Guest guest Posted October 19, 2003 Report Share Posted October 19, 2003 Jo, It sounds like from your description of symptoms that the pain increases as speed and stretch increase (as opposed to just speed). In a sprint, as speed increases, so does the ROM. Also, with an injury or regular training, adhesions and scar tissue are likely to form within and between the soft tissues (even more so if the training induces high cortisol levels and inadequate recovery). These adhesions change the elastic properties locally causing either point specific pain or general pain in the region. This could cause the symptoms that you've described. You could try using a couple of glute, hamstring and piriformis stretches to get more information. Compare active and passive flexibility in these stretches bilaterally. I would then try a few PNF techniques to reduce reciprocal inhibition. Then perform the tests again to check for any neurological relaxation. If the changes are not significant, obvious bilateral differences are still present, or the symptoms aren't immediately improved then there are likely some adhesions. I would advise asking your therapist about this and check into someone specializing in ART or myofascial release. They could enlighten you more in this area for I am certainly not an expert in either of these techniques. I will say that when experimenting with various PNF techniques (each individual will react differently to various techniques, and this may differ from muscle to muscle) and the two above mentioned techniques, I have seem some impressive improvements in both pain and performance. I have also seen these techniques used to get immediate improvements in lifting technique. Good luck and I hope this helps. J s MS, CSCS, NSCA-CPT College of ton, SC 29401 USA (843)953-1424 jjacobs24@... Basketballer Rehab Hi supertraining group, here is my request: A basketball player complained about soreness and slight disturbance to run at max speed coming from the left glute area without locating a specific point, about 4 months ago. It disappear the few following weeks while keeping away from the court. He then went under an individual resistance/plyometric training this summer during which it never came back and went well. The physio at first, identified what I thought it was: a strain highly likely in the glute medius. The off season went well: he was doing progressive resistance training and various exercises, combined with rehab and finally compensated the deficit in term of strength of his glute between left and right via selected exercises. Unfortunately, following 12 weeks of training, it came back 3 weeks ago. Nothing particular seems to trigger it, as it is very difficult to control what I was doing outside. It has come to the point where he has a sore glute especially when waking up and slightly limp while walking, still after 3 weeks of nothing. The physio advice to get on with it and therefore, I stopped him with lower limb exercises. Even after a substantial stop of nearly 3 weeks, the soreness still appears sparingly here. It seems to be speed related and not very much directional related as he can do various SAQ exercises while warm up and fast feet exercises at decent speed without discomfort. However, impossible for him to feel confident on a progressive run of 30m straight line increasing speed to max. I have come to the point where I got confused and mostly unable to identified the problem but mostly the relevant solution. Therefore, any suggestion, shared experience or past problem regarding gluteus area would be greatly appreciated as I tried to provide as much information as I could. Regards Jo Brun, Bath, UK. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 19, 2003 Report Share Posted October 19, 2003 Jo, It sounds like from your description of symptoms that the pain increases as speed and stretch increase (as opposed to just speed). In a sprint, as speed increases, so does the ROM. Also, with an injury or regular training, adhesions and scar tissue are likely to form within and between the soft tissues (even more so if the training induces high cortisol levels and inadequate recovery). These adhesions change the elastic properties locally causing either point specific pain or general pain in the region. This could cause the symptoms that you've described. You could try using a couple of glute, hamstring and piriformis stretches to get more information. Compare active and passive flexibility in these stretches bilaterally. I would then try a few PNF techniques to reduce reciprocal inhibition. Then perform the tests again to check for any neurological relaxation. If the changes are not significant, obvious bilateral differences are still present, or the symptoms aren't immediately improved then there are likely some adhesions. I would advise asking your therapist about this and check into someone specializing in ART or myofascial release. They could enlighten you more in this area for I am certainly not an expert in either of these techniques. I will say that when experimenting with various PNF techniques (each individual will react differently to various techniques, and this may differ from muscle to muscle) and the two above mentioned techniques, I have seem some impressive improvements in both pain and performance. I have also seen these techniques used to get immediate improvements in