Hamstrings, oh hamstrings…I think you’re more important than I realized

As I briefly mentioned in my previous post about my frustration co-existing with my obvious progress, I think strengthening my left hamstrings will help pull that side of my pelvis back into a more normal position.

This morning my little medial hamstrings on my left side are notably, slightly sore, and in a good way. That is so cool. It means they are activating, and can now be strengthened. Seeing as they’ve visibly atrophied (they look and feel so floppy compared to the other side), it’s super exciting to know they are turned on and I can strengthen them. What did I do yesterday to make them sore? I did three sets of 8-10 glute bridges twice total, and the PRI 90-90 exercise sitting in a chair, with the EMS unit on my medial hamstrings.

Evidence for this line of thinking:

The Postural Restoration Institute (PRI) mentions one of the first things generally done is using the hamstrings to pull the left pelvis back.

I even had a knowledgable physical therapist I highly respect tell me single leg romanian deadlifts would help calm down my painful adductors.

And looking back over this year and a half of hell, the weaker that hamstring got, the worse my pain became. At my most painful point in March 2018, if I was laying on my stomach and tried to use my hamstring to lift my foot off the ground, I could barely do it. At the time, I didn’t give it a ton of thought because, frankly, I was overwhelmed and in one of the deepest depressions of my life. Alas.

The more I used walking aids, particularly both forearm crutches, the weaker my hamstrings seemed to get. And the more my pain increased.

This interesting article from Swiss Physio has some interesting points that hit home for me:

“Throughout the stance phase the hamstrings act to stabilise the pelvic girdle and propel the body, and therefore the centre of mass, forward. The faster the walking pace the more muscular activity is needed to maintain stability…

Any weakness may result in an anterior pelvic tilt and thereby an excessive lumbar lordosis, especially if the gluteus maximus is weak as well.”

Yep, that’s me, including the anterior pelvic tilt I go into when placing weight on my left side. So it stands to reason that strengthening my hamstrings (and glutes) will help naturally correct that.

And this interesting statement is from https://fulltorquefitness.com/?p=262, and highlights the importance of the Biceps Femoris (one on of the hamstring muscles) in hip stabilization and the SI joint:

“Together these muscles [the deep longitudinal muscle slings] work as stabilizers of the hips and core. This is mainly seen as we walk, these muscles absorb energy from the ground and transfer it up the body. Where the energy being set up will dissipate before reaching the head if the core is acting properly.

The Biceps Femoris has a special value in the stabilization of the hips. As the Biceps Femoris is contracted the sacrotuberous ligament is pulled down with it. This forces closure of the Sacroiliac Joint (SI Joint).”

Now, as I take steps to strengthen my hamstring, I notice I’m in less pain and feel sturdier on my feet. I’m mentally kicking myself a bit. I really, really wish I hadn’t let the muscle wither away to this point. Oh well…

Interesting observation: after doing two sets of 3 glute bridges last night, I was to the point of exhaustion. When I got up off the floor, I could literally, barely walk. In that moment, it provided me the opportunity to momentarily observe my gait when my glute and hamstring muscles were exhausted. In a way, it was really interesting, because it provided immediate evidence that my hamstrings and glutes are very, very important. It allowed me to hypothesize that therefore strengthening these same muscles should allow me to walk better. That’s encouraging.

It’s a gateway to accessing other areas of dysfunction

Of course I understand that activating and strengthening my hamstrings won’t fix everything, because my situation is complex. However, I strongly feel it is very, very, important because it will (1) directly influence how I walk and reduce my pain levels and (2) allow me access to other areas of my body that need straightening out and progress to more complex exercises that straighten me out as a whole, especially as the left side of my pelvis moves back into a more normal position. It’ll be neat when I can stand on one leg, hip hinge better, do single leg Romanian Deadlifts, single leg glute bridges, squats, and even walking with a more normal gait. These complex movement address other muscles in my body that need balancing.

