Hip Flexor Pain: Where Do You Stand?

August 5, 2019 at 4:57 pm 12 comments

Standing into the wind modified photo

Where do you stand?

Do you have pain when you pull your leg or legs deeply into your chest? A little hip flexor tendinitis? It seems that a lot of Pilates teachers do. I first realized this many years ago when nearly every teacher told me she was experiencing the same thing I was…and that her colleagues were also expressing the same issue. Well, surprise of all surprises, back then I did a little digging and found out what it is and how to get rid of it…and I hope I can help you, too.

When I was struggling with this, I went to a new-for-me chiropractor who does soft-tissue manipulations. The first thing she asked me to do was stand up so she could see my posture and she said: Why do you lean forward so much at your ankles?

BOOM!

There it is!

That’s all it took.

And so I went researching to understand where we are supposed to stand; and if it is where we are taught in Pilates.

Of course, I’m writing this because the answer is: it’s different from what we learn and teach in Pilates.

The Difference

OK, clearly, I was “leaning into the wind” like a good Pilates teacher. My weight forward so that I can lift my heels up. Listing forward like a bird about to take flight… Like the dancer that I am about to leap across the stage…

Except…

Except I am not a bird about to take flight.

And I am standing still, not about to leap across the stage.

So…research…

When standing still, we’re meant to stand with most of our weight over our ankles/ball-of-heels. We’re not meant to be listing forward. Not at all. That’s when we are about to move. Not when we are stable.

How much are we meant to be back over our ankles and ball-of-heel?
Approximately 60% of our weight should be back over our ankles/ball-of-heel.
A distribution akin to this:
60% – Heel (ball of heel/ankle)
8% – Mid-foot
28% – Forefoot (ball of foot)
4% – Toes

Yes…only 4% Toes and only 28% on the ball of our feet.
60% over your heel/ball of heel

Says who? Says the biomechanist. Nordin and Frankel wrote the great book: Basic Biomechanics of the Musculoskeletal System and Cavanaugh and Rodgers wrote the kickin’ paper (I’m nothing if not a good geeky researcher. I’m a blast at parties…) The Arch Index: A Useful Measure From Footprints. (J Biomech. 1987). Not to mention the many other research papers on the subject. Check out this graphic. See the load distribution? (The toes are at the bottom/front of the illustration and the heel is at the top/back)

Screen Shot 2019-08-03 at 11.58.30 AM

Standing load distribution on the foot. Copied from Nordin and Frankel’s Basic Biomechanics of the Musculoskeletal System.

And see this one which is about peak pressure at the forefoot (measured in KPa –  KiloPascals)

Screen Shot 2019-08-03 at 12.03.44 PM

Standing peak pressure on the foot. Copied from Nordin and Frankel’s Basic Biomechanics of the Musculoskeletal System.

I know…I know…it feels really groovy to lean forward into the wind. You feel your abdominals more! I know! But…you are stressing your calves (gastrocnemius and soleus) as they are desperately trying to pull you back upright over your ankles/ball-of-heel and your quadriceps that are desperately trying to make you not crumble to the floor.

Also…you’re not really getting the appropriate activation of your hamstrings, gluteals and spinal extensors. These are essential to be working to keep you upright. You don’t have to squeeze them…they should just work for you because you’ve created an environment in which they engage on their own.

What’s it look like?

 

 


Sacrilegious? Not at all.

Also…I know that it feels sacrilegious to do something that your favorite teacher or teacher trainer told you is correct. I know. However, it’s OK to realize that they are very well-meaning just not educated in this realm. Most amazing Pilates instructors and teachers are educated on the human body by other Pilates people or dancers. If those people are not truly educated in biomechanics, then we often learn improper biomechanic actions. So…when we learn more, then we must adjust. No shame. Adapt and adjust and study more. And: references and credentials matter.

And who’s this lady to say so? I’m a biomechanist and ergonomist as well as a Pilates Teacher of Teachers. I became a research scientist because I wasn’t getting answers in the Pilates world. As I was getting education, it conflicted with what I was learning in Pilates. Our exercises are often super…but what we do inside and around them are often an issue.

What now?

With that, what do you do now that you’re used to leaning forward? How do you correct this?

1 –  Just rock back a bit in standing exercises. 

Put your weight more over the entire ball of your heel.

You should feel that there no way that you can lift your heels. And…there is no way you could lift both balls of your feet at the same time. Sure, you could lift your toes on both feet. You’ll also find that you could lift the ball of one foot, but not both at the same time.

Which exercises:

Standing Magic Circle/Power Ring – legs and arms

Arm Weight Series
Standing Breathing
Standing Chest Expansion
Standing Arm Circles at the end of so many exercises
Any standing exercise.
Well….not Standing Arm Springs. In Standing Arm Springs, we lean forward to play with our balance and to get more tension on the springs.
2 –  Stand over your ankles/ball-of-heel whenever you are standing still.

Are you listing forward when you teach? When you brush your teeth?
get back over your ankles/ball-of-heel just like I’m advising above.

