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The Guru: the root of Jof’s consistent right sided pain stems from thoracic stiffness

Nov 18th, 2014

Hi guru, For a few years I’ve had various problems on the right side of my body:

– After squats my hip is often uncomfortable. Sometimes this discomfort makes itself known in daily life.

– After deadlifts, sometimes the lower right side of my back feels over-worked.

– If I do a lot of skipping my right ankle hurts.

– When cycling 100km+ usually my lower back, hip and/or inner knee on that side are very uncomfortable.

– Even pullups aren’t without their issues; sometimes my upper back on the right side feels overworked there too.

– Probably related, I have a slight collapse of my right foot arch when I walk and I think my right foot turns out a little.

Fortunately these things don’t happen all at the same time… But as you can see, my right side has issues! My left side is completely fine though.

I’ve seen several NHS physios plus one private over the years. I’ve done all their exercises and stretches (bands, planks, balls… you name it!) as prescribed but no luck. It’s really frustrating – especially as I’ve taken up cycling recently and aside from the discomfort I’m completely hooked.

I’m male, 35, have a desk job and otherwise fairly fit if not especially flexible.

If you can point me in the right direction, I’d be eternally grateful!

Best Jof

The Guru Responded:

Morning Jof

 

Super frustrating!

 

You’ve got bags and bags of differing symptoms and sounds as if all the stretching and strengthening stuff was primarily designed for symptom relief not directed to establishing the cause.

 

Find the cause, don’t chase the symptoms.

 

As all your symptoms are right sided I’ll take a huge punt on the following….

 

If you do a right, single knee dip/squat and compare the control and wobble to that of the left – it’ll be miles worse. You’ve got really poor control (not necessarily strength) of your right lower limb – that’s probably why your arch is different on the right; you entire leg rolls in because you can’t control this rolling in action.

 

You don’t just wake up with poor control – it happen because of something attritional elsewhere. I’ll take another punt that you’ve got a really stiff and tight thoracic spine (which you may or may not feel) due to you being a bloke (!), age and sit behind a desk. It also fits when you do pull ups your mid back “over works” either due to not being able to move enough or most likely that you poke your chin out when pulling up, which “refers” a sensation to your mid back.

 

This thoracic stiffness causes your entire top bit of your body to slouch forward and to compensate this you lean back to keep looking forward.

 

The second you start to “lean back” (small tiny, inconspicuous movement but it’s the compensatory motion to moving the top bit forward) you no longer need to use your gluts – as that’s their job in walking, standing etc.

 

So….due to your stiff thoracic spine and compensatory posture (which is very common) you’ve now “lost” your gluteal drive – the controlling switch when to call up the power and activity. This makes your leg roll in as the control’s gone south…

 

Whew! Short answer – get more movement in your thoracic spine and get better control, not strength of your gluts and core.

 

Pilates based, endurance focused, control stuff when you’ve got the ability to move better is a goer..

The Guru

Six Physio

 

Jof wanted to take this a step further:

Awesome; thanks so much for the detailed response.

 

Is this something I can/should work on on my own or is this something SixPhysio would work on from the start? If the latter, what can I expect there?

 

One of the questions I’m trying to answer currently is whether I should go in for a bike fit or deal with these issues first before attempting to get more serious on the cycling front. Thoughts?

 

Impossible to answer no doubt, but I’m interested in the prognosis also; is this something I’ve got a good chance of fixing and if so what sort of timescales? (As accurate as “weeks”, “months” or “years” is enough 🙂

 

Thank again!

 

The Guru responded:

Right then…

 

Yes, fixable. Months not years, but then again weeks make up months!

 

It’s about grooving the movement. If you want to hit the perfect, cross court, top spin, return serve you need to be coached as to how you do it – racket position, grip, movement etc and then you need to practice, practice, practice until you just do it without thinking. How long does that take? All depends on how much you practice and how good is the quality of your practice.

 

Same with the rehab you need to do.

 

We go about it in a joined up, 2 pronged attack. You need to be given the ability to move better through your thoracic spine – you need an external force (ie somebody doing it for you) to get it moving – this is the hands on aspect of care. You also need to be shown how to keep moving better through your thoracic spine and how to keep your lumbar spine more stable by using your “core” and improving the control and timing of your gluts.

 

Bike fit – super idea BUT it needs to maximise your anatomy rather than forcing you into a poor controlled body position but a perfect bike position. The bike must adapt to you, you don’t adapt to bike. The bike must help what you’ve got…

The Guru

Six Physio

 

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