How does NMT work?

Hip pain is common problem, and it can be confusing because there are many causes.  The most common cause of Hip Pain is arthritis for which you will need to see your GP for them to advise on the best treatment option of you. Trochanteric Bursitis Trochanteric bursitis is an extremely common problem that causes inflammation of the bursa, which is a protective cusion over the outside of the hip joint.  There are two main bursa which protect the hip joint, the superficial trochanteric bursa and the deep trochanteric bursa.  The superficial trochanteric bursa lies beneath the tensor fasciae latae (one of the muscles on the side of your hip) and the deep trochanteric bursa lies beneath the the largest of your glutes (gluteus maximus) both of the these muscles insert in to the Iliotibial Band (ITB).  Reduced flexibility in your gluteus maximus, tensor fasciae latae or ITB can cause trochanteric bursitis, from too much cycling or running or from running on uneven surfaces.  Another common cause is some women is an imbalance between your abductor and adductor muscles.  Trochanteric bursitis can also be caused by clients altering their posture as a result of a previous back injury. In all these cases a deep tissue or sports massage can help.  However if the cause is walking with more weight going through the outside of your foot (excessive foot eversion) then your make need to see a podiatrist for personalized orthotics. Hip Flexors Illiopsoas the main hip flexor, shortens when we sit down, so prolonged sitting can cause contracture (anatomical shortening) which can cause either lower back or hip pain.  I have personally found this to be a common cause of hip pain which can be successfully treated with deep tissue or sports massage. If you experience lower back or hip pain when standing up from a seated position then rectus femoris which is one your largest quadriceps muscle make be tight and/or your gluteus maximus which is the other muscle which helps your stand from a seated position may be weak.  If you suspect you have weak glutes you can strengthen them with squats and lunges. Fractures Hip fractures are common in the elderly with osteoporosis.  Stress fractures of the hip are common in people who participate in high impact sports e.g. long distance running, treatment is usually to avoid the high impact sport and this is usually successfully. When should I see my GP about my hip pain?  

• Inability to walk comfortably on the affected side
• Injury that causes deformity around the joint
• Hip pain that occurs at night or while resting
• Hip pain that persists beyond a few days
• Inability to bend the hip
• Swelling of the hip or the thigh area
• Signs of an infection, including fever, redness, warmth
• Any other unusual symptoms

  If you want to know if Vitality Therapy can help you with your hip pain then please email joanne@vitalitytherapy.co.uk.

Chair sitting is unique in that Gluteus maximi are totally relaxed at the same time as having an upright torso, and they are therefore not able to contribute to lumbar extension and back stabilization as they usually do. Without the help of the Gluteal muscles, the Erector Spinae muscles above become tired and painful in a very short time, and give up fighting to maintain the correct "hollow" in the lumbar spine. The diagram on the left indicates what happens to three key muscles when you spend long periods of time sitting. The Hamstrings (H) are shortened by sitting.  Also, during sitting, the Gluteus Maximus (GM) is relaxed and unable to tension the lumbosacral fascia.  This means the Errector Spinae (ES) muscle group must therefore perform the entire lumber extension workload. This article discusses the link between lower back pain and the following muscle problems:-

1. Shortening of the hamstring muscle.
2. Overworking of the Erector Spinae muscle group and the development of trigger points.
3. Overworking of the Iliopsoas muscle group and the development of trigger points.

Hamstrings are shortened and inactive while sitting causing tension.  This is so common I will write a separate blog most on Hamstrings. Without the help of the Gluteal muscles the Erector Spinae muscles become tired and painful very quickly and struggle to maintain the correct "hollow" in your lower back.  Even thought you may consider sitting an apparently restful posture it is actually an intense workout for the Erector Spinae and the Iliopsoas muscle groups. If you are not using a full and appropriately shaped chair back, your Iliopsoas muscles must pull your torso forward to stop you falling backward, and they have to do that at the short end of their range of contractile length. That is a sure fire recipe for Iliopsoas muscle shortening and development of trigger points. Here are some indications that you have a shortened Iliopsoas

• Diffuse achy - type pain radiating out from the groin area to the lower back, and possibly around to the side of the hip and the butt area. If the trigger points in the groin are not pressed, the pain is not sharp or stabbing.
• Relief of pain is often experienced by sitting down.
• Worse upon lengthening the iliopsoas, i.e. when one stands up, or straightens the hip joint.
• Worse for doing situps.
• Worsened by externally rotating the hip (i.e. making the knee cap look outward) when the hip joint is fully extended.
• In patients with sciatic nerve pain, lying flat on one's back with the legs out straight causes the trigger point tightened iliopsoas to compress the lumbar vertebrae together, with the result that the nerve roots of the sciatic nerve are compressed too.
• When lying flat on one's back, doing a straight leg raise reveals weakness on the affected side.
• In patients with sciatic nerve pain due to nerve root compression, lying flat on one's back with legs out straight stretches that trigger point tightened iliopsoas. The result is that the iliopsoas compresses the lumbar vertebrae together, and the the nerve roots of the sciatic nerve are compressed at the same time.

All the side effects of sitting for long periods of time can be addressed by deep tissue massage.

Following on from my last article on elbow pain, I wanted to share with you some exercises for increasing the mobility and strength of your elbow joint.

1. Stand or lie down. Bend and straighten your elbow to its outer limits without creating pain. Repeat 5 to 10 times.
2. Sit with your forearm flat on a table and the palm of your hand against the table top. Then turn your forearm so that the back of your hand is resting on the table and then turn your forearm again so the palm of your hand is against the table.  Repeat 5 to 10 times.
3. Practice screwing and unscrewing a screw with a screwdriver, while holding your upper arm close to your body.   Repeat 5 to 10 times.
4. Hold a dumb-bell in your hand (or a can from your kitchen cupboard) and then bend and straighten the elbow joint.  Repeat 5 to 10 times.  You can gradually increase the weight to build strength.
5. Stand up and do press ups against a wall.  Ensure that you bend your elbow to the maximum and fully straighten your arms.  Repeat 5 to 10 times.
6. Hold a barbell in your hands (or a mop handle or broom handle), bend and straighten your elbow joint.  Repeat 5 to 10 times.

Static Stretching Exercises

1. Flex one elbow joint to 90 degrees, then with your other hand resist your bent arm trying to touch your shoulder for 4 - 7 seconds and relax for 2 seconds.
2. Straighten your arm backwards and take hold of a banister or something similar with your outstretched hand and stretch for 6-8 seconds by bending your knees.