Daily Mobility Exercises by Dr. Kelly Starrett Forums Back QL refuses to relax/release

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    • #71188
      AvatarKyle Hiddleson

      Hey all. I have been fighting hip pain for the past 1.5 years. I started sitting more and was doing a lot of trail running in FiveFingers at the time, plus started walking in Vivo Barefoot shoes.

      Anyways. I have a few things going on: pelvic assymetry (left is rotated forward and up) as well as lordosis in lower spine. Symptoms include hip pain with internal rotation and also a shooting pain down outer leg.
      Most of the symptoms are recreated when I hit a specific point in my upper (left) QL with the ball, roller, or TheraCane. But I have been treating this point 3-4x per day for about 2 months now. I usually combine treatment of QL with a rotating cast of characters: hip flexors, glutes, quads. And I’ve been adding the hip reset and the gentle banded hip distraction from the book for the past two weeks. I experience relief immediately after treatment, but that point in the QL seems chronic. It’s not going away.
      Any ideas? I’m going to start working through BASL to start to get more scientific with my approach to diagnosing and treating movement problems – BUT, the pain is definitely holding me back.
    • #75480
      AvatarKyle Hiddleson

      Also, another interesting symptom that I’ve noticed is that the glute complex in my left leg (the pain side) has a LOT of trouble engaging when I run, practice martial arts, lift, or walk.

    • #75485
      AvatarNathan Richer
    • #75641
      AvatarKyle Hiddleson

      Hey David. Thanks for the response.

      Wanted to open this up again. I am a MWOD Pro subscriber now and have been learning a lot and working through various sequences. I am also doing a lot of Category 1 movements at the gym (box squats, ring pushups, deadlifts, pull ups, working on front rack position). Seeing massage therapist with more regularity.
      My hip pain has been reduced by quite a bit, and now I’ve got persistent back pain. The hip rotation is still there. The lordosis (overextension in lumbar) is still there, but stabilizing.
      I’d like to target the hip rotation problem and so will refocus on the the ep. 128 stuff, BUT…
      What professionals could I see to help me with this? Is this hip repositioning thing the territory of a chiro? Physio? Osteopath? If not, who?
      Also – what sort of “disciplines” would the ideal person be able to instruct me in? PRI? Egoscue? Etc….
    • #75642
      AvatarNathan Richer

      hmm lots of thoughts! 

