Hip Pain Treatment: The hip rotators and the deep six muscles.

Hip pain is caused by excessive muscular tension in the lower body which pulls the pelvis (hip bone) out of alignment, which causes pain. Additionally, tightened hip rotator muscles restrict range of motion in the hip socket, which wears down the cartilage inside the hip socket. Hip pain is a musculo-skeletal problem.   

Hip pain causes

Hip pain involves a series of muscles. All the muscles that attach to or surround the pelvis need to be treated to unwind hip pain.  Muscles that need  to be  addressed are the calves, hamstrings, groin (adductors), ilio-tibial band (I.T. band), psoas, glutes, quadriceps, and the hip rotator muscles of the thigh-hip junction. The best approach to resolve hip pain is to receive assisted stretch therapy in a method called Active Isolated Stretching (AIS). AIS first unwinds the larger muscles of the lower body. Afterwards, AIS loosens the hip rotator muscles, also known as the deep six muscles. The deep six muscles are the small muscles of the hip that create rotation and control pressure inside the hip joint. Conventional Stretching techniques are inadequate in preventing or repairing hip pain because the procedure does not completely open the targeted muscles.

How do the hip rotators become painful?

Hip pain is created by tightness in large outer muscles of the lower body and tightness in small inner muscles of the hip – the hip rotator muscles. Just addressing the hip rotator muscles will not cure hip pain because the more external (superficial) muscles form a cast over the hip rotators that must be stretched first.

The glutes. A tight buttocks contributes to hip pain

The glutes are directly external (superficial) to the hip muscles and they are a prime example of large external muscles forming a restrictive cast around the hip rotators. In AIS therapy, the client lays on a table and is held down with a seat belt to isolate the gluteal muscles. Glute stretches (there are five in AIS therapy) will be more productive with a trained therapist assisting because people with hip pain usually have major restrictions in the glutes.

Tightness in the hip is caused by a collection of restricted lower body muscles

Hamstrings, quadriceps, and groin muscles get tight through the aging process, sitting, and through sports and physical activity. The hamstrings, quadriceps, and groin muscles attach at the knee (patella) and the hip (pelvis). So when these muscles are tight they cause a tensional strain on the hip, which contributes to hip pain. The calves are often overlooked in hip pain, but they are among the strongest muscles of the body. Unreleased pressure in the calves pulls the hip bone out of balance in a similar tensional line with the hamstrings. The psoas muscle lies deep inside the stomach. The psoas gets tight through sitting and doing abdominal exercises incorrectly. A tightened psoas creates tension in the junction between the upper thigh and the hip. Therefore, psoas tension must always be examined in hip pain cases.

The I.T. band. Iliotibial band tightness contributes to hip pain

The other major outer muscle affecting the hip is the ilio-tibial band (I.T. band). The I.T. band runs down the leg, lateral to the quadricep. I.T. bands can get tight through aging, sitting, or running and they are very difficult to stretch with self-applied stretching (assisted stretching is necessary). Every person with hip pain has tight I.T. bands. Every runner has I.T. band tightness. Because this muscle attaches at the pelvis (the hip bone). It is a primary contributor to hip pain.

The deep six muscles: final destination.

After all these superficial leg muscles are optimally lengthened, then AIS treatment can take place at the hip rotator muscles. Just stretching the above mentioned superficial leg muscles will greatly alleviate hip pain, but the final step involves the deep six muscles (hip rotators). The deep six muscles are the: piriformis, obturator internus, obturator externus, quadratus femoris, gemellus superior, and gemellus inferior. The deep six muscles are small muscles that connect the top the thigh bone to the inside of the hip socket. The hip is a ball and socket joint. Hip rotation is controlled by these small muscles. And if these muscles are not stretched (when someone experiences hip pain) then the range of rotation inside the hip socket will decrease and the pressure inside the hip socket will increase. Limited range of motion and increased pressure inside the hip will wear down the cartilage inside the hip socket. Because tight hip rotators muscles cause a constant friction going over a limited space, which will burrow a hole in the cartilage to the point in which a physician will look at an MRI report and conclude that the client needs hip replacement surgery.

Why would AIS help my hip pain, when conventional stretching didn’t help?

Hip pain can be resolved with Active Isolated Stretching therapy. But it cannot be corrected with conventional stretching, pnf stretching, yoga, or thai massage. The non-AIS forms of stretching hold the stretch for too long. Holding the stretch for more than two seconds elicits the automatic stretch reflex which prevents the target muscle from stretching. The non-AIS forms of stretching ignore stretching at angles, and focus primarily on stretching the belly of the muscle. The belly of the muscle is only one aspect of the target muscle. There are five other areas to stretch in the target muscle which is why muscles that are stretched in conventional stretching don’t retain their flexibility. Additionally, non-AIS forms of stretching use the wrong positions to stretch the target muscle. The target muscle must be relaxed. For example, traditional stretches for the calves and hamstring muscles place the muscle in a state of contraction (specifically called eccentric contraction) and thereby do not allow full expansion of the target muscle.

Internal and external hip rotator stretches

Aaron Mattes, the developer of Active Isolated Stretching, states that his greatest contribution to the field of bodywork may be the internal and external hip rotator stretches that he designed. The deep six muscles are underneath the glutes, psoas, hamstrings, quadriceps, groin, and I.T. band. Opening the hip rotators needs a trained therapist assisting the process. To prove this point, many dancers and yoga practitioners experience hip pain. Both groups do extreme amounts of stretching to the outer leg and lower back muscles, but they commonly experience hip pain. This is because they can’t get reach the deep six muscles on their own. The internal and external hip rotator stretches of AIS takes the pressure off the hip joint. This process creates space inside the hip joint. And creates an atmosphere that can allow worn down cartilage to regenerate. Cartilage can regrow inside joints, a healthy diet and Active Isolated Stretching are two elements that can facilitate this process.