Training thoughts moving forward 

  • I think I’ll try switching focus to fast twitch fibers for a bit with my EMS unit.  Apparently, hamstrings are primarily composed of fast twitch fibers. I didn’t realize that. Doggonit.
  • Eccentric training where I can.
  • Try different foot positions to target different hamstring muscles (neutral, outward, or inward)
  • Try dorsiflexing and plantar flexing to target different hamstring muscles.
  • Eat more protein.

 

*Did some research from Strength Sensei)

Impatient, Frustrated, Discouraged…And Yet Improving

Life seems to be all about paradoxes and contradictions. I’m no exception, apparently. I’m impatient and frustrated, and yet improving. It’s more important now more than ever that I record my improvements, or else they’ll slip by me unnoticed as I compare myself to other people.

Here are my latest improvements:

  • I have increased internal rotation. Notably. Got down on my knees today, and was able to rotate my left foot out/left knee in farther than I have in a long time (a year?). I can actually get my foot in line with me knee, whereas before my foot was inside the knee when looking down, as in stuck in external rotation. Dare I say it, but now I think I can even get a little actual internal rotation. This is huge. Every bit of internal rotation I get, the more access I have to my glute muscles and medial hamstrings. And how have I achieved this improvement? Several things. Reverse clams. Sitting, moving my legs as close to internal rotation as possible, and activating the muscles (adductors, hamstrings, glutes) in that position by pressing my foot in different directions.

 

  • Glute bridges actually produce a burn in my glutes and hamstrings. It’s been ages since this exercise produced a burn anywhere other than my right lower back (yes, you read that correctly…my lower back). Seems like now the correct muscles are being activated. And while some may say only my glutes should be activating…oh well. My left hamstrings have visibly withered away, so they need MASSIVE work. I hypothesize that strengthening my hamstrings will help pull the left side of my pelvis back into position (I think it’s rotated forward at the moment.) I’ll take activation of both muscle groups for now, thank you very much. This is HUGE. Now I can do this exercise every day, or as much as I my body can take.

 

  • I’m increasingly using no aid walking around the house. This presents a huge paradox for me. Out in the world, I alternate between one crutch and a cane mostly. Once and a while (rarely), no aid. While this is overall an improvement, it making me work harder than ever. This makes life feel twice as hard as it used to be when I was on two crutches, because then I could simply lean on the crutches. Walking with fewer aids is hard work, and when life gets hard, I get discouraged. Nevertheless, me using less aids is an improvement. I need to remember this, even as I struggle to get accustomed to fewer walking aids. Sometimes I miss using two crutches, even though I think it made my lower body weaker overall.

 

  • My right, less symptomatic hip is less achy than it used to be overall. I’ve noticed the improvement since making it a point to be on my feet around the house more (working on the computer, etc)

 

  • My standing stamina is improving. While walking 10 feet with no aids is still a struggle, standing on my feet and carefully shifting my weight is getting easier. I’m able to last around a couple hours (max) on my feet. This much, much better than the 20-30 minutes I used to last when I was at my worst months ago. At my worst months ago, I was terrified that I was one step away from a wheelchair. Not anymore, woot!

Thoughts

Has using walking aids hindered my progress? I wonder. Now that I’m doing corrective exercises, walking without any aid may have its benefits. My muscles may grow stronger. My muscle slings may learn to work together.

Everything is hard. Everything. Turning while standing. Maneuvering. 10x the effort. However, my theory is that my muscles will adjust to the increased load and will also respond quicker when I need them. If less movement this winter increased my pain and feebleness, it stands to reason that mindful, careful increased movement will help me get better.

