Wednesday Q&A 750: Treating Hip and Pelvic Pain, The Importance of Scapular Stability, Helpful Tips When Sore

Today's podcast is sponsored by one of our favorite products - almond cow. We've been using it for a well over a year, and I say we, mostly my husband Mark who is moooing. Honey, what are your thoughts about almond cow? This is the Moo Man! He's back! I love the almond cow, because we know how great it is, anything that you can make a plant-based milk with, you're sad, and I just have it, I don't need to make that much, it's just sitting in the pantry, and then when we're ready, I just make it, it takes a minute, tastes so good! It tastes so good, and for those of you who are thinking about it, let me tell you why. There are no added preservatives, any kind of artificial stuff. You put in it what you want, you can sweeten it to your taste. It is so easy to make, so easy to clean up, and it's pure gold. It really is. A lot of recipes on the almond cow website, you have the recipe, so you don't have to think you don't have to go anywhere to find it. It's there for you. Yes, we love it so much, so if you're interested in getting your own, go check out the link, or just go to their site, almond cow.co, and you can use code LARA for extra savings. Go get yourself one, and have fun! I'm Laura Hyman, and welcome to Redefining Movement, a lit podcast designed to investigate all aspects of movement from my background in physical therapy and neuroscience. My mission is to help everyone find freedom through smarter movement patterns and compassion for ourselves and others, so together we can live our most uplifted lives benefitting all beings. Welcome to Wednesday, Q&A, where you all ask the questions, and we answer, woo! I'm joined, as always, by my fearless, gorgeous, and majorly talented, co-host, Kristen Williams. Seriously talented, you'll have to check out our new swag that she, Kristen, designed with a little bit of help, but mostly on her own, and it is awesome. So check out our shop, make sure you do that. Yes. Okay, all right, we have some good questions, right? Yeah, here we go. So this person asks, "What is the role of manual therapy in treating hip and pelvic pain, especially for athletes who are postpartum individuals?" I thought that was interesting to kind of, yeah, there was two segments. Yeah, I can start off with that. I think it varies. Certainly, hips are something that I have found in my manual therapy practice to be very responsive. They are very responsive to joint mobilization, a lot of times people, the joint capsule, which is the ligaments that tie the, go from bone to bone, and they hold the joint together. All right, get a little less juicy, a little tighter as we age, as we sit more, we're finding, we get older, we get a job, and we sit less, and so we move through our hips a lot less, and so. Sit more. Anyway, with that. What's that? Sit more. You said sit left. Sit left. Yes, we sit more. Thank you. And so, a lot of people can get away with that and have no issues, but if you're an athlete or if you are a postpartum female who then throws some crazy hormones into the mix, and I think a lot of times they can even be a little hyper-mobile with the postpartum, but especially that hypomobile, meaning lacking mobility, I just found that me doing manual therapy on hips is extremely useful, teaching someone to mobileize their own hips with straps is extremely successful. When it comes to pelvic pain, I am not experienced, I'm not a pelvic floor therapist. I know a lot of people who have been to pelvic floor PT, and there is manual therapy that they do in pelvic floor, so I don't know enough about that. I would expect that it too is helpful, but all of these are compliments. They're a tool that if you work on, I mean, Laura, we'll go into a lot of the placement of the pelvis as it relates to the hip, the foot and ankle as it relates to the hip. The rib cage as it relates to the hip and pelvis, SI joints, pelvic floor, all tend to be eye together there. Manual therapy can play a big role, can be very helpful in speeding up a process, I think, but I hate having people being beholden to their therapist. I have been so surprised, Laura, since we went, you know, COVID hit, we went online, started doing a lot of online physical therapy, how many people with hip and pelvic issues that I have helped never touching them, and I helped them simply by assessing their movement patterns, their strength, their mobility, giving them ways to treat themselves. It's been extremely successful, so I would just caution people to know that manual therapy is a tool, it does work, especially in this area, but there's a lot we can do through better movement, through self-hair, whether it's my own facial, self-care, my own fashion, self-joint mobilization, new movement patterns, posture, Laura, take it and run, I know you got a lot to say on it. Yeah, I mean, I think that manual, and we both like manual therapy in different ways, I think manual therapy, like you said, for the area, for the person who has like really sticky hips or that area around the joint capsule that's just not, has kind of gotten a locked feeling, is very, very helpful in promoting the better mobility patterns. For most people, what manual therapy is, is helping communication, it's helping the nervous system communication, and that's why there's so many other ways you can do that without touching somebody, or having them touch themselves. It is a great adjunct, but like I taught, this is a great question, I just taught this morning a class called Soak the Soaz, and the soaz, we say soaz, we're really referring to the Ileossoaz, which is two muscles that can join, and it runs, you have one on each side, it runs from your upper inner thigh, through across the pelvis to the back body, and what I was afterwards, we were just talking, because everybody