Mukunda,
After gross body reading and observing how my client holds his body, it appears that his right hip is cronically medially rotated. Standing, I observed that the majority of weight is on the left leg, right knee is bent and right hip rotates medially. (Client has low-back/hip pain located on the left side). Right shoulder is high and medially rotated as well. Detail ROM identified that internal rotators are extremely tight (external hip rotation measures 20L/15R, and hip flexor length identified knee abducting and straightening–reflecting tight TFL and quads. The entire ROM on hip movement was limited, well below average. Strenght tests reflected weak hamstrings. What exerises do you suggest to extend the right hip to neutral, and what would you recommend for releasing internal rotators?
Check your language. medial rotation is internal; lateral rotation is external. Which is it? Clarify you may need to rewrite this then i can respond more clearly too. My initial hit is below –
internal rotation is sign of collapsing, life is too demanding. Giving up against the struggle; one might consider the psychology of body language to see if this person really wants to change. Not always do the body language, energetic intention and mind align.
Weak hamstrings usually means tight hip flexors and/or quadriceps. doing exercises for all these motions will improve posture. namaste
The client appears to cronically rotate his right hip internally, towards the medial line of the body. Right shoulder is following right hip, internally rotating as well. Client complains of low back pain, expecially on the left side. The client is a very active, athletic man, spending lots of time on the golf course. Being passive is not his style, so it appears.
My question is how do I assist him with balancing his hips (right hip/shoulder extending back to neutral?) In addition, how do I release internal rotators (ROM of external rotators was very limited–see above.)
That is more clear. Watch your languaging. Internal or medial rotation is when the body collapses tightening groin or pectoral if shoulder. External or lateral rotation is opposite - over opening to world an agressive stance. Natural when one is over ROM opposite will be below normal ROM - but you always have to use goniometer to be sure. Some bodies don’t follow the predicted pattern.
The other part of your languaging that needs clarification is the word extend. Extend is not clear. Extension is opposite of flexion a backward motion. But to extend implies lengthen so this does not imply strengthen nor stretch, just elongate. So i would recommend you not use the word and if you mean to elongate use that word.
Another concept is balance. In general we are seeking balance not really to bring all bodies to the average ROM and MT of #5 strength for all motions. One must consider the symmetry and psychology of the individual. Optimal is really to use the languaging of the doshas and seek sattva for the individual. In this case it may be best to leave his ROM where it is. To answer that question i need you to clarify your statement of he has low back pain. You did not assess what muscle or region has the pain. I need to know if it is latissimus, quadratus lumborum, or erectors. To determine that you move his body in ways that isolate the motions of eah of these muscle and find what alleviates his pain and what aggravates it. Find this out and report.
Given that he golfs we need to know if he is right handed that will naturally compress the right lower back. If his physique build is such that he has a left lumbar curve then fixing his yoga practice will not correct his pain. It may likely be he needs to give up golf. Or have an expert tutor who understands kinesiology and golf to show him better technique in using muscles he is neglecting. In addition showing him how not to use the muscles he is irritating.
This is how you make sense of MT and ROM assessment. You must adapt to the individual. I caution you not to hold onto postural bodyreading. This is not an accurate part of the assessment procedure. Just consider these imbalances. The true test is what happens when you apply ROM and MT to such possibilities as you are seeing in standing or lying postures. Especially in this case one has to be certain that you are not projecting your problems onto others.
BE sure your bodyreading is clear. Do not project this means that from your readings of the posture. Bodyreading is not enough evidence; it is often misleading and confusing.
Postural differences do not matter as much as the assessment of ROM and MT. You seen to want to weigh your findings much more on postural differences. They are confusing when taken alone. Stop it. Each of the tests is gradually gathering more evidence. There is misleading information coming from their posture it may just be a temporary or emotional stance. To be sure you must have the findings confirmed at least twice if not three times in different assessment procedures.
It is clear that you cannot give SYT recommendations yet. Your assessments are clearly not definite. Until you follow this procedure you will continue to be confused. It is not about aligning the posture. That has little to do with how to make recommendations. This is not an Iyengar procedure which you seem to be following. I am not really sure how your thought process is going but aligning the posture will not end in freedom from pain, unless you are lucky. With some minor issues this will be the case but when dealing with chronic problems one needs lots of data before deciding hips are truly internally rotated.
What needs to be there would be the following ?
In supine position toes are pointing straight up or nearly so
In standing feet are straight ahead, turned out toes is normal (standing and lying)
During ROM internal rotation supine reading of less than 35 degrees (same in prone)
External rotation ROM will be greater than 50.
If all these factors are there then diminished internal hip rotation is present.
If the reverse then there is increased internal hip rotation.
To verify it even more the following would be there in MT for diminished internal hip rotation ?
Internal hip rotator will test weak.
Once the findings have been verified by at least 2 tests then you make recommendations for what to do. Without that you are guessing at what will help. One can always be a good guesser or have a diligent client who just does plenty of homework and they make you look good.
But in this case if there is diminished internal hip rotation one can look up the chart in my book and give recommendations that would include all poses where internal rotation is used (page 255 look at gluteus medius and tensor fascia lata ?
JFS #5a; standing closed hip poses ? Virabhadrasana I, Parsvottanasana; or make them up such as sunbird with the hip internally rotated, etc.
For this procedure to work, one must slow down and take each step of the assessment procedure one at a time. you cannot rush to what do i do; or your recomendations will simply layer on more stress. that will make it harder for the next therapist to work with. I hope this clears up the issue. If not let us know. Namaste