My working theory at the moment:

Psoas firing and strengthened –> pectineus firing (and strengthened?) –> adductors release as a result, and maybe heal from the repetitive strain they’ve been under –> glute medius becomes uninhibited by adductors –> while I also do muscle sling work to get everything to work together (use walking poles?) –> gait restored

Observations

Working the anterior sling in the seated chair exercise seems to be helpful. Especially as I twist towards the painful side, I’m able to slightly lift my left leg off the floor. Still difficult, but a little easier. I also try to focus on kind of sucking the leg into the hip, in hopes that I’m activating my psoas and pectineus.

Working the anterior sling – laying, sitting, standing

There may be more to this anterior sling work than I expected.

New Observations

  • New chair exercise for anterior sling. Interesting is that I have to mindful give my side muscles an extra squeeze. After doing it off and on for an hour or so while working at my computer, when I got up and did the standing version of it, I was able to turn much farther to the left without my adductor locking up on me. This is something I’ve been struggling with for a while, so it’s interesting I had such drastic results in such a short time. Interesting. Also interesting is when I sat back down and lifted the left leg, it was significantly easier. This is something I really, really have struggled with this.
  • An interesting variation to the chair exercise for the anterior sling: while twisted to the left, I’ll activate my left glutes by pressing out into my hand(s).

Movements to make a video of:

  • Seated anterior sling movements from side to side

Movements to do for the rest of my life:

  • Seated anterior sling movements from side to side
  • Laying anterior + posterior sling movements – glute bridge when you can
  • Rotational lunges – for the lateral sling
  • Standing on one leg – for the lateral sling

More Progress

Wow. I did a photo shoot today that had me on my feet for nearly 2 hours (there were a few minutes were I sat down, but that’s it). I opted to use one crutch, even though I’m in the process of acclimating to a cane around the house and for short errands.

Speaking of which, I’m using the cane two weeks earlier than I planned.

Two weeks ago I did an hour long shoot on the crutch, and I remember being very tired afterwards. So much so, that when I flopped back into the car and drove home, my left hip muscles were literally stinging for a bit.

Not today. Huh.

After the shoot, I wasn’t very tired. Odd. Got home and went to the gym. Did some rotational lunge work on BOTH sides – modified on the weak left side – and then got on the treadmill for 15 minutes. Then got in the jacuzzi and did some one legged stands in the hip-deep water. Did some other adductor and abductor activation work.

Got out. Had some immediate tiredness, but it was gone by the time I got to Qdoba to pick up dinner.

I’m noticing my stride wanting to lengthen on the weak, left side, almost as if my glutes are wanting to propel me forward more.

I’ll take it. And even with all this, I struggle with impatience. It’s like, I’m seeing improvement, but it can come fast enough. Still, I’m very, very thankful to be moving in the right direction so far. This is precisely why I need to write this progress down, because otherwise I tend to lose perspective and despair that I’m not making progress at all…

…when, in fact, I am.

Future Plans – Sling Work

This is what I’m doing right now, and it’s working so far:

  • Continue with rotational lunges in jacuzzi and out (lateral sling.)
  • Stand on one foot more (lateral sling)
  • Reverse Clam Shells
  • Bridging (I want to get to single leg eventually)
  • *Practice laying leg extensions with arm movement (posterior sling) – Not doing this regularly. Need to.

Things I need to add:

  • My left adductors are really weak. So weak, it gets painful when I bring them towards the midline of my body. I’ve been avoiding this movement, but I think I need to face it. There may be the possibility that these weak adductors are what’s causing my abductors to be tight. It’s worth exploring. As it is, these weak adductors are also a weak part of that anterior oblique slings. I think that’s a large part of why my leg stays away from my body when I walk.
  • Be on feet more during day, but be strategic with it.
  • WATCH THE ORDER in which I do things. I should try activating the left adductors first (pressing leg into cane while standing does this), then activate abductors in that position by pressing into cane. Then practice putting weight on left leg.

List of slings from https://breakingmuscle.com/fitness/re-thinking-functional-movement-the-sling-systems-of-the-body:

“Anterior Oblique System: External and internal oblique with the opposing leg’s adductors and intervening anterior abdominal fascia.

