Restarting dedicated flexibility work

[AlexanderEgebak]

Hello everybody.

I used to be active here some 5-7 years ago and remember how helpful people were back then. I have had some trouble navigating my appearance in online communities so here I am trying to find my balance.

The last years I have been going heavy with focus on strength training while flexibility while also maintaining my flexibility.

The last few years though I have noticed an increased irritability in my body. Particularly related to spinal issues/Hip/SI-joint imbalances. I have spent a great deal analyzing the issue (and being practically in paralysis by my analysis - former physiotherapist nerding it out) so I figured maybe some of you could kick some cold logic through my thick head so say.

Most important physical findings:
- functional scoliosis to the right side with obliques and q. lumborum pulling ribs lower and maybe raising hip slightly
- mobilizations, manipulations and massage temporarely reduce tension and adjust posture
- muscle strength tests at various muscle lengths show no nervous inhibition
- stretching feels "stiff" and relieves tension to allow more range of motion. it is not a stretching sensation but rather a sense of stiffness leaving the body
- right hip locked solid during attempts internally rotate hips. it has always done this. as a child I remember kicking unevenly with my legs while swimming.

Flexibility:
- Close to a full pancake and full pike when warmed up
- Bridge is decent after warmup though spinal tension holds me back rather than a lack of flexibility
- Split when fully warmed up is 30cm from the floor with my thighs
- Most difficult positions are inner thigh and piriformis stretches. movement is mostly in the spine which makes me hesitant to pursue in order to not stretch myself further into a scoliosis
- front split also not too great and also feels very different side to side due to inherently differently felt biomechanics.

I think that is the most important information. Some health care professionals have hinted at the issues stemming from some kind of auto-immune reaction. That only partly makes sense to me is not too helpful.

So in essence, while my puzzle to me is unsolvable, and it might be for you too, maybe you could help me with exercise selection based on the above information?

[Kit_L]

What a pity we cannot refer to the earlier, voluminous, exchanges from years ago.

Now, can I assume you are a qualified physiotherapist now, and up to date on all their perspectives? This will help to structure the conversation, and pitch at the right level. You wrote:

5 hours ago, AlexanderEgebak said:

- functional scoliosis to the right side with obliques and q. lumborum pulling ribs lower and maybe raising hip slightly

It is possible that the obliques and Q.L. can pull the ribs down, but the same muscular forces cannot raise one hip. This is simply is not possible: gravity only pulls towards the centre of the earth. Assuming both your feet are flat on the floor and your legs are gently straight, and your weight is reasonably evenly distributed between them, the respective hip heights can only be a function of the combined bone lengths of each leg; everything else in the body will adapt to this positioning (hips tilted, the three curves in the spine reproduced to a lesser degree in the plane of the shoulders, and the body rearranged over the feet so that the forces created by gravity are distributed as widely as possible throughout the body). This is a "functional scoliosis": a necessary adaptation.

Please have a think about this, and respond, and we can go from there. Do you have a meditation or relaxation practise?

 

[AlexanderEgebak]

I am a qualified physiotherapist /even though Im not practicing anymore), and I am updated on some of their perspectives, but not all.

I noticed that I have a tendency to lean to the left and feel a bit unstable if I even I am resting evenly on both feet. The "raised hip" is a feeling I have, as if something is twisted, raised, rotated out of place.

The closest I get to a regular relaxation practice is posture and breath work I do in between singing lessons

[Kit_L]

OK; thank you.

Please try this simple but effective test:

If you DO have a leg-length discrepancy (LLD; so we are talking structural LLD here, not functional), then many entailments follow: L–R hamstring ROM differences; same with hip flexors; same with lateral flexion, and same with whole-spine rotation. 

Because the first researchers in this area decided that LLDs of less than 10mm were assumed to be not significant, the researchers missed where a significant fraction of the population sits (as in, actual measured on whole-body x-ray leg length differences) of 5 mm to 9 mm or more, around 39% of the populations measured. If you are doing vertical load-bearing activity, even 5 mm can be significant. 

I worked with one Hawaii Iron Man athlete who only had a 2–3 mm difference as far as we could tell (he was an engineer and we use some pretty exotic methods to do the measurements), but because he ran 100 miles a week in his winter training, he had the same strength and flexibility pattern differences that someone less active but with a much greater difference could have had.

Please ask someone to help. The test is simplicity itself. Try to stand with your weight roughly evenly distributed (bare feet will help) and simply try moving the block back and forth, re-distributing your weight each time. Under one side, it will feel wrong, or uncomfortable, or some other response; under the other, you'll feel more balanced. This crude test, perhaps surprisingly, is better than a whole body X-ray; I can explain, if you wish.

