The Hip: A balance of Range and Stability – by Chris Clayton
When my wife and I travel, we do as most people do; we look at the tourist attractions and marvel at them, but we also like to get away from the areas that draw the throngs of people and go investigate what lies beyond.
It was slightly different in late 2019 while we were in the beautiful Czech Republic . We were on a mission, a mission that would indulge our inner anatomy nerds in a new way. We were in Prague and investigated all of the stunning sights that it provides, when Maree booked us on a tour to Kutna Hora, an hour or so train ride away from Prague. Specifically, we wanted to look at the Sedlec Ossuary or “The Church of Bones”. I have attached a link below for you to read more about the history of the Sedlec Ossuary in case you wish to know more. The point of this trip was not only to see a peaceful Czech village with amazing Cathedrals and a rich and diverse history. We wanted to very specifically look at the 40 000 sets (approximately) of bones arranged in the Ossuary. These bones have been there a very long time, originally laid out by a sight impaired monk to keep them on hallowed ground and then later arranged more artistically in 1870. What we got to see was large arrangements of femurs and sacrums side by side in skeletal murals. What took my initial interest was the sturdiness of the neck of the femur that virtually all of them presented. Also that nearly every display that the 1870 artist had created all showed what appeared to the naked eye as strong and robust structures. After taking all of this in our eyes started to look at the variances of one femur compared to another, from one sacrum to another, acetabulum to acetabulum and so on. The remarkable thing is how much difference there can be within the same joint from human to human. It was stunning!
This leads me to this article’s topic “The Hip”. So greatly relied on for movement and stability and often pointed at by us all as an area of pain and dysfunction. Our hips are involved with so much of our movement that we very quickly notice when something is not quite right. Like the shoulder, the great ranges of movement available to the hip come with the challenge of stabilising it. Numerous myofascial units make up the stability and motivating team of the hip, with even more units overlying the hip covering two joints (Rectus Femoris and the hamstring group) to help us move when we want to. Each unit needs to play its part in the right sequence with the correct movement in the right timing with the appropriate tonus. So it is not too hard to imagine that it only takes one or two of these units to be out of synchronicity to cause us some of that aforementioned pain or discomfort.
Add in what we took away from the Sedlec Ossuary, which was a very clear confirmation of the varied individualised nature of our skeletal composition – even if it appears to be minor it is very noteworthy. Contemplating all of this would leave us thinking that treating the hip and body as a whole is a complex jigsaw puzzle of pains, patterns and posture. Thankfully, there are many brilliant practitioners from a wide range of modalities and professions than can and have helped countless numbers of us. For me, this is where Anatomy Trains Structural Integration (ATSI) was instrumental in broadening and deepening my approach to bodywork. More specifically, within the ATSI training syllabus we will find the Structural Essentials (Part One) series of workshops. There are six modules within Structural Essentials (Part One), and this is where we will find the Fans of Hip workshop. This module like all of the Structural Essential modules is a building block for students going on to Part 2 or all the way to Part 3 to become Certified Structural Integrators. These modules can also be stand alone workshops for those wanting to investigate that specific region of theory and treatment.
Like all Anatomy Trains workshops, we get to study and apply theory and technique using the Anatomy Trains lines as our roadmap and to assist us in forming our systems versus symptoms strategies.
What do we mean by a system versus symptom strategy? I once had a strongly built, retired gentleman with a sore knee come to the clinic. We did our normal pre-screen, history and bodyread. I then started working on his hip. The gent was a little abrupt with me (understandably, we can all be a little abrupt when in pain) and said “it’s my knee you know not my hip!” What had taken my eye in the functional assessments was that he did not achieve an easy balance of triflexion (of ankle, knee and hip) and that most of the restriction was at the hip. As most of us know when even doing a simple squat we need adaptability at all three of these joints to achieve a healthy functional movement. In this case, further assessments indicated that the restriction was in both flexion and extension (SFL and SBL) of the hip, which in turn was causing the knee to do more than its share. He also displayed little or no lateral adaptability (LL) on that side during the mid stance/single leg support component of stance phase. Add to that that his history told me of a prosthetic hip on that side and my touch told me there were issues and held areas within the region of the old surgical scar. Ease the hip, allow it to function to the best of its ability and stability and the knee (with some minor work) improved to the point where walking with his friends was once again an enjoyable part of the day.
As a therapist, my ATSI training gave me the sure footedness to manage and assist a client who was quite adamant that his knee should be treated and not his hip. My confidence gave him confidence and not only did we get a happy knee, I got a happy client who could not initially believe the change but went on to tell many others about the work.
Chris Clayton
References:
Upcoming Fans of the Hip workshops:
Fremantle, WA: 24th & 25th January 2023
Sydney, NSW: 3rd, 4th & 5th March 2023
Taiwan: 25th & 26th February 2023
To find out more about this workshop, please click HERE