Posterior Oblique System: The lat and opposing glute maximus.

Deep Longitudinal System: Erectors, the innervating fascia and biceps femoris.

Lateral System: Glute medius and minimus and the opposing adductors of the thigh”

Also, great article here: https://experiencelife.com/article/why-you-should-activate-your-sling-system/

 

 

Turns Out These Rotational Lunges Are Working My Lateral Slings Are Very Effective

The title says it all. Turns out my lateral muscle slings – adductors, same side glute minimus and glute medius were shut down on the left, weak side.

This past week, working on them has given me noticeable results. In fact, I’ve gone from one crutch to testing the waters with my cane.

Huh.

Also interesting is that standing on one leg also works the lateral sling. I’ve noticed an improvement in being able to do these. Can almost do it on my weak, left side.

Interesting.

A Rant: Trial, Error, Experimentation, and Taking Responsibility for Ourselves

The more I experiment with movements and apply deep thought to my situation, the more I’m coming to believe that, above all, I have to take responsibility for the health of my hips. It’s up to me to fix me. Not doctors. Not physical therapists. Not Google.

It’s so easy to visit a medical professional and expect them to rain down magical healing to my situation. Don’t get me wrong, medical professionals have their place, especially where some testing is concerned, but ultimately I’m responsible for figuring out what’s going on with my body. For me, this means taking time to put down the computer, get up, explore movements, and take careful note of how these movements make me feel and what muscles might be dysfunctional. Afterwards, I’ll often jump back on the computer to look for specific muscle groups or answers, but I CAN’T let Google do the thinking for me. I need to be naturally curious. Gone are the days where I’d lay on the couch and Google medical possibilities for hours on end but end up discouraged because I found no answers – or worse, too many horrible possibilities. Little did I realize I needed to get my butt up and explore movements for myself.

It’s way to easy to expect doctors, physical therapists, and other medical professionals to do the thinking for us. That’s a trap, because the truth of the matter is we’re just one of many, many patients they see. I’ve had physical therapists recommend cookie cutter exercises/treatments for weeks before realizing they’d forgot the actual details of my situation. I’ve had doctors see me for 15 minutes tops and then recommend hip replacements. I’ve had docs say, “It doesn’t matter what the cause is, you need a hip replacement.”

Really?

Not only that, but the way many of them (not all) are educated about the human body is simply not adequate. Many standard doctors don’t know enough about nutrition, or the way the entire body works together. Many are trained to accept common “facts” about the human body that are not facts at all, such as the “fact” that hip surgery will fix all your problems, or that all the pain is coming solely from the joint, as opposed to the muscles. One physical therapist I visited with noticed my lack of internal rotation and immediately said, “Well, that may just be because of the joint.”  What the heck does that mean? He clearly didn’t know (or have the time) to figure out what the root cause was and just used the nebulous, general term of “the joint” to diagnose (and discourage) me as unfixable unless I have surgery. I don’t think medical professionals realize how discouraging their words can be. It can shut people down from even trying to figure out the real cause and solution of an issue might be. Fast forward to today, and through trial, error, and experimentation I’m learning that I can see immediate improvements in my internal rotation by working on my internal rotator muscles through rotational lunges and reverse clams.

Who’da thought?

With all that said, I’ve had both physical therapists and doctors be very helpful in some ways. It was a different physical therapist that helped me learn that much of my pain was coming from my muscles, as opposed to the hip joint itself. And my stem cell doctor was great. Heck, we got cartilage growing back in my hip joint, which is too freakin’ cool.

All this to say, I’m learning I have to be curious about my body, because it’s up to me to fix it.

Deeper Findings: The Role of My Internal and External Rotators

The more I explore different movements, the more I am convinced that my internal rotator group of muscles in my hip are weak on the left side. In some ways, it seems obvious, especially given the fact that I have very little internal rotation on that side.