3 – Self-Myofascial Release

Until your sore tendons normalize, one to two times a day on a 6 inch (15.25 cm) diameter foam roller massage/“roll out” your quadriceps with special focus on your rectus femoris (both knee and hip extensor). It’s that guy that is likely inflamed. That’s who/what you’re feeling when you pull your leg into your chest and it hurts. So, get all the way up into the crease of your hip. Keep moving focusing on the stroke upward from just above your knee (do not roll over your knee cap) up to the crease of your hip. Remember that your quadriceps are four (4) muscles. So you have to roll the inner/medial pat of the front of your leg, the center and the side/lateral front of your leg.
Take only 30-60 seconds each leg. Don’t try to destroy your muscles. Just imagine that your soft tissue is what it is: fluid filled. Each cell and each tubule of fascia is full of fluid. So…we need to help move the fluid through congested areas of adhesions.

That’s it.
That’s it?
Yup.

Sometimes feeling better is as simple as that.

We’re not changing your exercises. We’re just working appropriate biomechanics.

Questions?
Drop me a comment and I will answer you!
Something personal?
Email me at info@TheVerticalWorkshop.com

References
Cavanaugh PR, Rodgers MM, Iiboshi A. Pressure distribution under symptom-free feet during barefoot standing. Foot Ankle. 1987 Apr;7(5):262-76.

Nordin M, Frankel VH. Basic Biomechanics of the Musculoskeletal System. 4e. Wolters Kluwer / Lippincott Williams & Wilkins. Baltimore and Philadelphia. 2012.

Ribeiro AP, Sacco ICN, Dinato RC, João SMA. Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study. Braz J Phys Ther. 2016 Jan-Feb; 20(1):87-95 

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The Difficult Client…

12 Comments Add your own

  • 1. Deborah  |  August 5, 2019 at 6:32 pm

    Love this. Thank you! Could you provide an explanation (a reference would be great!) about what the foam rolling actually, physically achieves and how long one could expect that new tissue-environment to last?

    Reply
    • 2. theverticalworkshop  |  August 5, 2019 at 6:47 pm

      Thank you for reading this, Deborah. I will provide a reference as soon as I can. Will be a moment, but I will get back to you on this.

      Reply
  • 3. Shannon Grossi  |  August 5, 2019 at 8:30 pm

    Weird timing of this article. 10 min before opening my email my right hip flexor gave out after getting out of my car. When I sat back down in the car again (I’ve had incredible pain on both sides of my pelvis while driving longer than 1 hr) I dug my finger into the crease and wowzers very tender there!! I’ve been rolling out but I’ll think more about standing too.

    Thanks! Shari

    >

    Reply
    • 4. theverticalworkshop  |  August 7, 2019 at 10:51 am

      Perfect timing!
      Keep me posted on this, Shannon.
      – Shari

      Reply
  • 5. Rachel  |  August 6, 2019 at 4:48 am

    This is totally me! I’ve been trying to correct it for a while but then lose focus when teaching a class due to my focus on the clients. I’ll try harder and add the rolling to my daily routine. Thank you so much for this. It was informative AND inspiring. XO

    Reply
    • 6. theverticalworkshop  |  August 8, 2019 at 11:14 am

      Hi, Rachel! I’m so glad that this resonates with you! I’ve received a lot of emails from teachers since I posted this telling me the same and this piece was inspired by just how many Pilates teachers experience this! So…keep me posted on how you progress here!
      Thank you!
      – Shari

      Reply
  • 7. charlotte's web of wellness  |  August 6, 2019 at 12:26 pm

    Hi Shari! Thank you for such valuable information. I’ve been telling my clients to hinge slightly forward…. I’m now going to tell them that I received new info from a biomechanist, ergonomist and a teacher of teachers that we’ll be standing correctly going forward. OY.. so much to learn and refine in the Pilates world. 🤗

    Reply
    • 8. theverticalworkshop  |  August 7, 2019 at 10:43 am

      Thank you for checking this out and seeing it in your own work. When changing actions upon learning new info, I suggest saying something like “Today we’re going to try something different!” Or…you can totally tell them what you wrote above! However you feel most comfortable and they feel most confident in you!
      And, we all have so much to learn! It’s good!

      Reply
  • 9. Ann Georgescu  |  August 6, 2019 at 1:51 pm

    Hello! This addresses an issue that I have had for awhile. I also suffer from what feels like ‘stuck’ or constantly ‘turned-on’ hip flexors in addition to the pain. Would this postural correction and these exercises address both problems? Thanks! Great article!

    Reply
    • 10. theverticalworkshop  |  August 7, 2019 at 10:45 am

      Hi, Ann,
      I’m so glad that you recognize this…
      Will this alteration in where you stand for both standing exercises (and any time you’re just standing) alter that other feeling you have? I imagine, but I’m not sure. We’ll only know as you alter this one thing.
      Will you let me know how it all goes?
      Thank you!
      – Shari

      Reply
  • 11. Dana Inman  |  August 11, 2019 at 10:01 am

    Love your articles! Not anymore, but I used to have a ton of achilles tendon and heel issues and now I think it was from doing exactly what you described, “trying to be a good pilates instructor” by leaning into the wind all the time. Thank you!

    Reply
    • 12. theverticalworkshop  |  August 11, 2019 at 5:19 pm

      Dana! I’m glad you sorted out those achilles issues! Thanks for reading this and sharing your thoughts!
      – Shari

      Reply

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