Treating hip asymmetry is part of what I would call the bread and butter of Sports Medicine Acupuncture®.
When a patient comes in with low back pain, knee pain, leg pain, or sometimes even neck and shoulder pain, one of the first things we do is pull out our measuring device and take exact measurements of the angle and tilt of their hips. This can give us a lot of information right away about which muscles are currently working correctly and which are stuck in either a too short or too long position.
Why Hip Asymmetry Matters
Our hips are the foundation of our posture and our movements. If our hips are asymmetrical, then muscle compensations will exist and they are almost always accompanied by pain and or weakness in the muscles or joints.
Short term, hip asymmetry can lead to inefficient or ineffective muscle firing, meaning you’re working as hard as you can to train, but you’re constantly working from a disadvantaged position.
Over longer periods of time, the asymmetry will eventually cause wear and tear on the joints and connective tissues that can contribute to chronic conditions such as arthritis, chondromalacia, or tendinitis.
A Real World Example of Treating Hip Asymmetry
Patient is a healthy 48 year old active male who likes to cycle and lift weights.
For several years, he’s noticed when he cycles that his right leg is able to drive harder than his left leg. He also notices his right leg is bigger and stronger than his left leg.
After several miles, it feels like his right leg is “filling up with fluid” and it begins to hurt. He describes the pain as a burning sensation in the right lateral part of his quad, IT-Band attachment, and proximal patella (kneecap).
In the last two weeks, the pain has become so severe that he has been unable to cycle and even when he’s just walking he has a noticeable limp.
What We Found
Right away, I suspected the root of this patient’s problem was asymmetrical hips.
I pulled out my measuring tool and I found his hips had an 8 degree tilt on the right and only a 5 degree tilt on the left. His right side was also elevated 1.5 degrees compared to the left.
So, I know right away that the muscles connected to the back of his left hip (primarily his glutes and hamstrings) are shortened compared to the right and the muscles connected to the front of his right hip (primarily the TFL and quads) are shortened compared to the left.
After measuring his hips, I had the patient perform a squat assessment to see if his movement patterns matched the measurements I took. Like most well-trained athletes, his squat form was pretty good and he was pretty good at hiding his deficiencies, but when his left knee started moving towards the centerline every time he squatted I knew my suspicions were confirmed. His left glutes were weak and not firing correctly.
I put him on the table and performed some manual muscle tests so I could try to get a feel for what I had just seen and measured.
I pulled his left leg away from the centerline and asked him to resist as I pushed it back towards the centerline. He couldn’t do it. His left glutes were barely working and couldn’t resist the modest amount of pressure coming from my hand.
I tested his range of motion in both hips and it appeared to be normal and I checked the right hip (the painful side) for evidence of arthritis and found none.
I also checked his right side for tightness in the TFL muscle using a special test called Ober’s test and it was positive.
Tightness in this muscle often leads to IT-Band friction syndrome, which causes pain on the lateral aspect of the quad and knee.
At this point, I felt we had a very good “complete picture” of why his right leg always felt like it was working overtime when he cycled and how that had eventually led to the development of pain in his quad and knee.
The Treatment Plan
The patient came in nine times between February 22nd and April 22nd.
Each visit we would start by stimulating the muscle motor points of the affected muscles using acupuncture in order to reset their relative positions in space.
An electrostim device would be connected to some of the needles to help facilitate this “resetting” and also to help bring inflammation and pain down in the relevant areas.
After acupuncture and e-stim, we would use PNF stretching to stretch his glutes, hamstrings, iliopsoas, and quads. Stretching these muscles is an important part of helping his hips to get back to a neutral alignment.
I also taught him postural corrective exercises that he performed diligently to help correct his hip alignment.
A couple times I performed cupping on his right IT-Band to help break up the tight fascial adhesions and allow the tissue to glide more smoothly over the muscle when he exercised.
During his first follow up, the patient noticed he had become acutely aware of how poorly his left glutes were firing when he was trying to cycle or squat.
A big part of what we do with Sports Medicine Acupuncture® is to bring awareness to various parts of the body by increasing proprioception (your internal awareness of your body) of those areas.
I noticed at the beginning of this treatment that his limp was already gone.
During his fourth treatment, after challenging his left glutes again and finding that they were now firing correctly, I recommended that the patient start to slowly ramp up the length and intensity of his bike rides.
At his fifth treatment, he said he felt significantly reduced swelling and pain after his ride, but he noticed some muscle soreness in his left glutes after training that he wasn’t used to feeling. This is a sign to me that his left glutes are starting to “come back to life” and do more work when he trains.
By his sixth treatment, he told me this is the most relief he’s felt with his right leg in years.
By his seventh treatment, he said he was able to do a heavy squat workout and a long ride without any aggravation to his right quad and knee.
When he gave me a similar report during his eighth treatment, I recommended we push out his next treatment two weeks to give him some time to really test it and see how he does without any interventions on my part.
During his ninth treatment, he said he felt almost 100% better and that he was continuing to train without any aggravation to his right side.
I would consider this patient to effectively be done with treatment.
It’s common for connective tissue injuries to linger a little while after getting 90% better fairly quickly. If he continues to do his exercises and train mindfully, he will make a full recovery on his own.
He can also come in every couple weeks for a tune up, which will give me an opportunity to make sure his body isn’t trying to revert to his previous patterns and also to facilitate the last 10% of his recovery, but this phase of treatment is usually optional.
Hip asymmetry isn’t always necessary for imbalance and chronic injuries to develop.
When I catch a patient like this one, I get excited because I know I have exactly the right tools and techniques to give them a lot of relief fairly quickly.
Another patient may have chronic low back pain and when I measure their hips they appear to be symmetrical, but they still have imbalances between the front and back of their body or between the lateral muscles and medial muscles.
These patients would get a similar approach, but we would emphasize different muscle groups, different stretches, and different exercises to help them find balance.
Check out Sean’s Sports Acupuncture Case Study blog for more articles like this!