lifting technique. Good luck and I hope this helps. J s MS, CSCS, NSCA-CPT College of ton, SC 29401 USA (843)953-1424 jjacobs24@... Basketballer Rehab Hi supertraining group, here is my request: A basketball player complained about soreness and slight disturbance to run at max speed coming from the left glute area without locating a specific point, about 4 months ago. It disappear the few following weeks while keeping away from the court. He then went under an individual resistance/plyometric training this summer during which it never came back and went well. The physio at first, identified what I thought it was: a strain highly likely in the glute medius. The off season went well: he was doing progressive resistance training and various exercises, combined with rehab and finally compensated the deficit in term of strength of his glute between left and right via selected exercises. Unfortunately, following 12 weeks of training, it came back 3 weeks ago. Nothing particular seems to trigger it, as it is very difficult to control what I was doing outside. It has come to the point where he has a sore glute especially when waking up and slightly limp while walking, still after 3 weeks of nothing. The physio advice to get on with it and therefore, I stopped him with lower limb exercises. Even after a substantial stop of nearly 3 weeks, the soreness still appears sparingly here. It seems to be speed related and not very much directional related as he can do various SAQ exercises while warm up and fast feet exercises at decent speed without discomfort. However, impossible for him to feel confident on a progressive run of 30m straight line increasing speed to max. I have come to the point where I got confused and mostly unable to identified the problem but mostly the relevant solution. Therefore, any suggestion, shared experience or past problem regarding gluteus area would be greatly appreciated as I tried to provide as much information as I could. Regards Jo Brun, Bath, UK. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 19, 2003 Report Share Posted October 19, 2003 Jo, The type of injury you're describing has the potential to cascade into a more complex and more debilitating problem. When the gait is altered, in this case as a result of a hip/glute injury, the body will move in a manner to avoid the injured part. It can't bear the load because it's injured, so some other muscle/muscle group has to pick up the responsibility for executing the movement pattern. When a muscle/muscle group assumes responsibility for executing a movement pattern for which it's not intended, an additional injury develops. The cycle continues. I had a severe hip problem myself that has required a number of treatment modalities before I regain functionality. Rehabbing your client will most likely NOT be a one-step process where a simple exercise or stretch makes him better. I'll boil down my advice regarding your client because every case is different. There are some basic places to start, however. First, you need to be able to perform an assessment of your client's hip/pelvic structure. If your client has an inherent pelvic/hip misalignment, it will be difficult to improve his condition. Kind of like a misalignment on the front end of a car; you can keep replacing the tires, but until you realign the front end, the tires will wear quickly. If you haven't been trained to do so, I recommend you refer the client to someone who can perform the assessment and tell you where the areas of concern lie. Start by getting an assessment of both left and right internal and external hip rotators. Make sure the assessment includes an actual measurement in degrees of rotation and that you know the acceptable range as well as where your client lies relative to the acceptable range. Know the placement of the pelvis; is it anteriorly tilted or posteriorly tilted? If so, how much? These are just starting points - there are a lot of other tests that can be performed to assess and alignment and muscle function. From there, a program needs to be designed to realign the body accordingly. All movement originates from posture; if the posture is faulty, there's a higher risk for injury, especially as time and the activity progresses. Second, it sounds like it's time to refer your client to a competent neuromuscular therapist (NMT). I'm not sure if the U.K. uses the same term as the U.S. uses for this type of work. An NMT has different training from a physio and a massage therapist. (Although some physios may be trained as NMT's too.) They have the ability to manipulate muscles and tendons in a unique way. A competent NMT can realign things you would never think could be realigned. Regarding my own hip problem, my sacrum was grossly mislocated, causing tremendous pain sitting and referring pain throughout my entire lumbar region in just about any activity I performed. My NMT literally repositioned my sacrum. In one visit, 20+ years of restricted hip movement were gone!!! It was like getting a new hip. I had tendonitis in both elbows from years of abuse. Doing pushdowns using even the lightest weights caused pain. He spent 10 minutes manipulating the tendons and muscles attached to the joint and I walked out amazed. The list goes on (I had my own project list, having beaten up my body for decades). Based on your description of the location and frequency of the glute