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“Strengthen your glutes.” “Activate your core.”

“Tight hamstrings are causing your low back pain.”

These are just some of the common statements many patients are left with ringing in their ears after appointments with healthcare practitioners.

We can all be guilty at times of using these clichéd phrases for one very simple reason, it’s easy. It makes for an easy diagnosis, it makes for an easy explanation and most of all it makes treatment a breeze.

But, what if this is just part of the puzzle?

If childhood taught me one thing, it’s that the corner pieces are by far the easiest to find in the mess, but they never make up the whole picture. Unless it’s a four-piece puzzle set, and that’s just plain boring.

Yes, many patients with low back pain or hamstring strains will have tight hip flexors. They may have ‘poor core activation’. And yes, they could have ‘weak glutes’. But the answer to these problems may not be as simple as stretch and strengthen!

This approach might help alleviate some presenting symptoms, but we need to find and resolve the cause of these issues, rather than just giving every patient the same generic advice. If we can do this effectively then the puzzle starts to take shape.

I’m not suggesting this is an easy process, nor will it be the same for every patient that walks through the door, we need to work out WHY these symptoms are presenting and WHY this area in particular is giving us trouble, that’s the challenge.

One reason the abdominal and gluteal regions are perceived as weak could be due to a neurological phenomenon known as reciprocal inhibition. This states that when one muscle is contracted the muscle opposing its action must relax. In this case the anterior hip muscles (hip flexors) are chronically contracted causing relaxation (or inhibition) of the hip extensors (most commonly the gluteus maximus). In the same vein the lumbar spine extensors are tight causing the lumbar flexors (abdominal muscles) to relax/inhibit.

This combination gives us an overall ‘symptomatic region’ of the body that is centered around the hips, pelvis and lower back.

No amount of core activation, glute strengthening or hip flexor stretching alone will give long-term, sustained relief if the causative factors for this are not addressed concurrently.

Rather than just putting a band-aid over the problem, we need to look at more effective long-term solutions.

Don’t get me wrong, band-aids are great, they do their job brilliantly… if they didn’t then people wouldn’t buy them. But, if you keep falling over and grazing your knee, you’re going to need an awful lot of band-aids. Surely it makes more sense to put your effort into not falling over… rather than reapplying band-aid after band-aid.

This ‘band-aid’ approach can be applied to patients when practitioners simply address their presenting symptoms and not the underlying cause.

More often than not these patients come in to see us and present with a common story, “I’ve had this for years, it comes and goes, it’s always stiff in the morning”.

It can become frustrating for the patient, but also the practitioner when the same problem keeps showing up time and time again.

Every patient is different, so therefore causative factors are bound to vary but the lumbopelvic region in particular is usually reacting to or compensating for a restriction from above or below. Therefore, a thorough investigation of the thoracic spine, feet and ankles, the upper limbs and beyond is absolutely necessary to get to the root cause of the problem.

Don’t get hung up blaming the ‘weak’ glutes and abdominals, they aren’t really lazy or weak, they simply haven’t been given the chance to do their jobs effectively.

James Shanahan

Registered Osteopath

 

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