Perseverance
For those living with chronic conditions, it’s easy to get discouraged. Medical diagnoses such as “osteoarthritis,” or “femoroacetabular impingement” (FAI) can make you believe that your condition will only get worse or, at best, can only be treated via surgery. Some experts even argue that we are best off learning to “accept” our conditions, learning to live with them rather than making ourselves angry or depressed by trying to fight them. But what if they are wrong? What if we can not only fight them, but win?
Fighting has been the point of this series of posts about my struggles with hip pain. In my personal experience, one should never give up looking for solutions (though I realize that this might not be the best advice for everyone1). One problem is that it is easy to make progress in the beginning, but it gets harder to do so as you improve.
For instance, if you’ve never done certain kinds of intense physical activity, like weightlifting, you will likely make tremendous progress during your first year, but will then discover other physical issues which are impeding your progress. You might have weak secondary muscles, or limited mobility in other parts of your body that are blocking you. One friend is having problems with his deadlift because of weak back muscles.
This is actually one of the things I love about lifting weights. When done safely, it can help reveal physical limitations you weren’t aware of, teaching you about your body. Once you discover these limitations, you will need to step back a bit and focus on these secondary issues before you can return to your usual training routine. Ideally this would be done with the help of a professional trainer or physical therapist.
If I were to chart my overall wellbeing on a graph from -10 to +10, then when this all started about 5 years ago I was at -3. Not catastrophic, but the chronic nature of it was affecting all parts of my life. With hard work and the help of therapists and trainers, I was able to get up to about +3 after about four years. That is what my earlier blog posts described. But then I faced an important question: is this as good as it gets? Can I ever get back to +10?
For the past year and a half I’ve felt like I was stuck. In some ways I was now in better shape than I’d ever been in my life, even better than when I was doing varsity sports and martial arts in my twenties. My hip was much better too. I no longer was in pain all the time, and I was getting proper sleep. But I still was having problems. Sometimes, especially after sitting for a long time, I would get up and start limping. And I couldn’t easily put on my socks and shoes anymore. These and some other issues made me feel like I had the hips of someone twice my age.
Was this just something that I needed to accept? Would it just continue to get worse over time until I needed surgery? Or was there something I was missing, something that I could do to start making real progress again? If you know me, you know that I didn’t accept it, that I kept fighting. I’m glad I did! If I was at +3 six months ago, I’d say I’m at about +6 or even +7 now. And in some ways I actually have better hip mobility now than I did when I was young.
The transverse abdominis
The title of this series is “Waking Up My Glutes,” but it turns out that my glutes weren’t the only muscle that needed to be woken up. A few months ago I went to a new physical therapist in Taipei and he told me I need to work on an exercise that is called “abdominal hollowing” or the “stomach vacuum.”
The problem is that, when you look at YouTube videos on this exercise, you get a lot of body builders doing something very different from what my therapist wanted me to do. Turns out that the problem has to do with which muscle is being targeted. The body builder version, like you see in this video, targets the rectus abdominis, which are the muscles which give you a pretty six-pack. However, what my therapist wanted me to work on was actually the transverse abdominis, a deeper muscle that wraps around your internal organs. It is often called the “corset muscle.”
Along with the other abdominal muscles, the transverse abdominis supports the torso and stabilizes the spine and pelvis during movement. It is very important to have voluntary control of your abdominal muscles—in other words, to be able to engage them when needed—in order to avoid overusing your back muscles for stability and support. (source)
The following video shows the exercise I am doing to train this kind of voluntary control:
Since I started doing this (as part of my longer morning routine), I’ve made steady progress again for the first time in years. Having gained a degree of control, I am now working on endurance, since the muscle gets tired easily.
It is very hard to find information on the relationship between the transverse abdominis and chronic hip pain online. If you do a Google Scholar search for the scientific literature, most of the hits are related to lower back pain, not the hip or groin. One thing I’ve learned, however, is that many of the same underlying issues can manifest themselves either in the groin or the lower back, depending on the individual.
Protective muscle guarding
What is harder to figure out is why a weak or inactive transverse abdominis can lead to hip mobility issues. The theory put forth by my PT seems reasonable: my body is engaged in something called “protective muscle guarding”:
A protective spasm is the brain’s reflex attempt to prevent further damage to injured tissues. By ‘splinting’ the area with a spasm, muscle ‘locking’ effectively reduces painful joint movements. The brain simply acts to protect the body: ‘When in question, lock the muscle.’”
By learning to use my transverse abdominis, I am simultaneously learning how to relax the other muscles which tense up to protect my hip. (In practical terms, I’m doing variations of the “dead bug” pose after doing the “abdominal hollowing” exercise.)
A bigger question is how and why this started in the first place? I can’t recall any recent injury that could have caused it. The best theory we’ve been able to come up with is that it is a delayed reaction to inguinal hernia surgeries I had as a teenager. On the right side, where I have problems, I actually had to have the surgery twice because the FDA later banned the implant they used the first time.
Resilience
I still don’t know if I’ll ever get back to +10 with regard to my hip mobility, but in other ways I’m already at +20, since all this work has given me new kinds of strength and mobility that I never had before. Every time I post one of these essays people seem to think that an expression of sympathy is the appropriate response, but that makes me think they missed the point. Yes, there are issues I’m still struggling with, but I feel like someone who should be congratulated for overcoming extreme odds to win a sports competition, not like someone who needs sympathy.
The specifics of how I overcame chronic hip pain are probably only relevant to a very small set of people with similar problems, but I’d like to think that the overall story can serve as inspiration for people who are trying to decide for themselves whether to keep on fighting or simply accept their body as it now is. Maybe you can’t actually fix what’s wrong with you, but in the process you might fix a lot of other things, and improve your overall conditioning, making your body as a whole more resilient than it was before. The body is a lot more plastic than we tend to think of it. Even in middle age you can still make tremendous gains in mobility, changes you never thought possible.
There is really no way to tell if there is a potential fix for your problems or not, so you have to simultaneously keep trying while also cultivating a degree of acceptance at the same time.↩︎