pain and the way the pain progresses, your client could very well have a misalignment that's causing pain to the piriformis. Given the compensating pattern of his gait, there may be a number of things getting pinched. A good NMT who knows his/her anatomy and kineosiology cold can get to the root cause fairly efficiently, so it's well worth the time and money. Best wishes, Barb Dunn, CSCS Indianapolis, IN > Hi supertraining group, here is my request: > > A basketball player complained about soreness and > slight disturbance to run at max speed coming from the > left glute area without locating a specific point, > about 4 months ago. It disappear the few following > weeks while keeping away from the court. > He then went under an individual resistance/plyometric > training this summer during which it never came back > and went well. The physio at first, identified what I > thought it was: a strain highly likely in the glute > medius. The off season went well: he was doing > progressive resistance training and various exercises, > combined with rehab and finally compensated the > deficit in term of strength of his glute between left > and right via selected exercises. Unfortunately, > following 12 weeks of training, it came back 3 weeks > ago. Nothing particular seems to trigger it, as it is > very difficult to control what I was doing outside. > > It has come to the point where he has a sore glute especially > when waking up and slightly limp while walking, still > after 3 weeks of nothing. The physio advice to get on > with it and therefore, I stopped him with lower limb > exercises. Even after a substantial stop of nearly 3 > weeks, the soreness still appears sparingly here. It > seems to be speed related and not very much > directional related as he can do various SAQ exercises > while warm up and fast feet exercises at decent speed > without discomfort. However, impossible for him to > feel confident on a progressive run of 30m straight > line increasing speed to max. > > I have come to the point where I got confused and mostly > unable to identified the problem but mostly the > relevant solution. > > Therefore, any suggestion, shared experience or past > problem regarding gluteus area would be greatly > appreciated as I tried to provide as much information > as I could. > > Regards > > Jo Brun, > Bath, UK. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2003 Report Share Posted October 22, 2003 Jo: Check reflexes and muscle strength. Any weaknesses or positive neurological changes could (and most often does) indicate an injury to the back such as a bulging disc or nerve root impingement. Mike Hadden MS LAT ATC CSCS STS Program Director of Athletic Training & Exercise Science Simpson College Indianola, IA 50125 >Jo, > >It sounds like from your description of symptoms that the pain increases >as speed and stretch increase (as opposed to just speed). In a sprint, as >speed increases, so does the ROM. Also, with an injury or regular >training, adhesions and scar tissue are likely to form within and between >the soft tissues (even more so if the training induces high cortisol >levels and inadequate recovery). These adhesions change the elastic >properties locally causing either point specific pain or general pain in >the region. This could cause the symptoms that you've described. You could >try using a couple of glute, hamstring and piriformis stretches to get >more information. Compare active and passive flexibility in these >stretches bilaterally. I would then try a few PNF techniques to reduce >reciprocal inhibition. Then perform the tests again to check for any >neurological relaxation. If the changes are not significant, obvious >bilateral differences are still present, or the symptoms aren't >immediately improved then there are likely some adhesions. I would advise >asking your therapist about this and check into someone specializing in >ART or myofascial release. They could enlighten you more in this area for >I am certainly not an expert in either of these techniques. > >I will say that when experimenting with various PNF techniques (each >individual will react differently to various techniques, and this may >differ from muscle to muscle) and the two above mentioned techniques, I >have seem some impressive improvements in both pain and performance. I >have also seen these techniques used to get immediate improvements in >lifting technique. Good luck and I hope this helps. > > J s MS, CSCS, NSCA-CPT >College of ton, SC 29401 USA >(843)953-1424 > >jjacobs24@... > > > Basketballer Rehab > > > Hi supertraining group, here is my request: > > A basketball player complained about soreness and > slight disturbance to run at max speed coming from the > left glute area without locating a specific point, > about 4 months ago. It disappear the few following > weeks while keeping away from the court. > He then went under an individual resistance/plyometric > training this summer during which it never came back > and went well. The physio at first, identified what I > thought it was: a strain highly likely in the glute > medius. The off season went well: he was doing > progressive resistance training and various exercises, > combined with rehab and finally compensated the > deficit in term of strength of his glute between left > and right via selected exercises. Unfortunately, > following 12 weeks of training, it