Interesting, however, is that the more I do gentle rotational lunge movements with that side, the more internal rotation I gain. Sometimes, I’ll notice an immediate improvement in my internal rotation.

And there seems to be a direct correlation between how much my pain adductors learn to lengthen (which reduces pain) and how activated my internal rotators are.

The rotational lunges I’ve been doing have been very, very helpful. The reverse clam movement seems to activate my internal rotators as well, so I need to do more of those. I’m hoping the two movement complement each other. However, with me compliance becomes an issue with any movement that requires me to lay down, simply because it takes alot of work for me to get down on the ground. Therefore, I’ve been practicing with standing movements that focus on activating my internal rotators, such as focusing on rotating my left heel out (but keep it planted to the ground) while I rotate to the left. Also, focusing on driving the left knee inward is a helpful cue. If I can find a good corner to place o the outside of heel, then that helps too. And placing my hands on my hips and feeling those muscles move is very helpful.

Speaking of placing  my hands on my hips, I can feel a clear difference when my internal rotators are active versus the external rotators, especially on my right (stronger) side. It’s extremely helpful having a stronger side to compare the weaker side to.

Upping My Game

Considering trying some/all of these for a week, in addition to what I’m already doing, to see if it helps me move even more in the right direction:

  • SUPER IMPORTANT: Rotating lunge on weak leg. Twist to left. Sarah Duvall recommends this exercise too, here. This should help your pelvic floor as well. I notice an immediate positive difference in my strength and pain level when I do these. Also, the same day I started doing these, I noticed my leg length discrepancy (while sitting on couch and leaning back with knees drawn partially up) was noticeably less. To start off, I’m doing a bunch of isometric holds first and adding in a little bit of twisting where I can. This is quite the challenge. Considering taking this movement to the pool to see if I get greater range of motion)
  • Standing leg extension for hamstrings and glutes. Progress to band when you can. Use with EMS Unit.
  • Practice putting as much weight as you can on weak leg while in internal rotation. I seem to stand better on one leg when in internal rotation, as opposed to external.
  • Glute bridge
  • Laying on stomach leg extension with EMS Unit
  • Fire hydrant tissue work
  • Walking in park or on treadmill (have done this just a couple times in the last week, so let’s do more)
  • Reverse clam
  • Normal clam (when you can do it without popping and clicking and excessive TFL activation)

Back to Doing Photo Shoots – After Six Months!

Today was an important milestone. I did my first photo shoot in six months, and I did it on ONE crutch (which was a spur of the moment decision).

I last approximately 57-ish minutes on one crutch, woot!

And it gets crazier. I went home, sat on the couch for an hour doing computer work, and when I got up my left leg/hip muscles were still turned “on”, and there was significantly less pain than when I normally just stand up from sitting. I remember going, “Whoa” as I put weight on the leg and felt it hold me up. Later on when I sat back down, and then got up again, it was more “off” like normal, but still, we’re making progress.

This changes things. While it’s still tough work being on one crutch, I need to do that more. I have grocery shopping at Kroger in my sites, and then eventually working up to the larger, Meijer.

I’d also like to start using one crutch when I walk into and out of the pool facilities. In fact, I did that today. It was a challenge (especially since I’d already completed the photo shoot in the morning, so my legs were a bit worn out), but I did it.

The strides forward (no pun intended) I’ve made these past eight days have been more than usual, and very encouraging. So what have I been doing?

