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Jan 12th, 2014
Gareth asked The Guru for the following Physiotherapy Advice:
Hi I’ve been struggling with a hip/lower back pain that radiates down my shin for over 3 years now. I’ve had scan and x rays to no avail and seen countless physios without any change.
Someone recently recommended some core strength exercises to see if that helps which I’ve been doing for a few weeks now. So my question is, do you think that I’m going in the right direction and how long should it take for the muscles to strengthen and work?
The Guru Responded:
Strength, without stability is worthless. Gaining strength is easy – the more you do the stronger you’ll become.
Becoming more stable is tricky – and it’s why strength program’s for dealing with chronic MSK issues don’t work.
Stability is controlling joints through range and is independent of the load placed on it. When you’ve trained stability and can control the muscle, then you can go hell for leather with strength training.
It does sounds as if you’ve got a functional issue (what you do) rather than a structural one (hence nothing seen on MRI). You need to find out why – you don’t just wake up in the morning with these issues, they develop over a period of time so what you think maybe the trigger is in fact just an innocuous knock which is the straw that breaks the camels back.
One thing I’m absolutely sure of is where you feel the pain is NOT where the problem lies….and that’s the key to getting better.
Thanks for the reply. The injury started predominantly in the hip due to running and gradually got worse as i ran through the pain. Have you any advice on what my next course of action should be as the Nhs have completely given up on me and given that I live in the north east it would be difficult for me to come down to London for treatment
The Guru Responded:
Yup – first up is don’t chase symptoms.
Understanding what’s causing this and change this. You won’t feel results overnight as you getting rid of the problem rather than just the problem. Think of it like a persistent bruise due to you constantly stubbing your toe – you can do things so you don’t stub your toe tomorrow but it will still stay pretty painful for the next few days. Your back/pelvis/hip is exactly the same.
The most common cause of persistent back/hip issues is a really stiff but painless thoracic spine which makes you lumbar spine move too much without enough control. This lack of control causes the pain.
You need to improve the movement in your thoracic spine (especially at work) and stabilise your lumbar spine by recruiting your gluts and core (not strengthening)
This is one of the best, pain free stretches for thoracic spine as long as you’ve got the ability to move better, lie on the floor like this for 10 minutes
….and that’s the tricky bit. Someone needs to give you this ability to move your thoracic spine more and your low back less, even if it feels stiff. That’s the muscles protecting it, not the lower back joints….
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