Wednesday, February 6, 2013

DIY Body Fixing (Groin Pull example): Give yourself time to work the problem

Ever have an issue that seems to be with you for ages - it's a niggle, a nag, it's not painful but it's enough to through you off your game? Maybe you've seen someone about it, sorta had indifferent results, but mainly you just suck it up? After all - what's gonna get rid of it? Working the movement, not the muscle, that's what.

The following is the story of getting to a point of simply having had enough with just one of those problems - an adductor/groin pull recurrent tweak kinda thing. It's about having enough and saying dam it, let's just fix this. And doing so. Main take away: making the time to work the problem with a Movement based solution is like the joy one feels after banging one's head against a wall - it feels so good when ya stop. And so, to the particular case...

The Adductor Tweak

Perhaps you've had a tweak way up in the leg - right where it attaches to the crotch area? This area - usually referred to as the groin - most often means that there's something funny going on with a group of muscles in the inner thigh - the adductors.

The adductors have a variety of roles to play - one is that they bring the leg towards (and past) the midline of the body; the other is that they turn the top of the leg in or out depending on position of the hips, and another biggie is that they support the hips in bending forward. These are the muscles that we can feel come on if we lie on our backs, put a ball between the legs and say "squish that."

Problem: Adductor Discomfort in Pistol Squat, Left Side

On and off for years, and esp. since last january i think, my left adductors would send up signals saying they did not like to do pistols. Not pain but discomfort to the point that it was a real trial working the left side.

Indeed, if i'd had to describe it i would have said it did not feel like everything was hooked up. GOing back and forth, comparing where energy seemed to be going on the funky left compared with the fine right - something felt definitely out of whack.

I finally had had enough.

I had a workout day last week where i wasn't quite sure what i was going to do - supposed to be high volume leg work - and was just not into going through this again with the left side. So, cracked out the books and decided to debug this mofo once and for all. Inspired by a previous master class on shoulder debugging, i thought i must see how far i can get applying the same methods to myself.

First Check: what's the complement (or antagonist) muscles?

In the case of the adductors the glute med and TFL both move the hip in opposition to the adductors. Super. Hypothesis: perhaps these guys are a bit off line, and so bringing them back online - ensuring they're firing is a good idea.

Usually this is where a movement coach can help do the muscle testing, but i was on my own. It did seem that i could fire up the right glute, glute med and tfl more intensley on the right than the left.
DIY note: if you're not sure where these muscles are, something like a surface palpation guide - that helps identify the bulges in the skin against the muscles depicted in anatomy texts - is a great help. A couple i like:
  • Basic Clinical Massage Therapy: integrating Anatomy and Treatment - the book draws the muscles over the surface, as well as showing the surface view of the muscles. [US Amazon || UK Amazon]
  • Fields Anatomy Palpation and Surface Markings (4th Ed) - nice technique guidance here too. [US amazon || UK Amazon]
  • Atlast of Living and Surface Anatomy for Sports Medicine. - includes cadavor shots. [Amazon US || Amazon UK]
From this identification assessment, i ran through a bunch of simple techniques to bring these areas back on line - i hoped.

Redo the movement - in this case a pistol - ya it seemed a bit better but not tweak free.

Second Check - anything tender here? 

Doing some light massage as per recommendations around neuro-muscular training and trigger point stuff, just wanted to see if there were spots that on light exploration were not happy to be worked manually. There were. Compared with the right yup these guys were sending up signals. Was also getting a wee bit from the area, too. Interesting, eh?

Third Check, where IN THE MOVEMENT does it hurt?

My next task was to find not so much where in the muscle/tendon area there was some manual touch based ick, but where in the movement there was a problem. For this exploration, i used a pistol variant i learned from Kenneth Jay - to put the non-stance foot toe-touch on the ground - taking some of the balance work out of the pistol. AND THERE IT WAS - oh wow! did i find a very special place that fired up like a christmas tree of unhappy signals.

Now the challenge was to hold that position. and then work that position both manually and actively.

The manual part was to hold the area that was hinky to take it a wee bit out of commission and try the movement without it so much there. better? yes? ok. time to lie on side, relax and work the area. There's some great descriptions on doing this kind of work in Clinical Applications of Neuromuscular Techniques, Vol 2.  [US Amazon || UK Amazon]

Fourth Check: Work the ick in the Movement

But wait, there's more!
The killer solution in this that made the biggest difference was the hardest to do - psychologically - and this is what makes rehab the no fun bear that it is. In this case, it was: work the movement. Move into and out of where the discomfort is. Hold where the discomfort is; let go into where the discomfort is IN THE MOVEMENT.

In other words, not lying on a table leg out and manipulating, but actively going down into the movement (here the pistol, at a certain point past parallel - that's where the uglies happened) and explore there. My goal: hold that position, and wait it out to see what happens. Learn more.