loved the class, and I said, really what we did, because people always talk about stretch the soaz, stretch it out, you know, or get manual therapy in there, dig in there, all this stuff. I went to my manual therapist to release my soaz, well, they're not really doing that. The soaz doesn't change in size, or shape, or length, what you're doing is you're changing the relationship that the soaz has with the brain, right? So what we're really trying to do is improve the nervous system intelligence, and so that's what I was saying in class today, it's like, we're just making it supple, supple means that we're taking advantage of the length that it has and the strength within that, and that it's responsive, and it isn't gripping because of a nervous system responsiveness. So like if you're sitting for a long period of time, you are shortening the muscle from a mechanical perspective, but the brain still thinks that that's supposed to, that's supposed to maintain that, that because it's been a habitual thing, and you've compensated perhaps to move your low back instead of your hips as well, when you come up to stand. And so we create these patterns that our nervous system adapts to. So what we really do at the, yeah, and we could talk about this for hours, but the role is, is like Kaby said, it's a part of it, but more than anything, it's to help the communication. So how can we help it? Like if it's really in that mechanically shortened position, it doesn't mean it's strong. It also doesn't mean it's tight, and you just need to stretch, stretch, you need to rebalance it. So your nervous system doesn't respond by holding it in an shortened position, and, and manual therapy is absolutely a way to do that. And that can help prevent hip pain and pelvic pain, which are really going to be most likely associated with imbalance of the stacking of the pelvis and rib cage, and then all the things that happen around there. Yeah. Okay, next question from Sime. Can you explain the importance of scapular slash shoulder blade stability in preventing upper body injuries, particularly in sports like swimming or tennis, both of which I do. I will launch in first. This is great that you know, I think you probably take our classes to scapula. I think most of you probably know, but it's at the back. It's in, it's in our back body, but it's part of the shoulder. It's actually the most important part of the shoulder because it's like the anchor for the movement of the rest of the shoulder and arm. And when you're talking about upper body stuff, like swimming overhead, tennis, overhead pitchers, throwers, anything like that where you're going into bigger ranges, you need your anchor strong because you're really moving your arm with a lot more speed and probably force. And then when you talk about something like swimming, you're also coming through a medium that has resistance. So you need the anchor of your scapula to be strong. And when we say stable, we don't mean it's not moving. It's moving on the back ribs and this again goes back to this neuro motor firing. It is managing the movement of the rest of the arm by moving on the back ribs and maintaining that kind of connection to it. So that is, it is essential because when people experience upper body injuries, they usually feel it very infrequently, they feel it at the scapula. They feel it in the area that is less stable, which is the glenohemeral joint, the ball and socket. And then they think it's something around there. And in fact, it's the lack of that anchoring that creates either a shearing force or destabilizing force or overuse kind of force at the glenohemeral joint. So number one, working on any kind of overhead thing like swimming tennis, you also need to make sure that the muscles of your chest wall are pliable and open. And that means your posture is up, you have a good posture, you have a good starting position. Because say you're rounded, well, when you round your, your clavicles, which are also, your collarbones are also part of the shoulder complex. They are losing kind of their buttressing, which helps the scapula anchor. So it's, the shoulder is incredibly genius construction because you've got clavicles in front, which attach to the sternum, which is super stable. And then the clavicles brought in to help your, help kind of your wingspan. And then you've got the scapula and back anchoring it. So this arm can move all around in so many different directions. And people will often, because of their postural imbalances, lose some of their range and they'll try and get it in other ways with their ribs, perhaps, and that further can destabilize that connection between the scapula and ribcage when the ribcage is moving, instead of the arm moving, especially with overhead stuff, because that's where people are going to find their range is more limited. So yeah, work on your scapula stability. If anyone, my quick note is, if anybody were to come to me with shoulder stuff, that's always the first place I'm going to go, and it's, it's everyone needs it. When you see people rounding over, whether they're 20 years old or 80 years old, that's because they're weak back in the upper back slash scapula area. Yeah, yeah, that's a great point, you know, we talk about, we've got four joints of the shoulder, and like you said, people who are not moving well or controlled or stable in the scapula thoracic joint where the scapula articulates on the ribs, they're usually not feeling it there. They're feeling it in their shoulder because we've got these four joints, two of them are pretty darn stable, you know, AC joint, pretty darn stable, SC joint where Laura said, the sternum and the clavicle, pretty darn stable. There's more movement there than say at the AC joint, but so then we've got the scapula moving on the back body and then we've got this ball and socket joint that's really movable. So