Daily Mobility Exercises by Dr. Kelly Starrett › Forums › General › is banded distraction and joint capsule mob a load of bollocks?

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    • 02/13/2018 at 11:12 pm #71864
      AvatarNicholas Casini
      Participant

      From the excerpt of Supple Leopard:


      “The easiest way to deal with muscle stiffness is to bring the joint into a good position by using a band, and then to create movement through the joint, which I refer to as “flossing.” (Note: “Flossing” refers to movement.) Remember, your tissues adapt to your working positions. So if you sit all day, not only will your hip flexors become adaptively short, but the head of each femur will also move to the back of the hip capsule instead of remaining in the center of it, where it belongs. And every time you perform deep flexion-based movements, the head of your femur will hit the edge of your acetabulum (hip socket). This is why you may feel an impingement or pain in the front of your hip when you squat or mobilize in positions that close that joint. Using a band to create a distraction—meaning that you create space or movement within the joint—will pull the head of your femur back to the center of the joint capsule and effectively clear that impingement so you can move into newly challenged ranges without discomfort.
      Using a band also helps you manage joint capsule restriction. Because the joint capsule is so thick and robust, you need a little extra tension to affect change. Going back to the rubber band analogy, you need to account for the thick end of the rubber band to create an equal stretch throughout the muscle. This is exactly what the band enables you to do.”


      In another section of the book talking about hip capsule mob:

      “Remember, it’s not just your muscles that get tight. Your joint capsule system accounts for a huge chunk of tissue restriction. Here’s an example: Say you experience an impingement at the front of your hips when you squat, restricting your range of motion. This is what I refer to as a “flexion wall,” which is your femur running into the front of your pelvis. In order to reach end range, you have to compensate by turning your feet out or overextending.
      If that happens, one of the first things you should do is reset the position of your hip to the back of the socket by using this mobilization. By aligning your knee directly underneath your hip and loading your weight over your femur, you can drive the head of your femur into the posterior capsule and restore normal hip function. It’s a quick and dirty way to improve the efficiency of your hip mechanics without having to see a physical therapist.”
      So first Kelly says if you sit all day the head of your femur will be at the BACK of your socket, so you need to use a band to pull it back to the FRONT.
      But then in another section of the book, Kelly says you get impingement if the head of the femor is running into the FRONT of the socket so you need to use a band to put it BACK.

      So which one is it? Is my hip capsule running into the FRONT or the BACK of my socket? 
      I see the direction of the band on mobilization of the hips changes all the time from front to back to sometimes lateral. 
      They cannot all be beneficial (ie creating SPACE in the hip socket) if the hip capsule is only impinged in ONE direction right?

      I’m not saying this doesn’t work, but the logic of using the band to create space seems to be flawed (my main point of this post).
      When I do the posterior chain mob the band is on the front of my hip pulling my femur back into my socket to “create space”.
      When I do the hip extension / hip flexor mob, the band is on my high hamstrings pulling my femur into the front of my socket to “create space”.
      Logically, they cannot both make sense, unless you’re telling me when hip capsule gets impinged in different directions depending on my position. 

      However, I can understand if you say, during the hip flexor stretch, you’re using the band to help further pull the extended hip into further extension…but that’s a different reason than creating space inside the hip capsule….

    • 02/26/2018 at 2:48 am #77156
      AvatarPatrick Thomas
      Participant

      It may be confusing by the way it is worded.
      See if this helps.
      The head of the femur belongs in the center of the hip capsule.
      Sitting all day the head of the femur will move to the back of the hip capsule.
      With the banded distraction the femur is moved to the center of hip capsule. This is where the head of the femur belongs. The head of the femur in the center of the capsule effectively clears the impingement.

      With an impingement at the front of your hips you mobilize to the back of the capsule to move the femur from the front of the capsule. As you crawl forward you bias the tissues at the front of your hip capsule.

      You use a band to create space and facilitate movement around the joint.
      Hooking a band around the hip allows you to pull joint surfaces apart so you can reset the joint into a good position.

      You can create a distraction in different directions.
      Distract laterally pulls your hip into the side of the capsule.
      Distract toward the posterior pulls your hip to the back of the socket.
      Anterior distraction pulls the hip forward.

      Depending on the situation you can run into the front or the back of the capsule.
      You could be seeing an up/down stream compensation of another issue.
      The distraction creates space to facilitate movement into a better position.