came back 3 weeks > ago. Nothing particular seems to trigger it, as it is > very difficult to control what I was doing outside. > > It has come to the point where he has a sore glute especially > when waking up and slightly limp while walking, still > after 3 weeks of nothing. The physio advice to get on > with it and therefore, I stopped him with lower limb > exercises. Even after a substantial stop of nearly 3 > weeks, the soreness still appears sparingly here. It > seems to be speed related and not very much > directional related as he can do various SAQ exercises > while warm up and fast feet exercises at decent speed > without discomfort. However, impossible for him to > feel confident on a progressive run of 30m straight > line increasing speed to max. > > I have come to the point where I got confused and mostly > unable to identified the problem but mostly the > relevant solution. > > Therefore, any suggestion, shared experience or past > problem regarding gluteus area would be greatly > appreciated as I tried to provide as much information > as I could. > > Regards > > Jo Brun, > Bath, UK. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2003 Report Share Posted October 22, 2003 Jo: Check reflexes and muscle strength. Any weaknesses or positive neurological changes could (and most often does) indicate an injury to the back such as a bulging disc or nerve root impingement. Mike Hadden MS LAT ATC CSCS STS Program Director of Athletic Training & Exercise Science Simpson College Indianola, IA 50125 >Jo, > >It sounds like from your description of symptoms that the pain increases >as speed and stretch increase (as opposed to just speed). In a sprint, as >speed increases, so does the ROM. Also, with an injury or regular >training, adhesions and scar tissue are likely to form within and between >the soft tissues (even more so if the training induces high cortisol >levels and inadequate recovery). These adhesions change the elastic >properties locally causing either point specific pain or general pain in >the region. This could cause the symptoms that you've described. You could >try using a couple of glute, hamstring and piriformis stretches to get >more information. Compare active and passive flexibility in these >stretches bilaterally. I would then try a few PNF techniques to reduce >reciprocal inhibition. Then perform the tests again to check for any >neurological relaxation. If the changes are not significant, obvious >bilateral differences are still present, or the symptoms aren't >immediately improved then there are likely some adhesions. I would advise >asking your therapist about this and check into someone specializing in >ART or myofascial release. They could enlighten you more in this area for >I am certainly not an expert in either of these techniques. > >I will say that when experimenting with various PNF techniques (each >individual will react differently to various techniques, and this may >differ from muscle to muscle) and the two above mentioned techniques, I >have seem some impressive improvements in both pain and performance. I >have also seen these techniques used to get immediate improvements in >lifting technique. Good luck and I hope this helps. > > J s MS, CSCS, NSCA-CPT >College of ton, SC 29401 USA >(843)953-1424 > >jjacobs24@... > > > Basketballer Rehab > > > Hi supertraining group, here is my request: > > A basketball player complained about soreness and > slight disturbance to run at max speed coming from the > left glute area without locating a specific point, > about 4 months ago. It disappear the few following > weeks while keeping away from the court. > He then went under an individual resistance/plyometric > training this summer during which it never came back > and went well. The physio at first, identified what I > thought it was: a strain highly likely in the glute > medius. The off season went well: he was doing > progressive resistance training and various exercises, > combined with rehab and finally compensated the > deficit in term of strength of his glute between left > and right via selected exercises. Unfortunately, > following 12 weeks of training, it came back 3 weeks > ago. Nothing particular seems to trigger it, as it is > very difficult to control what I was doing outside. > > It has come to the point where he has a sore glute especially > when waking up and slightly limp while walking, still > after 3 weeks of nothing. The physio advice to get on > with it and therefore, I stopped him with lower limb > exercises. Even after a substantial stop of nearly 3 > weeks, the soreness still appears sparingly here. It > seems to be speed related and not very much > directional related as he can do various SAQ exercises > while warm up and fast feet exercises at decent speed > without discomfort. However, impossible for him to > feel confident on a progressive run of 30m straight > line increasing speed to max. > > I have come to the point where I got confused and mostly > unable to identified the problem but mostly the > relevant solution. > > Therefore, any suggestion, shared experience or past > problem regarding gluteus area would be greatly > appreciated as I tried to provide as much information > as I could. > > Regards > > Jo Brun, > Bath, UK. Quote Link to comment Share on other sites More sharing options...
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