Once you have a play with this, we can talk further. My own LLD is about 18mm, evenly divided between tibia and femur, RHS.

[AlexanderEgebak]

On 8/15/2024 at 12:33 AM, Kit_L said:

OK; thank you.

Please try this simple but effective test:

If you DO have a leg-length discrepancy (LLD; so we are talking structural LLD here, not functional), then many entailments follow: L–R hamstring ROM differences; same with hip flexors; same with lateral flexion, and same with whole-spine rotation. 

Because the first researchers in this area decided that LLDs of less than 10mm were assumed to be not significant, the researchers missed where a significant fraction of the population sits (as in, actual measured on whole-body x-ray leg length differences) of 5 mm to 9 mm or more, around 39% of the populations measured. If you are doing vertical load-bearing activity, even 5 mm can be significant. 

I worked with one Hawaii Iron Man athlete who only had a 2–3 mm difference as far as we could tell (he was an engineer and we use some pretty exotic methods to do the measurements), but because he ran 100 miles a week in his winter training, he had the same strength and flexibility pattern differences that someone less active but with a much greater difference could have had.

Please ask someone to help. The test is simplicity itself. Try to stand with your weight roughly evenly distributed (bare feet will help) and simply try moving the block back and forth, re-distributing your weight each time. Under one side, it will feel wrong, or uncomfortable, or some other response; under the other, you'll feel more balanced. This crude test, perhaps surprisingly, is better than a whole body X-ray; I can explain, if you wish.

Once you have a play with this, we can talk further. My own LLD is about 18mm, evenly divided between tibia and femur, RHS.

I have given this some thought and tried the test. I also had a chiropractor do standardized standing and seated hip flexion tests to measure leg length difference.

The result: The chiropractor suggests a 1cm leg length difference. He also noticed sacroilliac "rigidity" and stiffness.

The test at hand: Doing the weight shifts I feel more comfortable on the left side and unstable, tense and out of place on the right side. The instability persists even through a very slight elevation corresponding to the assumed leg length difference.

The heavy weight bearing argument makes sense seeing how Im still lifting heavy weights. Also realizing that through hip rotation stretches like the tailor pose variations I may inadvertedly have pushed for spinal scoliosis rather than hip rotation flexibility.

I would also underline the fact that my hip has always felt a bit "out of place"; since forever. I feel as if it has been exaggerated through these last 10 years though, unfortunately.

[Kit_L]

The chiropractor's tests are not as accurate as the standing test I described in the clip above; there are many reasons for this claim. Nonetheless, let us assume that you do have a structural leg-length difference (let's use the shorthand of LLD from now on) of 1cm, or more. The 11 studies I referred to briefly above were whole-body X-ray studies (just what you measure on a whole-body X-ray to determine LLD led to a vigorous debate all by itself).

A 10mm LLD was claimed to be the point of significance but with zero arguments to support this; the 10 studies subsequent to the first one simply accepted that significance point and ran with it. Lesser differences can be significant, depending on lifestyle.

5mm is definitely enough to cause all the problems you have noted and a great many more. Let us accept the chiropractor's assessment of 10mm. Heavy lifting will exacerbate all the adaptations the body must necessarily do to adapt to the asymmetrical forces acting one it, because the body needs to distribute these forces as widely as possible throughout its structure, muscles, bones, fascia. All have to adapt (this is automatic and out of our control, BTW; and not a problem). An induced scoliosis is one such adaptation; I have one myself, but it is of no significance now. You can see my scoliosis in the video above; it is exaggerated when I put the blocks under my longer leg, and when I put the blocks underneath the shorter leg, my spine becomes more or less completely straight. 

So—what to do? First, adopt a relaxation practice, daily, and commit to three months. If you do this, you will notice many changes, and most will be permanent by then. The nexus here is that the majority of the discomfort in your body is coming from the asymmetrical adaptations your body must have made; all the stronger places are also holding more tension. Learning how to really relax will make an unimaginably large difference in your daily life, more than literally anything else you can do. Held tension is what is causing the "irritability" in the body you mention in your first post. As many others have reported in this forums, you cannot imagine the effects of this before you feel them—so get started today.

Some background here: https://stretchtherapy.net/relaxation-wiki/

Next, a simple stretching program is needed, and the key muscle groups to loosen are the three hip flexors. You will need to concentrate especially on the partner hip flexor stretches, and the quad-hip flexors stretches—it's possible to have loose quads (when stretched on their own) and loose hip flexors (when stretched by themselves), and very reduced ROM when both ends of these muscles groups are stretched at the same time—this is completely unexpected by flexible people (like dancers and gymnasts) but we have seen this literally hundreds of times, both in the clinic and on workshops.

