscle connection.  This is what makes getting into a good position so hard… the first step is squeeze the glutes, and in all the videos I see, they just say squeeze the glutes.  But even after activation drills, I may squeeze my glutes, but other times I may be contracting something else… addutuctor, TFL, an external rotator… no queues allow me to consistently do it correctly.  For example, if I try to screw my feet into the ground and/or turn my knees out, sometimes I end up just trying to do this from the tibia.  In addition, all this concentration ends up getting me so tense, so it’s a perpetual cycle of stress and frustration.

      Trying to crunch up and round my back more while supine kind of helped with glute bridging today, so if I try to take that approach, hopefully I’ll see some results… I suppose I may have been trying to flatten my back with only my TVA and not my rectus in the the recent past, perhaps because of the emphasis I would hear about the need to strengthen the deep abdominals not going into trunk flexion.  Of course, crunching up gets me all screwy with my neck… I’m always trying to look to make sure my form is correct, and if i realize it and try to relax the neck, it just ends up tilting backwards.  Trying to tuck my chin ends up being just like trying to contract the glutes… sometimes I’m using the right muscles, other times I’m just firing different stuff around the neck.

      The other part is distinguishing lumbar spine and thoracic spine movement, since chest out for years was probably just more lumbar extension, which coaches weren’t correcting.  So much of this is mental, because when it clicks, it clicks and I perform great.  I just wish there was a fool-proof way for me get into the right position every single time, just like the bracing sequence seems to do for everyone else.  This way I’d be able to practice these movement patterns correct every time.  I already think about my posture 24/7, and I do devote time to stabilization exercises.  So I continue to look through mwods, and now the mwod pro videos, to see if I can find anything new that will help my brain click. 

    • #74519
      AvatarNathan Richer

      Proper posture should be achievable without tucking your chin. It is a common reaction to try to tuck the chin when you bend a bit fwd to connect the bottom of the ribs with the top of your pelvis/pubic bone.  You need to develop the ability to do that AND be able to have your neck in neutral position, stacked on top of the spine.  You should be able to do this in any position, while lying down or standing.

      It could be that you need more t-spine mobility.  Work the t-spine with a double lacrosse ball or better yet a Gemini.  See if you can loosen that up over time which will help get the neck and head in proper position while you brace and lock your ribs to your pelvis.
      Practice makes perfect. What cues may work for someone else may not work for you.  That’s why coaches have a ton of cues and methods to figure out what gets you to do what they want to do.
      Start by doing hip hinging exercises only to the limit you can maintain proper alignment. then inch forward from there. Don’t stress about not being able to get all the way bent over. Gradually build to it. Be patient! I feel your pain – it can take months to get to where you want to go. Just keep at it every day until you get there.
      Do all the MWOD mobs and smashes and see if they improve the situation.
      And make sure your back’s discs don’t have some serious problem that should be addressed first!
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