Unwinding Musculoskeletal Compensation
…..it’s no wonder your hips and back are always in a bad mood!
My “go to” daily exercise doesn’t look much like an exercise. In fact, it isn’t exercise at all, but a isometric hold of my hamstrings in order to reposition my pelvis. My pelvis is rotated right and tipped forward in an anterior pelvic tilt. I’m not too self-conscious about this poor posture as this maladaptation is one most common postural compensations I observe in my patients.
When you spend too much time on one foot the specialized cells in your joints, called mechanoreceptors, provide a positive feedback loop that encourages you to remain biased toward a particular lower extremity, usually the right. That is to say, as you spend more time on your right foot vs. the left, your body begins to favor this musculoskeletal posture and it becomes your new normal. Your nervous system will alter the length tension relationship of muscles throughout the spine, legs, ribcage and arms, in order to accommodate this new preferred posture. As the muscles seek to stabilized your joints at these new angles, your joints are now asked to accept force at sub-optimal positions. This new normal will begin to have negative downstream repercussion that ultimately manifest at joints such the lumbar spine, hips, knees, ankles. This is the road to joint degeneration. Early manifestations of these neuromuscular maladaptations include chronic muscle soreness or tightness, repeated muscle strains or joint sprains, multiple injuries affecting just one side of your body and chronic neck and back pain.
The pelvis is formed by two hemispheres of bone, a right and left ilium and it is connected in the posterior by the sacrum and the pubic symphysis in the anterior. The sacrum is the base of the spine and consist of 5 fused vertebrae. The pubic symphysis is a joint between the left and right pubic bones separated by a pad of cartilage called a meniscus. The pelvis, while appearing rigid and stable moves quite a bit. When an individual begin to favor the right lower extremity in sitting, standing and walking, the body begins to “hold” the pelvis in a right-rotated position. However, the spine is alway trying to counter this right rotation, by rotating back to the left. This “fight” between the the compensatory right rotation of the pelvis and the counter left rotation of the spine creates tension, friction, and ultimately degeneration in the SI (sacro-illiac) joint and lumbar spine. In this postural context it begins to become obvious why so many of us suffer from back and SI pain.
As with the tension in the sacrum and spine, when the pelvis is rotated to the right the body must make compensations at both of the hips such that our thighs (femurs) are reoriented forward in right-rotated hip joints. The right femur ends up chronically internally rotated while the left femur ends up chronically externally rotated. This poor positioning of the hips has implications for both the musculature and the hip joints. Positional adaptations create muscles that are lengthened and irritated, while other muscles are shortened and irritated. The change in length and angle of the muscles causes some of the them to be, “activated” or chronically high-toned while other muscles become “inhibited” or chronically low-tone. If you have ever been told that your are not activating your glutes, a right rotated pelvis is most likely the cause of that glute inhibition. The hip joints don’t escape stress free from this positioning either as the head of the femurs no longer sit properly in the joints. The body can buffer this lack of joint congruency for awhile, sometimes decades, but eventually the joints will degrade.
Because I plan to be hiking, running and biking for decades to come, I start many of my days by activating my hamstrings. The position of my pelvis has made these muscles relatively long and weak. To activate this muscle group you will need a wall and a 4-5 inch ball.
Down Regulation and Repositioning
Lay on your back with your feet flat on a wall, knees and hips bent to 90 degrees. Place and hold the ball between your knees, squeezing the ball enough such that it does not fall. This motion activates a portion of your adductor magnus muscle that likes to behave like a hamstring. Pay attention to your foot orientation and pressure. Your toes should be point straight up to the ceiling, your feet in-line with your knees and feel a bit of pressure through the arches in your feet. Now the important part, slowly inhale for 5 seconds through your nose and then exhale through your mouth. Repeat that breathing pattern for 5 repetitions. You may feel groin muscle activation and even a bit of fatigue in this area, most likely more so on the left.
Now gently pull down on the wall with your heels, slightly elevating your tailbone off the ground. This movement should have put you in a posterior pelvic tilt; your low back should be flat on the ground. This movement activates your hamstrings. Again, you may feel more activation on the left side. Repeat the same breathing pattern as noted above, then rest for 30 seconds. The breath work in this exercise is important as the intro-abdominal pressure it creates stimulates the pelvic floor, helping to “reset” the position of your pelvis. Repeat this two step exercise 4 more times and then daily for a couple weeks.
Should your symptoms persist, try the progression below.
Neither of these exercises are “the one” exercise that you will need to fix your musculoskeletal compensations, but they are a good place to start. The exercises described above both activates your hamstrings while relaxing the low back musculature, a necessary first step in unwinding the musculoskeletal compensations described above.