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Hip joint sub dislocating during pike/deadlift


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A couple of years ago, during a Jefferson Curl, I felt the femur heads of both hips slightly sub dislocating.
It felt as the heads were forced toward the front. 
I stopped Jefferson curls and after a while, the discomfort went away.

A year ago, I went through a period of intense stretching of the legs, using Stretching & Flexibility, especially the Hamstrings and Hip flexors (with partner variations).
One night, before going to sleep, I did a relaxed pike in the bed, and again my hips sub-dislocated, exiting a little out of the sockets and going back.

I stopped stretching and after a while, the discomfort went away.
During the convalescence, the hips were loudly popping every time I made a Deadlift move (same kind of sound of when you crack your knuckles, with no pain, but with a distinct feeling of movement in the joint and a bit of discomfort).
Even when picking up something from the floor, on the ascendendt phase, at around 90° of flexion of the femur in the hip, there was the popping.

A week ago I had a popping with light pain, during a proper deadlift. A 85% of 1RM weight. I was fatigued as it was the 5th set, and I was generally on the verge of overtraining (I since started a deload period).

I would like to understand the mechanics of this, could it be a Hip Flexors weakness? Any test I can do to narrow down the cause?

  • if I do a pike with feet apart, shoulder width or more, no popping
  • if I do a pike with feet pointing out (externally rotating the hip), no popping
  • if I do a pike with knee in maximal extension (actually hyperextension, for me), no popping, it only happens when the knee are flexed  little, as in a deadlift
  • When I try to pike, it feels like the Hamstrings are pulling forward the head of the femur, kind of causing a joint distraction.
  • I made a sketch showing the direction I feel the head of the femur going.
  • Also the discomfort, slight pain I feel, is in the front region of the hip capsule.
  • If, during the ascent of the deadlift, I consciously contract the glutei, the popping is greatly reduced or eliminated
  • I tried light foam rolling of the area below the iliac crest, where the quads attach, the tensor FL, and immediately afterward, the pain/popping was greatly reduced or eliminated.

 

Any thought/suggestion is greatly appreciated.

Femur Head subdislocating.jpg

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Hard to say what it could be exactly.

The general rule of thumb I have is that most peoples exercise training for the lower body is heavily focused on extension based motions of the hips and knees. Squats, deads etc. So there should be a decent amount of hip/knee flexion work so it would be worth adding some in if you're not already. 

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Emmet, thank you for the reply.

I’ll incorporate some hip flexors strength, I guess I was too fixated on the “short hip flexors from sitting” and did only try to stretch them without strengthening.

 I agree it’s difficult to say what it is, the sensation I feel, of the femur head coming off the socket “forward” doesn’t agree with the direction the hamstrings are pulling during a pike.

 I mean that if you follow the line of pulling I should be feeling the head of the femur sub dislocating towards the my back.

but when the hamstrings are pulled tight by locking the knee, I don’t feel the instability.

Another hypothesis could just be a laxity of the hip capsule, I have generally shoulder and knee ligament laxity, maybe I have it in the hip as well. That could explain the chronic tightness of my hamstring, maybe they are trying to compensate the instability in the hip joint and/or in the knee. 

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  • 2 weeks later...

After some research, I think it might be a Femoral Anterior Glide Syndrome.

Contracting the glutei intentionally stabilises the joint and eliminates the popping. I have tight hamstrings and other symptoms described by Shirley Sahrmann, I might have weakened the frontal part of hip capsule deadlifting with a overextended lumbar spine (trying to contrast the tendency to lumbar flexion) and I think this may have switched off (at least partially) the glutei, during the lift. Combined with aggressive partner stretching of the Psoas (which I used to NOT train for hip flexion and is therefore weak), this may have caused the problem.

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Eric Cressey on the subject

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From Sahrmann (Diagnosis and Treatment of Movement Impairment Syndromes):

"One plausible reason hip joint motion becomes altered is that the hamstring muscles, with one exception, originate from the ischial tuberosity and insert into the tibia. (The exception is the short head of the biceps femoris muscle, which attaches distally on the femur.) Because the hamstring muscles, with the exception of the short head, do not attach into the femur, they cannot provide precise control of the movement of the proximal end of the femur during hip extension. When the hamstring muscular activity is dominant during hip extension, the proximal femur creates stress on the anterior joint capsule by anteriorly gliding during hip extension rather than maintaining a constant position in the acetabulum.

This situation can be exaggerated if the iliopsoas is stretched or weak and is not providing the normal restraint on the femoral head.

[...]

The greater trochanter will move anteriorly when the hamstrings are the dominant muscles. In contrast, the greater trochanter will either maintain a constant position or move slightly posteriorly when the gluteus maximus and piriformis muscles are the prime movers for hip extension.

[...]