  • Using my EMS (electrical muscle stimulator thingamajig) unit to help stimulate my muscle fibers while doing many of the movements listed below. I use the EMS unit 2-3 times per day, in about 10-20 minute increments each time.
  • while standing, I’ll tighten my glute medius/side muscles and let it propel my hips in the opposite direction. Important is that I keep both feet planted. It’s harder to do this on my left side than right, obviously. I’ll do a variation of this while leaning on each leg, on tiptoe, etc, whatever I can think of in the moment.
  • while standing, I’ll do a modified “hip hike”, where I’ll let my glute medius lift the hip and then propel it outward.
  • micro lunges, while twisting towards the leg that is forward and tightening the glute behind me. It’s really cool seeing the progress on these, it was painful to do them at all, even with shallow movements. As of today, however, it’s way easier. I only experience minor pain when doing shallow micro lunges. Now I can start making them a little deeper.
  • gentle deadlift/hip hinge bow
  • gentle leg extensions while leaning over counter, some while standing.
  • shifting weight side-to-side, then front and back
  • placing left leg slightly in front of me, as if I were going to take a step. And then slowly shifting my weight onto that leg. I only go as far as I can with minimal pain (I can’t get far yet). This one seemed to reduce my pain when walking with crutches and moving around in general. I’ve also started twisting away from the leg that is forward.
  • taking the stairs on occasion
  • 5-7 minutes on the elliptical (not every day yet)
  • stationary cycling
  • holding a side plank in the jacuzzi, starting today. This was challenging, even in water. Eventually I want to be able to lift the leg on top comfortably.
  • aqua exercises/jacuzzi routine for general tissue work and conditioning

Future progressions I’m considering:

  • adding weight to the leg extension while leaning over counter
  • doing the leg extension while laying flat on my stomach on the floor
  • standing on one freaking leg, yeah!
  • being able to do side-lying leg raises
  • being able to lay on my back and lift my leg
  • walking on the treadmill

Well, here I go back at it loading up for a photoshoot. After months of being humbled by these crutches, I’m slowly reintroducing myself to doing photo sessions with clients again. It’s amazing the things we take for granted until we lose them and have to work hard to get them back, like simply being able to walk. In my case, I’m working hard everyday to get my hip healthy again and battle through osteoarthritis. And you know what? The cool thing is I’m getting there, bit by bit. Each day so far brings more strength and a little less pain, woot! And it’s so flippin’ neat to see the actual cartilage growing back when the doc does imaging. I have gained an entirely new perspective and empathy for people dealing with chronic pain. Before all this, I didn’t get it. Physical fitness was my thing, and it came easy to me. Talk about learning a life lesson. Everyone is dealing with some kind of personal battle ( be it physical or emotional) , so be patient with people. And if you see someone with crutches, a cane, a walker, wheelchair, etc, then hold the door for them. Be kind. Be friendly. Don’t judge, because it could be you one day. Yes, I’m still on crutches, and yes, I have a long way to go, but so far I’m slowly moving in the right direction, and I thank God for it. The photo session went well by the way. At the last minute, I decided to do it on ONE crutch instead of two… It was a success! Here’s to baby steps! #feelingblessed #theprocessofbecoming #beatingosteoarthritis #osteoarthritis #crutchlife

Well, here I go back at it loading up for a photoshoot. After months of being humbled by these crutches, I'm slowly reintroducing myself to doing photo sessions with clients again. It's amazing the things we take for granted until we lose them and have to work hard to get them back, like simply being able to walk. In my case, I'm working hard everyday to get my hip healthy again and battle through osteoarthritis. And you know what? The cool thing is I'm getting there, bit by bit. Each day so far brings more strength and a little less pain, woot! And it's so flippin' neat to see the actual cartilage growing back when the doc does imaging.

I have gained an entirely new perspective and empathy for people dealing with chronic pain. Before all this, I didn't get it. Physical fitness was my thing, and it came easy to me. Talk about learning a life lesson. Everyone is dealing with some kind of personal battle ( be it physical or emotional) , so be patient with people. And if you see someone with crutches, a cane, a walker, wheelchair, etc, then hold the door for them. Be kind. Be friendly. Don't judge, because it could be you one day.

Yes, I'm still on crutches, and yes, I have a long way to go, but so far I'm slowly moving in the right direction, and I thank God for it. The photo session went well by the way. At the last minute, I decided to do it on ONE crutch instead of two... It was a success! Here's to baby steps!