if we aren't stable in that, that scapula, which you call the footprint, I almost think it'd be like, it's the pelvis of the upper extremity, it's the core of the upper extremity. You know, whenever people have back pain, hip pain, knee pain, what are we end up doing? We give them core exercises, we stabilize the pelvis, we, and by stabilize to Laura's point, we don't mean it doesn't move. We mean that it moves well and it moves with control, there's eccentric control, there's dynamic control. Same thing is true at the shoulder for it. That's part of why we're bipedal, right? You know, we've got this beautiful arm that can move all over, but if you're in a sport where like you said, we're going against resistance, it's repetitive. We need to be strong there. I will point out that we need to come away from the shoulder too. I think people will hyper focus on the shoulder. We need to look at how the trunk is moving, that, that thoracolumbar rotation, the rib mobility as it is against the spine, we need to look at back mobility, even hips. So we contend to hyper focus on what's happening at the shoulder when the shoulder hurts. So scapula, same thing Laura, first place I go to, second place I go to rib cage, how is it stacking up? But then I'm going to look further down the chain. Is there hell this tip anteriorly? Are they lacking in rotation through that side body? If you can't move there, you're going to move in your shoulder. And that's because it's such a mobile joint, that's where you're going to get injured. So it definitely plays a huge role in and of itself, but looking further away, even at the opposite side, the opposite hip. How is it moving when we're thinking of swimming, throwing sports, tennis? There's a lot of full body mobility that needs to be happening. And again, mobility, with stability, which equals that adaptability that we focus on so strongly in the lit method, people get this mixed message. They think that we want people to walk around holding everything stable, stable means not move it, right? Moving, no, we want dynamic stability. We want adaptability to the demands we're placing on the body, and the shoulder just happens to be one of the more susceptible areas because it is so mobile. But just start at that scapula, because it's like the core, it's the core of the rotator cuff to, you know, the rotator cuff is going to help hold the glenohumeral joint, scapular stability is that scapula thoracic joint, the scapula PS is the socket of the glenohumeral joint. So it's it's playing a role in two separate joints. It's really it's part of the AC joint too. So it's the scapula plays a role in three out of the four joints. That's unique. So it's it is really the the head hancho, if you will, of the shoulder girdle complex, the upper extremity. And then yeah, look down the chain. If you're having wrist issues, elbow issues go to that scapula because it's the core of not just the shoulder, it's the core of the upper extremity. Like you said, it's got to be that footprint. It's got to be where we find the dynamic stability. So the other areas are not being victimized by its lack thereof. I always think about like when you do the like twister when you go you want any of these games where you spin the thing and that thing goes around the only reason it can spin like that is because the center is holding its position well, right? And so when we talk about shoulder movement and this big, the rest of the arm moving, it's nice. Think of that spinning thing like it's able to spin because that's holding well, but if that wasn't held well in position and would fly off your arms, not going to fly off, but that's the kind of idea. Like it's coming from this really that thing is moving as well, but it's it's pulling the energy toward it versus like just you know, freewheeling it. Have you ever dreamed of watching Wales breach in the ocean while you're drinking coffee? Well, guess what? That dream can come true because we're going back to Baja Mexico on our next retreat. We're going there from February 22nd all the way to March 8th. You can join us on one of those two weeks. This is a recharge and get lit up retreat. This is an amazing place. We were there last year. It's in Baja. It's on the tranquil coast of the Pacific Ocean where as I mentioned, you will see Wales breaching playing and it is just gorgeous to watch. You can go out on a whale watching trip. You can go snorkeling. You can go kayaking. You could also just chill out at the incredible Prana Del Mar. This facility is gorgeous. There are places to relax all around including a pool and a roof deck and then we of course are going to be doing some yoga. We'll have twice daily lit classes. We will be bonding with our amazing lit community while enjoying chef-prepared meals in luxury accommodations. Don't miss out. Come join us. Check out the link in the show notes. Okay. Finally, we have khaki creations. What can help when you're sore from working out? This is probably pretty universal people have experienced that. What would you say? For me, the very first thing is to keep moving. I see a lot of post-exercise soreness helped by my lit practice. If I go run a half marathon that I know I'm going to be sore. If I get on my mat, after I get on my mat the next day, I can move through that. We have to move that lactic acid out. I certainly think there are other elements like hydration, nutrition that will impact it. Nine times out of 10, I feel that moving through it is the number one way to just speed up that process. Knowing that soreness is a good thing, when we're sore, and I mean a tolerable mass soreness. People can go way over and be actually overdoing it and causing damage, but that's how we increase our muscle mass. That's how we increase our bone mass. It's through stress and strain, and so we need to feel those moments of soreness to know that