Holding the position was in itself a challenge just in terms of being able to maintain the position - finding how i could hold myself in that place in the movement long enough without falling through the movement and without moving into pain rather than just discomfort. Sweating ensues. Kinda cool, from an observer point of view.

using the 20kg kb as a counter weight to let me get into the
ick position and hold it longer than i could if i just tried to hold it for as long as i could.
 When the hold/ick rather lets go, come up and work down a little lower each time
and then explore eye position.
holding down here with eyes left and UP made a surprising difference.
this work also then becomes a little faster, a little less hold,
more working through the specific partial of the whole movement.

Higher Up and Further In: Adding Visual Activity.

I also did some eye work while i was down in that position and holding it - near far drills and the such like - to bring on more systems actively while i'm sorta static otherwise. This is me re-applying something Eric Cobb had suggested last year when we were trying to work through this problem in a limited amount of time then: the idea was get down to the bottom of the pistol and stay there and do vision drills. Turns out this was largely a great idea - just not sufficient. The refinement i brought to it - after having more time to work the problem from square one, and arrive back pretty much at exactly this same point (validation or what?)- was that for me, now, working not just the bottom of the movement but exactly where and around the discomfort/weakness in the movement was turned out to be the biggest contributor to release from this issue.

After a few of these sink-into-the-discomfort-and-hold reps, and the discomfort going down each time, i did partials that started just above, went through the ick to just outside of it. And the ick started to go further away. By the time i was done - and done was discomfort had largely moved out of the partials - i was able to do the same toe touching pistol full range of motion without the big red lights going off.

Fifth Check: real work

several days later it was another leg day. time to see if this worked; if the fix had stuck, functionally. I was still aware of the area up there in the gears (perhaps some DOMS) BUT the discomfort when doing weighted pistols just wasn't there. IT really wasn't there. I had the nicest left side leg work that i'd had in ages. Hope for the lag on the left in terms of load rises. Maybe a 24kg pistol is in its future too?


What does this mean, that the discomfort seems to have been addressed? Does it mean that my hypothesis that something wasn't firing was correct? that i got the muscles more coordinated to play nice together? That there was a visual issue past partial in the squat? I don't know. I don't know what happened. Maybe there was some fascial stretching going on in this too, or neural fatiguing or...
What i know is this combination of just working the movement  with the tools i know [note on tools below] seemed to help address it. Working the movement; working in motion. To work the motion i likely did not need anatomy - just follow the discomfort - but i don't know if i would have had the same confidence to work that motion without some of that knowledge - to form hypotheses and test them.


The add's on that side are not 100% - i just tried a pistol on my left and a bit of a tweak is peeking back, suggesting that other issues may be at play. So it's going to take reps. Again. Like my shoulder rehab that took thousands of light reps with a band in both the push and the pull direction to get the wiring of the brain pattern and tissue to remember how to do those movements without pain.

 The happy thing is i have hope: i have something to rep in. Likewise i have some proof of efficacy: i've just had a recent great discomfort-free heavy work session; i'm pretty sure i can keep working this system to get back there again and have it be increasingly sticky in the positive.

Take Away: "I need more time, Captain" 

Patient Persistence; work the problem
This effort at physical analysis to get to a good result took a couple hours. IF going to see a coach, it likely would still have taken that kinda time - but it was worth it to dig in and get to a solution point.
If working with a movement coach you trust, and dealing with a sticky problem, you may want to ask about booking a double or triple session - maybe getting a discount for that big a booking - in order to have the space to work the problem; to test and retest and get to a place where you have a MOVEMENT solution.

I stress a MOVEMENT solution because getting release on a table in a passive position is different than finding a solution for one's athletic activity - and that's where we want the solution to be - when we're doing the work we want to do. Does your person work muscles or movements? Just a question.

Dialing In: 

And one more thing: i'm not recommending you try this set of steps on yourself; i'm making no therepeutic recommendations whatsoever. I'm offering a view that it seems if we're patient, persistent and apply knowledge about the body and especially nervous system to work a problem, even something that's been going on for what feels like ages can be addressed. Right now.

Notes on Tools:

Understanding a wee bit about anatomy/kinesiology - about where a muscle takes a limb around a joint - i have found to be extremely helpful in working a problem to resolve the issue.
That said, i'm also very conscioulsy drawing on muscle activation techniques i learned in zhealth courses like strength and suppleness, neural activation techniquest from t-phase, and all the anatomy we did in the master trainer program. What becomes exciting is being able to explore a problem to work the problem, to bring in some extra knowledge, and get towards a solution. Manual work is awesome to help to understand an accute response. Active work is powerful to wire in the solution.

If you have a hinky issue that's gone chronic, talk to me - or, may i suggest, get a movement coach and MAKE THE TIME to work the problem

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