Here are the best exercises: https://www.youtube.com/@KitLaughlin/search?query=quad hip flexor

You will notice that you are much tighter on one side with any of these exercises—this is a major consequence of your LLD, and the main cause of the SIJ "rigidity and stiffness", too. You'll recall that the origins of all the fibres of psoas and iliacus are the anterior surfaces of all the lumbar vertebrae, and they share fascia with the lowest part of the diaphragm, and quadratus lumborum, and their insertions in the femur mean these muscles have significant leverage on the rotational positions of the vertebrae (as well, this is a major factor in the scoliosis you mentioned). The reason it's essential to balance quad length is because of its attachment (anterior inferior iliac spine, or AIIS)—asymmetric resting length here is a very significant contributor to anterior pelvic tilt and rotation; again visualise the scoliosis. 

We have found that the greatest bang for the buck (in terms of results gained for time spent) is to do two strong stretching sessions a week only (one session can concentrate on the quad-hip flexor exercises; the other on only the partner hip flexor exercise) and need take no longer than 15–20 minutes.

The third recommendation is a small (5mm I suggest) heel lift in the shoes you train in. If you train in bare feet a quarter kg plate underneath your heel when doing any of the vertical load-bearing exercises will work just fine. Use something thinner if this feels too much. This heel lift needs to be relatively non-compressible. I used a piece of leather that was about 6 mm thick in my Olympic lifting boots, and in the days when I used to wear shoes a similar lift in them as well. 

The fourth recommendation is to concentrate on unilateral training for six months or so (single-leg strengthening in particular) because while you might not feel this, one leg and glute will be weaker than the other. 

The general rule is to loosen the tighter of any pair of muscles, and to strengthen the weaker of the pair. This way whole body symmetry will be attained, in time. Doing the relaxation exercises speeds these adaptations, too. Comfort in the body (along with improved function) will be the result.

[Matt Chung]

> it's possible to have loose quads (when stretched on their own) and loose hip flexors (when stretched by themselves), and very reduced ROM when both ends of these muscles groups are stretched at the same time—this is completely unexpected by flexible people (like dancers and gymnasts) but we have seen this literally hundreds of times, both in the clinic and on workshops.

This is very interesting and not something I would've expected. Out of plain curiosity: were the flexible people (e.g. dancers, gymnasts) surprised to see OTHER individuals who had loose quads and loose hip flexors with reduced ROM on both ends when stretched at the same time, or surprised that they themselves (i.e. the dancer/gymnastic) had reduced ROM in that same scenario?

[Kit_L]

14 hours ago, Matt Chung said:

This is very interesting and not something I would've expected.

Neither did they—and (we think not coincidentally) many of these students had back pain that had not responded to other interventions. Loosening the quads–hip flexors together was perceived by these students as a massive release of tension in the lower back muscles. 

And yes, they were surprised by both their own inflexibility in this particular ROM, and the same in other flexible people. Many of these students had decent front splits (but always through hamstring length and not hip flexor length) too, but the ROM at the hip joint was radically reduced when the back leg was flexed at the knee. This is why we have so many HF and quad exercises. My solo quad-HF exercise reveals this dramatically on workshops and in classes: We ask everyone to do the relaxed back leg version first, and see/feel what depth they can get that way (we teach in mirrored spaces, so this is readily visible) then we repeat the exercise with the back leg loosely folded. The majority can't even get the thigh aligned with the spine in this version—but consider this for a moment: how can you run efficiently if you don't have this ROM when in a loaded stretch position?

To run efficiently, you need this ROM in a completely relaxed way!

 

[AlexanderEgebak]

On 9/5/2024 at 2:50 AM, Kit_L said:

The chiropractor's tests are not as accurate as the standing test I described in the clip above; there are many reasons for this claim. Nonetheless, let us assume that you do have a structural leg-length difference (let's use the shorthand of LLD from now on) of 1cm, or more. The 11 studies I referred to briefly above were whole-body X-ray studies (just what you measure on a whole-body X-ray to determine LLD led to a vigorous debate all by itself).

A 10mm LLD was claimed to be the point of significance but with zero arguments to support this; the 10 studies subsequent to the first one simply accepted that significance point and ran with it. Lesser differences can be significant, depending on lifestyle.

