Posted by Dr. Ben Kim on May 05, 2014 Natural Health Solutions In response to last week's post on the collegiate soccer player who recovered from a hip labral tear without surgery, a surgeon friend in Singapore asked me to explain how I think excruciating pain from a hip labral tear can be resolved with simple stretches and foam rolling. If there is a flap of loose labrum in the joint cavity, how can this not illicit pain with certain movements? I have found that in some cases of limited range of motion and intermittent sharp pain in the hip, the injured hip looks and behaves much like a frozen shoulder. The shoulder and hip joints are similar ball-in-socket joints that enjoy a wide range of motion which necessitates that they are stabilized by many layers of strong ligamentous tissue, collectively called a capsule. While the ligamentous capsule that stabilizes your shoulder and hip joints needs to be taut to prevent dislocation, it also needs to be lax in the right areas to allow for optimal range of motion. Take, for example, your shoulder. If you start with your arm by your side with your palm pressed against your thigh, and then slowly raise your arm keeping your palm face down, you'll find that it becomes uncomfortable to raise your arm above ear level without rotating your shoulder so that your palm faces up. This is because the ball of your arm bone - the part that sits in the socket of your shoulder joint - needs to slide inferiorly so that it doesn't rub up against the underside of a joint made up by your collar bone and shoulder blade. This inferior glide of the arm bone in the shoulder socket must happen for optimal range of motion during all overhead activities. If inferior glide doesn't happen, the ball of your arm bone will inevitably rub against other tissues in the area, most commonly the nerves and blood vessels that supply your arm (brachial plexus and subclavian vessels), which can cause all kinds of hurt, including sharp pain with overhead activities. Over time, it's actually quite common for the capsule that surrounds your shoulder and hip joints to lose its natural laxity. Overuse, a rotator cuff injury, accumulation of toxins, and even just a gradual loss of tissue elasticity with age are primary causes of tightening of this ligamentous capsule. This is especially true for athletes who repeatedly put their arms through a throwing motion. We have long referred to this state as adhesive capsulitis or frozen shoulder. But few health care providers seem to recognize that this same loss in capsule laxity can restrict proper range of motion in the hips, which can lead to explosive pain when the head of the thigh bone (femur) rubs against nerves and blood vessels around the hip joint. In the case of a tear in the labrum of a hip joint, I don't doubt that a loose flap of labral tissue can illicit pain. But my experiences tell me that in some cases, the body can adapt to some degree, usually by laying down scar tissue. Over time, persistent pain can be due to the scar tissue and capsule tightening restricting range of motion rather than the original labral tear. By stretching and foam rolling the muscles and ligaments that surround the hips, you can work toward restoring some capsular laxity, which in turn, allows for proper range of motion and hopefully less friction on nerves and blood vessels, which often equates to an easing or complete abatement of pain. Hips can freeze just like shoulders can. For both of these ball and socket joints to work properly, you need to maintain the right amount of flexibility in the capsules that stabilize them. So injured or not, it's highly worthwhile to stretch these areas regularly. Last week's article on a natural approach to treating a hip labral tear includes links to stretches that you can do for the muscles and ligaments that surround your hips. For the one stretch that you can do to ensure a healthy shoulder capsule, have a look here: How To Ensure Optimal Internal Rotation Of Your Shoulder Joint Capsule This shoulder stretch is critically important for baseball, tennis, and badminton players, as well as for swimmers and others who repeatedly put their shoulders through overhead activities. I hope this information is helpful to some ailing shoulders and hips out there. If you give any of the stretches mentioned here a try and have questions, please use the contact form at our online catalogue to reach me.
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