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Barry Wahner, DC — 4931 Wissahickon Ave (near Rte 1), Philadelphia, PA 19144 — 215.842.2227

If you have problems in your hips or pelvis, the usual treatment is:

 Anti –inflammatory medication and rest

The result is predictable:

Temporary reduction in symptoms and then symptom flare-up .







Getting “Hip” to It

Getting the finest care, with a chiropractor who truly partners with you, can change the quality of your life. This article can guide non-athletes as well as ambitious cyclists and other athletes. So read on!

“I have no power in my leg!” “My hips ache.” “My back hurts.” “I think I pulled my groin.” “My pelvis is out.” “It just hurt,s Doctor!”

Of the different complaints heard from cyclists, the hip area is one of the most commonly involved. Cyclists (as well as all athletes) require strength and stability from the hip and pelvis. Without it they can’t transfer the power from the core muscles into the legs.

If you have problems in your hips or pelvis there is much to consider. Too often athletes are given a simplistic diagnosis without thorough consideration of all that could be involved. The diagnoses often given are: Bursitis, a pulled muscle or a pinched nerve. Oddly enough the treatment always seems the same:  Anti –inflammatory medication and rest. The result of this type of “care” is predictable: Temporary reduction in symptoms and then symptom flare-up with return to sport.

Problems in the hip are often multi factorial. This essentially means there are several issues involved and all must be discovered and addressed for the best results. A proper evaluation must include:

  • A history of the problem, a history of their training
  • Description of any recent changes in equipment
  • Description of the symptoms including where these symptoms are felt. It is best to have the athlete point or touch the areas involved as it is amazing where people think their hips are!
  • Physical evaluation including posture, gait, mobility, palpation, strength testing and flexibility testing

Without this thorough evaluation you can’t properly treat the problem. We must also identify things that make your symptoms keep coming back, such as:

  • Faulty mechanics in the pelvis, hip, spine or lower extremity such as tight muscles, restricted movements, weak muscles
  • Structural imbalance in the feet such as foot pronation, hypomobile ankles, tight calves
  • Compensation in movement patterns due to other injuries or problems
  • Equipment issues such as improper bike fit or improper shoes

It may sound like a daunting task to get an evaluation that thorough, but the greatest challenge is really in finding a doctor or therapist who understands the mechanics of the hip and pelvis AND the demands of your sport.  When you properly diagnose and evaluate a hip problem, you can then fully treat the condition.

With “cookie cutter” treatment you are destined to have chronic, recurrent hip problems that hurt your performance -- or prevent you from participating in your sport!  As an athlete you don’t have time to waste when you are injured You need to get back to training and competing. To do that you must work with a professional who understands your sport and your athletic mindset.
Some common issues in cyclists that lead to pain and problems in the hip and pelvis are:

  • Sacroiliac joint dysfunction
  • Short/tight hamstrings and hip flexor muscles
  • Weak gluteal muscles
  • Weak lumbar extensor muscles
  • Pronated foot
  • Short/tight calf muscles
  • Pelvic or spinal joint dysfunction.

The common denominator for these issues is they lead to imbalance in strength and movement in the pelvic and hip joints. This causes compensation patterns which lead to pain, inflammation and overuse injury. When the doctor looks only at the area of pain and does not fully evaluate the entire “kinetic chain” from the foot up to the spine these other factors are not accounted for and thus not treated. Treating only the painful area may provide temporary symptom relief with the symptoms returning or never fully resolving. The longer this goes on the more the athlete develops compensatory patterns of movement leading to deeper problems.

Case example:
An elite level cyclist presents for treatment of right hip pain. He has no history of recent crashes or other trauma and no history of fracture or surgery to the pelvis, hips or legs. The pain began a couple weeks ago after a weekend of cyclocross racing. Thus far he has raced 8 times this cyclocross season.

Prior to this he raced a full season on the road without significant hip problems.  When asked to point to the pain he touches a point on the upper right buttock. He feels the pain especially when remounting the bike but also when rising up from sitting or when climbing steps.  He feels like he can pedal hard, but there is pain during these hard efforts.

Evaluation showed his pelvis to be low on the right side and rotated posterior. He had full right hip range of motion in all planes but there was pain in hip extension and hip external rotation. Low back range of motion was limited modestly in extension and there was pain in low back extension, rotation and flexion. Tenderness and tightness was noted in the right low back and the right hip flexor. Tenderness was noted in the right sacroiliac joint. Both hamstrings were short and tight. The hip flexors were tight and tender especially the right side. The gluteal muscles bilaterally and the right hip flexors muscles were weak. His gait was normal. Sit to stand was normal but reported as painful. Squat test caused both feet to collapse into pronation (with the right side more significant) and his lumbar spine went into flexion (he could not maintain a straight back). Intersegmental joint motion revealed restrictions in the sacroiliac joint on the right, the right lower two vertebrae and the lower thoracic vertebrae.

Diagnosis: Acute right sacroiliac joint pain and dysfunction

  • Joint manipulation of the lumbo-pelvic area on the right to restore motion and posture of the pelvis
  • Ice to the right lumbo-pelvic area to reduce inflammation and pain
  • This treatment helps the acute pain and inflammation but does NOT address the underlying issues that generated the problems to begin with. If that was the only care provided, symptom relief is expected but pain will likely return upon the next race or hard training session

Underlying problems leading to the acute sacroiliac pain were:

  • Tight and short hamstrings and hip flexors
  • Weak gluteal muscles and low back extensor muscles
  • Pronated feet

Therapy to address each of these problems brought balance to his hips and pelvis. He followed my therapy recommendations:

  • Specific stretches multiple times a day to lengthen the hamstrings and hip flexors
  • Exercises to facilitate and strengthen the gluteal and low back muscles
  • Custom molded foot beds were made and he was instructed to use them in all shoes, including cycling shoes

By performing these exercises he gained the benefits that were top priority for him:

  • Restored strength and balance
  • He completed a full season of cross racing without any further pain or stiffness!

In your athletic life, and other daily life, you deserve the same kind of evaluation and care for your injuries and pains. Your health and happiness are important!

Work with a professional who understands you and the demands on your body of any sports you love. You'll want a complete evaluation to find not just the acute problem but also the underlying factors which led to the problem.

By taking this more thorough approach to your evaluation and your treatment, you will have better results and less chance of chronic issues that slow you down. Getting the finest care, with a chiropractor who truly partners with you, can change the quality of your life.



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