5mm is definitely enough to cause all the problems you have noted and a great many more. Let us accept the chiropractor's assessment of 10mm. Heavy lifting will exacerbate all the adaptations the body must necessarily do to adapt to the asymmetrical forces acting one it, because the body needs to distribute these forces as widely as possible throughout its structure, muscles, bones, fascia. All have to adapt (this is automatic and out of our control, BTW; and not a problem). An induced scoliosis is one such adaptation; I have one myself, but it is of no significance now. You can see my scoliosis in the video above; it is exaggerated when I put the blocks under my longer leg, and when I put the blocks underneath the shorter leg, my spine becomes more or less completely straight. 

So—what to do? First, adopt a relaxation practice, daily, and commit to three months. If you do this, you will notice many changes, and most will be permanent by then. The nexus here is that the majority of the discomfort in your body is coming from the asymmetrical adaptations your body must have made; all the stronger places are also holding more tension. Learning how to really relax will make an unimaginably large difference in your daily life, more than literally anything else you can do. Held tension is what is causing the "irritability" in the body you mention in your first post. As many others have reported in this forums, you cannot imagine the effects of this before you feel them—so get started today.

Some background here: https://stretchtherapy.net/relaxation-wiki/

Next, a simple stretching program is needed, and the key muscle groups to loosen are the three hip flexors. You will need to concentrate especially on the partner hip flexor stretches, and the quad-hip flexors stretches—it's possible to have loose quads (when stretched on their own) and loose hip flexors (when stretched by themselves), and very reduced ROM when both ends of these muscles groups are stretched at the same time—this is completely unexpected by flexible people (like dancers and gymnasts) but we have seen this literally hundreds of times, both in the clinic and on workshops.

Here are the best exercises: https://www.youtube.com/@KitLaughlin/search?query=quad hip flexor

You will notice that you are much tighter on one side with any of these exercises—this is a major consequence of your LLD, and the main cause of the SIJ "rigidity and stiffness", too. You'll recall that the origins of all the fibres of psoas and iliacus are the anterior surfaces of all the lumbar vertebrae, and they share fascia with the lowest part of the diaphragm, and quadratus lumborum, and their insertions in the femur mean these muscles have significant leverage on the rotational positions of the vertebrae (as well, this is a major factor in the scoliosis you mentioned). The reason it's essential to balance quad length is because of its attachment (anterior inferior iliac spine, or AIIS)—asymmetric resting length here is a very significant contributor to anterior pelvic tilt and rotation; again visualise the scoliosis. 

We have found that the greatest bang for the buck (in terms of results gained for time spent) is to do two strong stretching sessions a week only (one session can concentrate on the quad-hip flexor exercises; the other on only the partner hip flexor exercise) and need take no longer than 15–20 minutes.

The third recommendation is a small (5mm I suggest) heel lift in the shoes you train in. If you train in bare feet a quarter kg plate underneath your heel when doing any of the vertical load-bearing exercises will work just fine. Use something thinner if this feels too much. This heel lift needs to be relatively non-compressible. I used a piece of leather that was about 6 mm thick in my Olympic lifting boots, and in the days when I used to wear shoes a similar lift in them as well. 

The fourth recommendation is to concentrate on unilateral training for six months or so (single-leg strengthening in particular) because while you might not feel this, one leg and glute will be weaker than the other. 

The general rule is to loosen the tighter of any pair of muscles, and to strengthen the weaker of the pair. This way whole body symmetry will be attained, in time. Doing the relaxation exercises speeds these adaptations, too. Comfort in the body (along with improved function) will be the result.

Thank you for taking your time to write such a detailed response!

- Regarding the relaxation practice:

This is another argument that piles up to begin relaxation practice. At some point I know I will budge once energy and time allows for creating some lasting habits with regards to this. Your arguments makes sense and learning to relax and let go of tension may reduce irritability and heighten awareness towards a relaxed posture and sense of comfort within my body.

- Regarding the stretching advice:

When I am doing the combined hip flexor stretch, I notice difficulty reaching the point of the psoas being stretched. What I think is happening is that as I am stretching my right front side, my spine arches and tilts to compensate and the posterior tilt is disallowed. The posterior tilt is easier to perform on the left side but feels blocked and tense on the right side. Of course, I will experiment on this further but I am worried that this stretching might worsen the scoliosis. When I am doing my singing practice this is exactly also what I am experiencing trying to posteriorly tilt: Experienced tightness and stiffness on the right side; left side nothing.

The explanation makes sense, also with regards to the tightness and rigidity of the pelvis and hips and why I sometimes feel imbalance, fragility and a lack of stability. However, this feeling has persisted for as long as I remember. All the way back to when I was 3-5 years old and was learning to swim; kicking unevenly with my legs during breaststroking. I cant help but feel as if another component might also have driven the development of what I am experiencing today.