      1. if you still have you pain and you are now in the gym, i would strongly considering backing off. laying reps and load on poor mobility/stability and poor movement patterns is going to increase your chances of injury or aggravating your current position.  i would instead do only bodyweight until these things were perfect with only your bodyweight. 
      2. i went back and reread your original post. it is possible that you have a disc(s) problem which is sending pain down your leg, as well as in your back and hip. have you gone to someone to get an MRI done on your back?  if it is a disc problem, you may not see progress until this is addressed as the disc may be hitting nerve bundles which are causing muscles to contract outside of your control.
      3. when it comes to lordosis of the lumbar spine, it is both a soft tissue and a motor control problem.  as for soft tissue, are you doing the couch stretch? tight hip flexors can prevent you from getting out of lordosis.  motor control is about proper spinal alignment and training your body to maintain this over time (ie. posture work).
      4. this then leads to your question about professionals and methods. 
      There are many ways to skin the cat. The list is very full of methods which can help you. but a lot of it really depends on person who is treating you, and how dedicated you are (ie. how much time spent, how much $$ you’re willing to spend) to the method to really give it go. I think many people start a method and give up way too soon because they expect results too fast, or they really weren’t willing to break their own bad habits.
      some methods are really about addressing symptoms and not the root cause. as much as i love ART and graston, they fall into that category as well as pure chiro adjustments. they are short term fixes to remove the pain but don’t prevent it from coming back. this is why i love MWOD so much. they are a lot about fixing both the short term and the long term. but it still comes down to the professional and their mastery and implementation.
      so i would go to Roop (seeing him next week!), but i would make sure i checked out the guy who just took the CF Mobility and Movement Trainer seminar. just because they took the class or knew all the smashes doesn’t mean they have the experience/knowledge to address your problem.
      i’ve gone to good chiros and bad chiros. i’ve gone to people who knew nothing but what they were trained in, and found through trial and error the people who went beyond what they knew now and could better treat my issues. I think that referrals are the way to go to check out professionals. i would ask around the MWOD community on who is good and who is not.  you may need to try a bunch of people and see if a person (and a method) resonates with you.
      as for the methods themselves, i think everyone has their favorites which has worked for them. i think that the constraints would be your location and who is close to you, and potentially how much money you can and are willing to spend. many of these would not be covered by insurance.
      so tell me, which methods have practictioners close to you?
      it would seem to me that methods you would want to get into are those that help with your posture.  I have had good success with Gokhale although i felt they were also missing some things which I filled in with MWOD principles. I know Foundation Training is pretty good and have heard good things about PRI. there are many others out there working on posture as well. I personally have been really impressed by DNS trained professionals (Dynamic Neuromuscular Stabilization http://www.rehabps.com) and am working on a cert in that right now. I have also heard good things about Somatics (http://www.hannasomatics.com). it is likely that your breathing is an issue and a hidden cause of your problems.  DNS talks a lot about breathing properly via the abdomen – other methods overlook this very important aspect.
      then i would fill in with things like ART, graston and weekly chiro treatments to address the short term pain issues until you improve your posture. 
    • #75650
      AvatarKyle Hiddleson


      #1 – Makes sense. I am really putting a lot of time into bodyweight only stuff right now, so we’re on the same page.
      #2 – Possible. I haven’t had MRI. I did have an x-ray about a year ago when hip pain first started and everything looked good.
      #3 – I could do more couch stretch. I was doing the banded version, since my quads were so messed up. I had a ton of knee pain in couch stretch. This is calming down a bit, but I need to keep smashing my quads and also doing the anterior hip openers.
      #4 –  I like MWOD a lot for several reasons: 1) it is empowering, 2) it seems to tie together many “loose ends” into a cohesive whole that makes a lot of sense to me. My gut tells me that one area that is weak for me (that MWOD doesn’t really address very well) is breathing.

      Re: which methods have practictioners close to you?
      Will research this. Also, I should say that I know Egoscue pretty well, so my thoughts are to stick with that, combined with MWOD + Gokhale stuff. I need to learn more about breathing as well, so will look into some of the stuff you mentioned above (PRI, DNS).
      Re: fill in with things like ART, graston and weekly chiro treatments to address the short term pain issues until you improve your posture.

      What are the differences between these three in your opinion? Would love to hear your perspective on this.
    • #75653
      AvatarNathan Richer

      of the 3, ART and Graston fall into one group and chiro is another.

      ART involves the use of your limbs/hands/fingers to massage you and take out knots and kinks through manual manipulation.
      Graston is like ART, only these practictioners use stainless steel tools to scrape out knots and problems in fascia and muscles. 
      I have found that ART can get deeper into muscles for problems, where Graston cannot reach. I had some great work done on my psoas – it was the most painful thing having someone drive thumbs along my pelvic bones! but man could i run more easily after that happened.  certainly a good practictioner can sense problems with their fingers as they probe you.
      However, I know of a Graston person who did magic with her tools. I had never met anyone who could rid my body of problems like she can. There is a sensitivity that you develop over experience and time with the tools so you can sense how hard to scrape, where to scrape, and when to stop.
      Chiro is more about adjusting the joints and putting them back into the right places. I have met good chiros and bad chiros. Some don’t know when they should NOT adjust you and make a problem worse. Some simply don’t even know how to adjust certain body parts, like the ankles or toes, or how to put a rib back into place.  your joints can get out of whack over time, or back out of whack after exercise. it is a good idea to find a good chiro to make sure your joints are properly aligned on a regular basis.  certainly some MWOD work will do this for you also, but there will be some adjustments that you cannot effectively (or safely) do yourself.
    • #75654
      AvatarKyle Hiddleson
      Thanks again, David. Another couple of quick ones for you:

      You said weekly chiro. How often should I do Graston/ART?