    • 03/22/2018 at 9:13 pm #77167
      AvatarTom Matchinsky
      Participant

      Language changes as people evolve their thinking over time. If you read the book but don’t follow along on the site, you are going to miss out how descriptions of how things are working have evolved. This is an unfortunate side effect of writing a book, you can’t make constant updates to them, this is why the website and its content are valuable. Your last sentence is more in line with what is really happening when you use a band. You are using the extra pull from the band to help exaggerate a position of emphasis while patterning in a motor control change around the joint capsule and muscles by doing focused contract relax work and moving purposefully through the bookends of the range of motion.

      Travis
      MWOD Staff
      • 05/22/2021 at 1:57 pm #712061
        AvatarKal Patrick
        Participant

        Not sure if three years is too late to join the chat but I have an additional question. I completely get Travis’ answer but have had a little difficulty with banded distraction in a different way. I have hip impingement in both hips (FAI) and have used banded distraction in an effort to help. While I’m sure FAI is quite over diagnosed I’ve got a fair amount of damage and limited range of motion so definitely strongly on the scale. Banded distraction helps ROM without a doubt. It doesn’t seem to maintain that improved ROM for long though and I’ve had a series of other minor tweaks (lower back etc) there after. My physio believes it may be making the hips less stable. I do a disgusting amount of core/glute strength but am staring down the barrel of surgery. Is banded distraction a cheap and temporary fix or has it got more potential than that? Love the work TRS!

    • 05/22/2021 at 4:11 pm #712087
      Kaitlin LyonsKaitlin Lyons
      Keymaster

      Always fine to add to a thread.

      FAI is caused by deformities in the femur, hip socket or a combination of both. So there is more impacting the situation.
      With a change in structure, it will be an ongoing situation that is monitored and needs work to be completed.

      Are you working up/downstream to maintain the best possible positioning given your constraints of FAI?

      Why does your physio believe it is making the hips less stable?
      Has your physio offered other recommendations or ways to address this situation?

      Have you considered pros/cons of surgery?
      In some situations, there is no avoiding it.

      I don’t think the true question is “Is banded distraction a cheap and temporary fix or has it got more potential than that?”
      In what context(s) is this question being asked?
      Banded distraction may or may not be the most effective solution or approach to what you are looking to impact/ your situation.
      There is no one size fits all way to address any situation.
      There are multiple paths to the same goals.

      Does this help?

    • 06/09/2021 at 1:34 am #719740
      AvatarKal Patrick
      Participant

      Wow Kaitlin, that was quick!! TRS set the bar at a different level. In response to your questions…
      Yep, banded hip distraction is actually me working upstream. My hips cause relatively little discomfort (unless I go into certain positions which I am pretty good at avoiding). My main issue is knee pain and am working hard on the hips in an effort to alleviate that.

      My physio proposed the tightness around my hips is the body’s natural response to the deformities/instability and trying to alleviate it may in fact be working against me as I lose that stability. He, like most, has proposed exceptional glute/core control and getting as strong as possible in the limited ROM that I have. The hope is that, particularly as I strengthen the posterior chain, it may actually facilitate some improved ROM in the hip. If not, it would still be strong in the positions I am able to achieve pain free.

      I have most definitely thought of the pros and cons of surgery and believe I’m a strong candidate for it and becoming more accepting of that. I guess my questions should be: does banded distraction have the potential to overcome hip deformities? It’s obviously impossible to know how far down that road I am from your end but have you guys had success with it in dealing with impingements? How often would you propose doing it? Does it have the potential to do more harm then good? As always, thanks for the constant insight and content….having done disgusting amounts of research online and the number of new tutorials and hacks I’ve stupidly sat though, TRS no doubt stand head and shoulders above the rest.

    • 06/09/2021 at 4:01 pm #720038
      Kaitlin LyonsKaitlin Lyons
      Keymaster

      Kal,
      Thanks for your nice words about TRS.
      We are glad you found it.

      There are definitely situations that require surgery and there is nothing wrong with that.
      Banded distraction is not going to overcome hip deformities. This is a structural change.
      Banded distraction could help achieve the best possible position given the constraints.
      Setting optimal conditions around the area can give slack.

      I don’t know enough about your circumstances to give recommendations on treatment or know if it would be harmful.

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