Often patients come in with the complaint that they have a hip out of place. While I understand why this is a widespread belief, I’m here to tell you that your hips are not the problem. Sadly, informing individuals of this could cause more harm than good!
What You’re Actually Feeling
To begin with, it’s not your hip that’s “out of position.” If your hip were out of alignment, it would be dislocated, painful, and you’d be on your way to the emergency room right away.
Second, when someone says their hip is “out of position,” what they truly mean is that they have one-sided low back pain in the S.I. joint region. It’s frequently due to a sensation of their back being locked, not moving correctly, or simply feeling out of sorts.
Many people have been taught that to “fix” this, they need to use special hand-on techniques such as muscular energy or manipulation to pop their hip back into place so they can move properly again. However, as I will demonstrate, this thinking can have catastrophic consequences.
Muscle Energy Technique (M.E.T.)
Muscle energy techniques (M.E.T.) were introduced to me in physical therapy school as a way to assist in realigning a pelvis that was “out of alignment.” To conduct these, you have the patient contract a specific muscle against your hand or body pressure to help “pull” the pelvis back into place.
After you’ve finished the muscular energy technique, remind your patient that your maneuver helped realign their pelvis and “placed their hips back in position.” What’s going on?
Movement Avoidance Due to Fear
While most people will respond positively to muscle energy for a short period, fear of movement is often the result. People are TERRIFIED of moving for fear of “popping their hip out again!”
If simply moving your leg against your therapist’s hands is enough to “put your hip back in place,” it implies that “throwing it out” again is relatively simple. How can patients believe in exercises like loaded lunges and squats (which D.O. create permanent structural change) if their hips are “thrown out” so simply by your hands’ manual pressure?
On a few occasions with my patients, everything is going great, they aren’t in any pain, but when it’s time to do a weighted lunge or squat, they are hesitant.
Here’s the reality. While hands-on approaches can quickly relieve discomfort and tightness, practical education is essential to avoid the subsequent and unavoidable fear of movement.
With easy manipulation or muscular energy procedures, your body would collapse to bits with a hefty squat or deadlift if your hips could go “in and out of place.” The last time I checked, they don’t because your body is built up of RESILIENT structures. It takes more than 1,000 pounds of force to distort fascia by even 1%.
Is it true that muscular energy techniques and spinal manipulation result in immediate pain relief? Absolutely. Is this pain relief related to correcting a biomechanical problem or a structural change, such as popping your hip back into place? Certainly not!
So, what am I going to do instead?
If you enjoy doing muscle energy procedures or manipulations, you must have proper training. I tell my patients that I’m not realigning their pelvis or putting their hip back into position; instead, I’m doing something that their brain likes, so discomfort in the area goes away quickly after the technique…and that’s all there is to it.
I also emphasize that these approaches are not a long-term answer to their discomfort, and I emphasize the importance of risk-free movement and loading immediately following these techniques.
One of my favorite loading tactics for folks who feel like their hip is out of position is to perform a loaded lunge variant with a greater range of motion, such as the reverse lunge from a step.
While the leg position appears to be similar to the muscle energy strategy described previously, there are a few significant differences:
This version is loaded, so there’s no need to be afraid of moving.
It is done on both sides, eliminating the danger of it being thrown out if you move the wrong way.
It is possible to accomplish it without the assistance of a practitioner, fostering self-sufficiency.
When squats and deadlifts aren’t tolerated, I’ve discovered that loading the hips at end range does away with feelings of one-sided stiffness in both the low back AND hips. Try this, and then get back to me on how it goes!
If you’re continually saying things like “my hip is out of place,” don’t worry. Your hips don’t move around, and you don’t need someone to “put them back in” regularly.
If you’re suffering from persistent one-sided hip/low-back pain, and you’re in the Asheville, NC area, we’d love to connect with you! CONTACT US TODAY!
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