      Also, should I really go get an MRI? Or is the x-ray + other work enough?
      One thing that scares me about MRI and similar procedures is that it always seems like they turn up problems, and I’m worried someone’s going to prescribe surgery or something crazy like that. Of course, I’ve never had an MRI so I definitely don’t know what I’m talking about. Any thoughts on that?
    • #75655
      AvatarNathan Richer

      re: frequency of appointments

      first i think the freq of appts is constrained by how much you’re willing to pay out of pocket. here in the SF bay, ART/Chiro/Graston can run $85-$120 per visit. i doubt it would be covered by insurance, and especially in today’s crappy, declining insurance coverage.
      second i think that it depends on how much you’re willing to work on your movement problems. 
      back when i went weekly, i was training for ironman. basically ironman training would essentially “break me down” each week, and ART/graston/chiro would put me back together for the next week’s workouts. so those treatments allowed me to survive training and get to the race! but also back then, i knew nothing about proper movement patterns, mobility, muscle compensations, and the fact that my glutes were inactive.  these all conspired to cause the break down each week despite me being able to get enough fitness to race ironman.  so i didn’t work on any of that, and thus required a lot of extra treatments to keep me going during training.
      HOWEVER, now that i’m a MWOD devotee, as well as studying other training concepts/disciplines, i now understand why i needed those treatments every week. i’m working on all my problems so actually i dont need to go as often now.
      but as you transition from dysfunction to good function, you may need to support the process if you continue training through that period.
      i think weekly is a good thing especially if you train weekly. but if you do a good job with movement patterns and mobility, i think you’ll find that you don’t need to go as often.  
      last thing – training load will also affect this. if you go hard every week, then the need goes up to release muscles that you for some reason can’t get to by yourself via MWOD methods.  certainly other disciplines like trigger point therapy can reveal that pain is not always local to where it exists and that you have to treat other areas that are non-intuitive to the untrained to really get at the root of the problem.
      re: MRI vs. Xray
      certainly Xrays are cheaper and easier to do. but they are two dimensional whereas MRIs are 3D. you’d have to take Xrays from multiple angles or else you might miss a disc protruding. also, sometimes Xrays are not that clear although i suppose experts at looking at them would spot problems. in an MRI, you’d be much more less likely to miss a problem.
      ha yeah i suppose you might find other problems in these body scans. but i think you should worry about the obvious problem and really figuring it out vs worrying about other possible problems they might find.
      i’d let the doc determine whether an MRI is necessary or not.
      as for surgery, i would always advocate trying any and every other treatment before you go under the knife. docs are trained to know what they know. if you go to a spinal surgeon for treatment, the first thing he will say is cut you open to fix the problem. know that you can always say no to any treatment. you don’t have to do anything anyone tells you they think you should do. if they get insulted you now have exposure to their character; i’d go find someone else on that aspect alone.
      two decades ago, i had 3 partially herniated discs. it took me 9 months of rehab but i didn’t have to get surgery to get painfree and back to function. certainly surgery for treating backs was much more common then than now.
    • #75660
      AvatarKyle Hiddleson

      Wow. Thanks so much, man. This has been incredibly helpful.

