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  • in reply to: Inhibited Psoas in FAI? #76712
    AvatarMelanie Blair


    Good to hear the MWOD recommendations are helping. Hang in there, stick with that daily mobility practice, and make sure you’re adding in a regular dose of hip strengthening work to minimize the aggravation in that hip joint!

    in reply to: We were in a rollover #76631
    AvatarMelanie Blair

    I agree with Kaitlin. Early on, you want as much hands on care from a skilled clinician as you can get. Disc herniations can be particularly nasty in terms of the pain involved and time to heal.

    I’m an outpatient ortho PT in Kansas City, MO and about 2/3 of my case load is spine-related pain. With a disc injury it’s important to remember that the pain it generates throughout the day is going to come about due to different mechanisms.

    Early in the day, especially upon waking, we know your intervetebral discs are going to be their most full, or hydrated. In a herniated disc, that means the spinal fluid that got back in there while the patient was sleeping the previous night is going to push on that bulge a little bit. The easiest way to wring out some of that excess fluid is to turn on your back, bend your knees so your feet are flat on the bed, bring your legs together, create a little tension through your abs, and slowly start rocking your knees side to side-NOT to the floor-just create enough rotation that you feel some motion through your hips and low back. This rotary motion creates a “ringing” or “flushing” effect to push that extra fluid out of the irritated discs. Two minutes of this rotation work first thing in the morning is usually enough for most folks to feel looser faster after they get out of bed.

    Following up that rotation work with a little bit of ab and glute activation, maintaining a neutral spine while engaging the abs and glutes, will help wake up those deep spine stabilizers that get inhibited when low back pain sets in. Around 2-5 minutes should be enough to get those muscle working more effectively.

    Try to avoid a lot of forward bending and sitting during those first 60 to 90 minutes of the morning. That means you’ve got to mindfully hinge around your hips, not round through your spine, when you’re bending over at the sink to wash your face and brush your teeth.

    Once you’ve been up and vertically loading those discs for a couple of hours (or less if your discs are really irritated), your going to be experiencing pain due to compression, as opposed to the over-fill of fluid in the disc you experienced when you woke up. As such, the intervention later in the day has to account for this.

    When you lie down horizontally, you are unloading the direct vertical
    pressure that disc endures when in an upright position. It depends
    on the individual in terms of which lying position (on your back, on one
    side or the other) is most relieving, but it’s important to get in that
    position regularly throughout the day for 10 to 15 minutes. Ideally,
    you’re staying ahead of the pain by unloading frequently, not waiting
    until the pain is at its worst. You can follow up that unloading with a little more ab and glute work before you get up and start moving again.

    The name of the game with disc injury is hydration management. If you can get on top of it, you will have a leg up in getting better. Remember, discs heal!

    Hope there’s at least 1 pearl in the above that helps your wife feel better sooner rather than later.

    in reply to: Inhibited Psoas in FAI? #76630
    AvatarMelanie Blair


    Do you have imaging that confirmed you have FAI? If not, I’d check that box first.

    If confirmed, I think you might do well to take a closer look at surgical intervention. The impingement caused by the acetabulum can cause a great deal of damage to the cartilage and the hip labrum. Though soft tissue mobility work and improving motor control can help, if there’s a problem with the architecture of the joint, there’s no exercise that will fix that.

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