Case Study-Neurological findings in the hips and how to treat them using neurological mechanisms in a clinical setting.

In a recent case, I had a client come in for a hip assessment.

While testing their fundamental joint range of motion (internal & external rotation) we discovered neurological tightness (NT) bilaterally in external rotation. There was a very distinct rise in tension coupled with a firm stoppage at the end range of motion. There was also no connective tissue coming online and lengthening to give the sensation of stretching. The neurological mechanism of neurological tightness was inhibiting us from achieving true anatomical end range and accessing mechanical tension or lengthening. 

Where this case became interesting is one hip had NT of the slow-twitch motor units/fibers, and in the other hip the fast-twitch motor units/fibers were the issue.

How did I come to this conclusion?

While treating the NT the one side that happened to be on the ST side, we overcame the neurological barrier by doing low-level isometrics (PAILs) for 60 seconds. We used the ability to feel a stretch as a feedback mechanism to know we are now feeling mechanical tension and NT has decreased. We achieved this after 2 sets or so. We continued to do 60-second sets until fatigued, so the nervous system would no longer "fight us", and we were able to then train the connective tissue and joint space.

On the other side, this strategy did not work. We tried 2 or 3 sets of low-level isometrics with no change. So I had the client do ramping sets to 90% of his safest maximal effort. After one set we got positive feedback, and he started to feel a stretch. We did three more hard sets until he fatigued and we continued to receive positive feedback by acquiring the appropriate stretch, and again, we were then able to treat and train the architecture and joint space.

Here's The Point

Assessment is king. Without a proper assessment, this client would have continued to try and stretch and continue to have no success because his nervous system was preventing him from doing so.

Based on prior experiences, the nervous system had set parameters regarding joint space. No stretching, foam rolling, or yoga, can bust through that neurological barrier, the nervous system must receive new information in order to begin to change those experiences. And that takes time.

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