      Seems like I need:
      • Short term adjustments – weekly (ART, Graston, Chiro)
      • Medium-long term adjustments – daily (MWOD + more mindful training patterns)
      • Long term postural restoration (including proper breathing mechanics) – training + ongoing practice (Egoscue, Gokhale, PRI)
      • A doctor’s opinion (see a good physician)

      A couple questions come up with this:

      1. How to identify a “good” practitioner in any of these areas? Should I expect to see immediate improvement? If I don’t, should I move on to someone else?
      2. What about Grey Cook / FMS-related stuff? Would this fall into the category of long term postural restoration? Am I covering this by training well and focusing on great form or should I see a specialist to help correct side-to-side imbalances?
      3. This seems like a major time commitment. I can train 3-5 times per week (gym). I can plan on a 1/2 hour session at home per day. And I can make time for one appointment a week. Any suggestions on how to fit it all in?
      Any thoughts on all of that would be appreciated. If not, no problem. These are questions I can wrestle with too.
      Once again, thanks for everything, David!
    • #75666
      AvatarNathan Richer

      How to identify a “good” practitioner in any of these areas? Should I expect to see immediate improvement? If I don’t, should I move on to someone else?

      I think there are a lot of ways to tell. the first is only see people via referral, or from people who gained real success from a practictioner and/or their method. and you have to watch out for the fact that the method often is not at fault but the person who is using it on you. it’s like the difference bet seeing Kstarr and some guy who just took his CF move/mob trainer course. 

      the second i would say is their attitude. bed side manners for practictioners is critical in my book. i have left arrogant, my way or highway practictioners who thought they knew everything, and people who didn’t want to listen to what i had to say.

      the last is the hardest. how long should you stay with someone to know if you should leave and try something new? it depends on a lot of different factors and may mean you’ll need to educate yourself better. for manual manipulation like ART/graston, you should see results immediately. however, there are nuances. for example, i tried a graston person who scraped me too hard, too much beyond what he should have done. i was literally injured from his treatment and needed time to heal from that. so i guess that is another factor – did this person actually hurt me? i’ve heard from other people of their experiences from PTs who stretched them too hard and they pulled something during that session. It sucks to hear of these things happen. hopefully you’ll find someone who knows enough not to injury you even if they can’t help you.

      for longer term things like posture, hopefully you can find a good person/method to help with that. you may need to test several and see if they resonate. If they are producing results, but stopping at some point, you may use that as a signal to try another method/practictioner/trainer.  if the person you’re working with doesn’t have solutions to your issues, definitely time to find someone new who will have a different viewpoint.

      What about Grey Cook / FMS-related stuff? Would this fall into the category of long term postural restoration? Am I covering this by training well and focusing on great form or should I see a specialist to help correct side-to-side imbalances?

      I am a fan of FMS and i certified in level 1 and 2. as with any method, it can work great or you may need to try something else. it also falls to the practictioner on their implementation of the screen and the correctives to you. what’s nice about FMS is that it is highly systematized and easy for a non clinician trainer to implement.  the early stuff in FMS doesn’t have a postural focus although that is often the result. However some of their recent work does start to really involve good posture.  Their latest DVD shows some work with kettlebells with Gray Cook and Dan John that has as a result posture improvement and correction.

      This seems like a major time commitment. I can train 3-5 times per week (gym). I can plan on a 1/2 hour session at home per day. And I can make time for one appointment a week. Any suggestions on how to fit it all in?

      Quit your job and become a full time athlete! Then be pampered like the pros!

      just kidding – do what you can. try taking classes on the weekend, like workshops.  if you can find a chiro that also does ART and/or Graston (like i did), you can get all of that in one appt. Hopefully a lot of the work can be done while you train. OTOH, i am a proponent of 24/7 training – shouldn’t you be training good posture all day long with standing/walking/sitting?
    • #75670
      Avatar[email protected]

      Standing, walking, sitting…….sleeping?  Perhaps the hardest most expensive part of everything?   It is hard enough to change while fully conscious, how about when I am asleep.  Worse, having a crappy bed but don’t have the 3k to throw at a decent one and even then not knowing whether it is the right fit.  From what I gathered, your bed should be soft and almost like a hammock shape.  For majority of us with with anterior tilt issues that is what is recommended…  

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