- Regarding heel elevation:

I rarely train in shoes and rarely do lower body strength exercises as my focus is primarily on calisthenics and upper body strength training. Lower body development mostly comes from stretching, handstand work and general sports activities I casually engage in. I will look into a sole for elevation.

- Regarding lower body unilateral training:

Seeing that I dont engage in lower body strengthening exercises would you still recommend unilateral strength training? My go-to exercise regiment right now are weighted pull ups, weighted dips, seated dumbell overhead press, bent over front rows, standing biceps curls coupled with handstand and gymnastics related mobility work.

- Further findings I wanted to elaborate:

Numbness and discomfort felt in the right heel, tingling sensations down my leg to my toes. Right side spinal stiffness probably going all the way up to the neck. Tense right side buttock muscles which are slightly atrophied compared to left side; less tight, more mass. Tendency to want to lean on my left leg. Stiffness in the spine from standing or walking as early as after 30 minutes. Tendency to always change posture, assymmetrical sleeping, sitting and standing postures.

[Kit_L]

If the advice 'makes sense' then action it.

Please re-read what I suggested in total, and then decide if your current level of suffering warrants you taking this advice. The relaxation advice is, as I have mentioned in the past, the most important of these suggestions. All are relevant and important, and all are likely to benefit you.

[oliviaa]

 

Hi Alexander

A few comments for you, from my personal experience.

 

I came to Stretch Therapy at age 20. I had been involved in several sports from a young age, with the main one being artistic gymnastics. As with many athletic endeavours, the doing of the sport confers a particular pattern of flexibility and strength. Gymnastics is very unilateral – almost no gymnast performs skills on both sides; everyone has a preferred side and that is the one that gets trained to do skills. [You mention your handstand training – when you do a lunge entry, do you always kick up by leading with the same leg? I am sure the answer is yes.]

 

One of the principles of Stretch Therapy is to pay attention to any left/right differences in your body. For the first few years I was involved, all I did was identify the left/right differences in my body – first focussing on flexibility, and then on strength – and work to redress these differences. Next, I focussed on individual parts of the body and identified any significant disparities in range of movement and activation. For example, shoulder function. My shoulder flexion was epic (if I say so!), but extension was limited. Again, I identified the restrictions and redressed these, first in range of motion, and next, I did the same for strength.

 

The reason for starting with range of motion is because if you try to work on strength when there is restricted range of motion/lack of connection to how to activate a muscle, you are liable to 1) recruit muscles other than what you are wanting to target to do the work, and/or 2) injure yourself. The flexibility work also enables you to feel individual muscles: once that has happened, then you can recruit them for the strength work.

 

Kit has recommended above that you incorporate unilateral lower body strength training. This is fundamental to physical function in humans – we move around on our legs. As we get older, maintaining strength, in particular in the lower body, is essential. Kit’s recommendation is in response to what you have written about your own body – now is the time for you to action this.

 

Kit has also stressed the importance of relaxation practice. You write:

 

"At some point I know I will budge once energy and time allows for creating some lasting habits with regards to this." [My emphasis.]

 

It doesn’t take any energy to lie down! With regard ’time’, how much time did it take you to write your posts above? Next time you sit down to craft a forum post, instead choose to put your time into the relaxation practice. It’s all about choices.

 

Side note: unlike many of the girls I did gymnastics with for over 10 years, I do not have any back or other pain. I truly believe that that is because I did what I have described above, all those years ago, and have continued this approach thereafter.

 

Cheers
Olivia

 

[AlexanderEgebak]

Thank you both for your inputs.

Olivia, thank you for chiming in.

You stress the importance of balancing out the asymmetry that accumulates in your body throughout the years, especially if you are performing load bearing activities that force physical adaptations. I appreciate that you elaborate on Kit's point about needing unilateral strength work which (lower body work in general) is something I have been shoving away for a very long time.

Lots of things are requiring my attention in my life currently which means that establishing new habits are currently very demanding to me, exhausting so to say. The low hanging fruits to me seem like incorporating the psoas stretching in my already existing stretching routine and adding 1-2 unilateral loaded exercises, perhaps split squats and single leg deadlifts.

And then, as things become habit, I can climb further up the tree and follow those of your recommendations that I perceive as more demanding to integrate.

[Kit_L]

14 hours ago, AlexanderEgebak said:

...exhausting so to say.

The exact reason you need to start the relaxation practise today. As Olivia said, it takes no energy to lie down.