Understanding Hip Pain
Resolving Hip Pain with Active Release Techniques (ART)
By Dr Jason Gray BHK DC MSc
Hip pain can prevent you from standing and walking comfortably, and can stop you from enjoying your favorite activities like running, playing golf, exercising, and gardening. It can even get in the way of a good nights sleep. To make matters even worse many common hip conditions are slow to respond to traditional types of care, often creating further disappointment and aggravation.
Fortunately, a new treatment technique known as Active Release Techniques (ART) is proving to be a very effective method to treat many common hip problems and is helping to get hip pain sufferers back doing their favorite activities. But before we talk about how ART works so effectively you first need to understand how the hip becomes injured in the first place.
How Does Hip Pain Occur: Understanding Scar Tissue Formation
Your body relies on a complex set of muscles to move, control, and stabilize the hip. Even basic activities like walking, or climbing stairs places a lot of demand on these hip muscles. This stress is even greater with activities like running or jumping. As the hip is subjected to this stress over time the muscles can become strained and overworked. This in turn creates small scale damage known as microtrauma.
To better understand this process, imagine these hip muscles as a collection of short little rubber bands that each need to stretch and contract as the hip moves. Then think of this microtrauma as like getting a little pin prick in some of the rubber bands. This little pin prick is very small but it still needs to be repaired, so the body puts a little dab of glue over the pinprick. This glue is actually new connective tissue that your body lays down over the damaged muscle fibers, and is often referred to as scar tissue, or soft tissue adhesion formation.
Initially this microtrauma and subsequent scar tissue formation does not affect how the muscles stretch or contract, but as the hip is stressed over the course of weeks and months it creates a repetitive strain cycle which is associated with more and more scar tissue being deposited in the area. Eventually this scar tissue will build up and begin to affect the health of the muscles.
Essentially, all of the little rubber bands become caked in glue compromising their ability to stretch or contract. This scar tissue can also cause different muscles and muscle layers to become stuck or glued together. In some cases this scar tissue can even restrict some the the nerves that pass through the hip muscles.
At first there is no pain as the body can rely on other muscles around the hip to compensate for the weak or tight areas. However, the body can only do this for so long, and as this cycle continues at some point a symptomatic threshold is reached and hip pain will develop.
The Traditional Approach to Hip Pain
In an attempt to relieve hip pain, a variety of treatment methods are used, either on their own, or in combination with other methods. Some of the more common approaches include anti-inflammatory medications, rest, ice, ultrasound (US), muscle stimulation (E-Stim), stretching and strengthening exercises, and when all else fails, surgery. Unfortunately, most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.
The main reason that these approaches are often ineffective is that they fail to address the underlying scar tissue adhesions that develop within the muscles and surrounding soft tissues. It is these adhesions that are binding the tissues together, restricting normal movement, and interfering with the normal flexibility and contraction of the muscles in and around the hip.
Passive approaches such as medications, rest, ice, and ultrasound, all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as stretching and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles, however, they themselves do not treat the underlying adhesions. In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery from hip pain.
Our Approach: ART – A Better Solution
ART stands for Active Release Techniques. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. What makes ART different from other treatments is that it is designed to identify and address scar tissue adhesions that are interfering with the normal function of the body. By locating and treating the soft-tissue adhesions with ART, it allows the practitioner to, 1) break-up restrictive adhesions, 2) restore normal tissue translation and movement and 3) more completely restore strength, flexibility, balance, and stability to the hip and surrounding area.
You can think of an ART treatment as a type of active massage. The practitioner will first shorten the muscle, tendon, ligament, or joint capsule, and then apply a very specific tension with their hands as you actively stretch and lengthen the tissues. As the tissue lengthens the practitioner is able to assess the texture and tension of the tissue to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area. There are over 500 specific ART treatment protocols which allow the practitioner to “feel” which structures have become problematic and require treatment. In this sense, each treatment is also an assessment of the health of the area as we are able to feel where the problem is occurring.
An additional benefit of ART is it can allow us to further assess and correct problems not only at the hip, but also in other areas of the “kinetic chain” such as the foot, ankle, knee, pelvis, and back. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific hip injury are addressed, even if they have not all developed pain.
How Fast Can ART Treatment Help with Hip Pain?
One of the best things about ART is how fast it can get results. In our experience, the majority of hip problems respond very well to ART treatments, especially when combined with home stretching and strengthening exercises. Although each case is unique and there are several factors that will determine the length of time it will require to fully resolve the condition, we usually find a significant improvement can be gained in just 3-4 treatments.