One possible explanation for anterior movement of the greater trochanter is that if the hamstring muscles are the dominant hip extensor, only the distal portion of the femur moves posteriorly but not the proximal portion. This occurs because the proximal attachment of the hamstring muscles is the ischial tuberosity of the pelvis, and the distal attachments are on the tibia and fibula. Only the short head of the biceps femoris attaches to the femur; because of the location of this attachment on the distal femur, its major action is knee flexion. The insertion of the hamstring muscles is to the tibia and fibula. During hip extension when the tension is being exerted on the tibia and fibula, the excessive flexibility of the anterior joint capsule allows the femoral head to glide anteriorly, particularly if the iliopsoas muscle is lengthened. Therefore the axis of rotation of the femur is displaced anteriorly, causing the proximal femur to move anteriorly while the distal femur moves posteriorly.

[...]

The iliopsoas muscle tests long and weak. Because the fibers of the iliopsoas muscle attach to the anterior joint capsule, contraction of this muscle is believed to keep the capsule from being pinched. 4 Therefore poor performance of the iliopsoas muscle can contribute to increased susceptibility of the capsule to impingement. The TFL muscle tests short, and the gluteus maximus or piriformis muscles test short and weak. The posterior hip joint structures are stiff or short or both, as indicated by resistance to hip flexion. The hamstring muscles also test short, particularly the medial hamstring muscles. The anterior hip joint structures are stretched, as indicated by excessive hip extension range of motion.

[...]

Intervention PRIMARY OBJECTIVES.

The primary objectives of an intervention program include the following:

1. Improve the posterior glide of the femur to correct impaired hip flexion motion

2. Reverse the altered hip flexor dominance by shortening the iliopsoas muscle so that the hip medial rotation produced by the TFL during hip flexion is appropriately counterbalanced

3. Correct the hip hyperextension and medial rotation if present CORRECTIVE EXERCISE PROGRAM Quadruped position. Rocking backward while in the quadruped position is the most important exercise and should be performed first. When performed correctly this exercise will stretch the hip extensor muscles and promote posterior and inferior gliding of the femoral head. The patient may need to push back with the hands if his or her groin is pinched from the contraction of the hip flexor muscles.

Supine position. Passive hip flexion is performed by the patient in the supine position to help restore the precise axis of rotation. If the thigh cannot be reached comfortably with the hands, the patient can use a towel behind the thigh to pull the knee toward the chest. It may be necessary to slightly rotate laterally and abduct the hip. The hip flexor muscles must remain relaxed.

Prone position. Knee flexion should be performed in the prone position, and the patient should prevent pelvic anterior tilt or rotation and hip joint abduction or rotation. Hip lateral rotation should be performed with the knee flexed to 90 degrees. This motion will stretch the ITB. Hip medial rotation performed with the knee flexed to 90 degrees will improve the extensibility of the hip lateral rotator muscles. Hip extension with the knee extended should not be performed unless the patient has a pillow under his or her abdomen to place the hip into flexion. This motion should be initiated while contracting the gluteus maximus muscle. To avoid stretching the anterior hip joint capsule, the hip should not extend past neutral. Hip extension with knee flexion must be performed in the same way to avoid stretching the anterior joint capsule.

Side-lying position. Hip abduction should be performed in the side-lying position with slight lateral rotation and extension of the hip to aid the recruitment of the PGM instead of the TFL muscle.

Sitting position. To increase the extensibility of the medial hamstring muscles, knee extension should be performed in the sitting position while maintaining the hip in a few degrees of lateral rotation. The patient should passively flex the hip by using his or her hands to lift the thigh to maximum flexion and then remove the hands from the thigh and actively hold the thigh in flexion. In this position the iliopsoas muscle is the only hip flexor that can hold the hip in this degree of flexion. If the patient can hold the hip in the end range of hip flexion and does not have pain, he or she can apply isometric resistance by pushing with his or her hand against the thigh.

Standing position. While standing on one leg the patient contracts the gluteal muscles to prevent hip medial rotation. The patient then bends forward using only hip flexion and then returns to a standing position by concentrating on contracting the gluteal muscles to produce hip extension, maintaining the contraction until he or she is upright.

CORRECTING POSTURAL HABIT PATTERNS. The patient performs a sit-to-stand movement without allowing the hips to rotate medially. The patient is instructed not to sit with his or her leg crossed or his or her thigh over the other thigh (i.e., hip flexion, medial rotation, adduction). If the patient must cross his or her leg, then he or she can sit with the lateral aspect of the leg on the opposite thigh (i.e., hip lateral rotation). The patient should not sleep with the hip rotated medially. It is important to correct the swayback standing alignment by instructing the patient to stand with his or her back to the wall, which can serve as a guide to the correct orientation for vertical alignment. The patient can also stand sideways to a mirror, and the therapist can teach correct alignment by instructing the patient to pull his or her hips backward.

Because new alignments feel unnatural, the patient needs to monitor alignment by using a mirror. The patient should be encouraged to contract the gluteus maximus muscle actively at heel strike when walking. Contraction will increase the participation of the gluteal muscles and decrease the dominance of the hamstring muscles.

---

 

I hope this can help others.

@Emmet Louis, @Kit_L, I would love to know your thoughts on the book, and on my hypothesis...

FIgure 2-8.jpg

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