we're growing our muscle, we're rebuilding muscle, we're rebuilding bone, through that feedback of soreness. If you're never sore, I would ask yourself, "What are you doing?" There are times I used to be at the studio and we were teaching, and I would just see people who came every single day. They were super religious, but they just sort of half-assed everything. I thought to myself, "That's probably how they can do it every day is because they aren't putting full effort in, because I'm a go-getter." I would come take Laura's class, and the next day I'd be like, "Super sore." I've learned now, after now doing yoga, doing yoga every single day while I teach, is that I will change my intensity, my amplitude of my practice, but if you're never getting sore, to me, I question the "why," and I don't mean painful sore, just like a little bit of, "Oh, I did some work." If your purpose is growth, if your purpose is growth by way of strength, if your purpose is growth by way of connected tissue responsiveness, I do think that soreness is a good indication of, "You did enough to rebuild, but it is a fine line," so we're sort of walking a balanced beam. What else do you have to say about that, Laura? Well, I would say, not knowing, like again, not knowing what you mean by sore, if this is a particular, like what Christian's saying is this regular, is this, the first thing, if you take aside all the other elements, which would be nutrition, hydration, sleep, and recovery, and you're moving, you're continuing to move, I would say, "Look at your form," like because, you know, say somebody who practices yoga, for example, is kind of chronically sore around their sit bones, well, that's an indication that you are straining an area that doesn't need to be strained, that's the musculotin in his junction, and that's probably because your mechanics are not optimal. So there's that type of soreness, which is the only kind of soreness I would be like, you need to change, well, you definitely need to change something up because what you're doing there is, your soreness then is your, like that chronically sore means something needs to change biomechanically. If like to Christian's point, because we think of sore, because we know our biomechanics are good, we think of sore as like, oh, we really like, you know, loaded this area, or the duration was really a lot more than normal, and so that's the other thing to pick, you know, if you're starting a program, make sure that you start at a reasonable amount, so if you've been doing nothing, doing 15 minutes of movement a day is a good place to start, and that can feel like a lot, and then you don't want to go right to 60 minute high power walk if you haven't been doing something, because that alone could make you sore, that's not going to make us sore because we're doing it regularly. So look at like what you're doing, look at your form, have somebody look at your form by the way, if you don't know, because you need to learn, and that's what we, I mean, this is like the top reason why people pay to belong to our platform is we're actually educating them, so they can understand, in their own body, they don't have to be told and monitored, yes, maybe sometimes, but they get it, it becomes in body. That is so worth, worth investing because that will change the way you move in throughout your life, not just during your movement practice. And then the other thing, like I would say, is monitor like, how much you're doing, is your body prepared for it? But you just change, you know, change one thing at a time, how much you're, how much you're exercising, and then the intensity of it, so that your body can adapt. But you know, that's what we have the lit platform for is that we have all types of classes on there. We have different levels, different time periods. We have the ability for you to slow down a class by just going to the, you know, video and slowing it down if you need to take it slower. And then we have a community where you can ask questions of others like, hey, do you guys also feel sore on your armpit sometimes and that people will be able to say, yeah, that's working some of those muscles that are really important. So check out our lit daily if you have not. And we are not going to ask you to ask any more questions because guess what? We're taking a hiatus. We have one more podcast episode after this. And then we're taking the first hiatus in a big one and in 757 episodes. So we will miss you all, but this will be your opportunity to catch up on other episodes. You can still write us, by the way, Laura Hyman, Laura dot Hyman, Instagram and KB Williams 99, just say hi and tell us how much you miss the podcast. We'll be back, but we want to take a little break and give you a chance to catch up. So you can also write us at support at lit yoga dot com. That happens all the time, by the way, people will even on the platform, people will comment on our videos and say, hey, Kristen, when I did this, this felt that way. And I, we get email alerts, I respond to every single one that I get. So yeah, that's what I love about, you know, the way we work is people say, this must be so boring for you because you're watching me do this. I'm like, no, I love it. This is like what fills us, it's educating people, helping people not need us as physical therapists all the time and, you know, learn to, as we say, feel at home in their own body. Mm-hmm. Yeah, lit is the prehab that everybody needs to feel really alive and joyful in your practice and in your life. And just know that we're still here always, because we are always, always, pulling for you. Thank you for joining us on this episode of redefining movement. If you like what you've heard, please like and subscribe wherever you get your podcast. Feel free to leave us a rating and review or share with someone you know. Check us out at www.lit-method.com.