“Best Aspects of Being a Physical Therapist”

During a follow up session with an inquisitive high school runner, she asked several poignant questions and made statements that help illustrate the best aspects of being a physical therapist.

The first question was, “Do you know every muscle in the body and what they do.”

I thought for a second and responded, “I think so.” I thought a brief instant more. “Well yes, of course. I probably could be stumped, though, if push came to shove.”

Then I went on to explain that it is more complicated than knowing the muscle and its action (what joint/s it moves), because it really is relative to the body position at an instant in time and whether a foot, both feet, one or both hands are in contact with an immovable object, such as the ground. How one moves during his/her meaningful task is variable, and there may be one strategy to accomplish the task that is painful, but the best part for me as a physical therapist is figuring out how to help someone perform that task without pain.

She then asked, “So can you do physical therapy to yourself.”

I replied in a somewhat disappointed tone because this is commonly how physical therapy is viewed. “No, and here is why…”

I went on to explain that physical therapy is a profession, not something one ‘does.’ As a physical therapist, I have a large toolbox of ‘treatment’ options, and as a professional I have to decide what the best strategy (which tools) to employ in order to address my client/patient’s pain complaint or performance goals. The best part of that is problem solving and having the time to work one-on-one with an individual to address him/her as a unique person. It is a partnership, and someone opening up to allow me to share in a sliver of his/her life experience is extraordinary.

The last statement this young patient made pertained to her preventing pain and injury in the future, so she can continue to live an active lifestyle as she goes off to college and beyond. For me this is really what our profession needs to be about. Physical therapists have the opportunity to be ‘upstreamists’ in the realm of healthcare through educating our patient/clients about healthy movement unique to his/her experience.

This is why I do what I do.

 

-Erik Bies, DPT MS

 

Check out this awesome TED talk about “Upstreamists” in healthcare, and understand how you as a healthcare professional should be thinking, and for those who are clients or patients, what you should look for in your healthcare practitioner.

 

 

Does improving hip extension mobility actually improve running economy?

Back, pelvis, and hip deep anatomy (anterior view). Psoas and iliacus flex and laterally rotate in open chain movements maintaining the precise axis of rotation in the acetabulum. In closed chain (standing), they are anterior struts for keeping the body upright and stabilizing the lumbopelvic hip complex. The iliofemoral ligament “checks” excessive anterior translation of the femur head in the acetabulum when extending and medially rotating the femur.

Runners, coaches, and other athletes are always looking for ways to prevent injury and become more efficient and economical while running.  In this example, let’s consider our athlete is the weekend warrior with a 40 hour/week desk job or high school student-athlete. This person sits several hours a day, with maybe a 10-minute walking break every hour. Conventional wisdom is that this person will develop a lack of hip extension due to tight/stiff hip flexors.  The hypothesis is that stiff hip flexors shortens stride length negatively impacting running economy, defined as steady-state oxygen consumption at a given running speed.

So does improving hip extension range of motion in individuals “lacking hip extension” improve running economy? According to the evidence, the answer is NO! Though a 20 year old article, this topic has been researched.1 Subjects were young, athletic male college students determined to have “less than normal hip extension” meaning they were unable to passively extend the thigh past 0 degrees. Subjects were divided into a THREE DAYS PER WEEK (yes that is all) hip flexor stretching group and a control group. On average, hip extension improved 9.8 degrees in those who stretched 3 days per week. Despite a statistically significant change in passive hip extension measured using the modified Thomas Test, improved running economy did not occur. The control group (those who did not stretch) actually showed greater improvement in running economy.

What does this mean practically? Improving hip extension through stretching anterior hip structures does not improve running performance at speeds associated with running at paces one could maintain for 10-20 minutes. Could it actually be counter-productive? From both injury and performance perspectives, YES!  Consider that running at faster speeds requires sufficient anterior stiffness to withstand the forces generated by some of the strongest torque producers in the body; the gluteals and hamstrings. It has been speculated with good biomechanical evidence that excessive hip extension forces and joint angles are associated with injury to the anterior hip joint.2 Furthermore, improving your stride length is not primarily the result of greater hip joint extension range but rather more distance traveled during the float phase of running. This requires power, the perfect combination of force production and timing. A well-timed and stronger stretch-reflex in the hip flexors generates a more powerful hip flexion moment. Finding the optimal blend of stiffness and mobility at exactly the right time is what is important.  Improving economy comes down to practicing a skill and improving timing of force production along with other metabolic processes.

How does this affect you? First, understand the goal of your flexibility exercises. If you are stretching because of hip pain, back off stretching and get assessed by your physical therapist. Stretching could be counterproductive even if you get short-term relief of pain. Are you certain you have limited hip extension? Don’t assume that working at your desk creates short and stiff hip flexors. Videotape yourself from a side view running at fast and slow speeds when you are not fatigued. Do you lose your “neutral pelvis” position. Even if you notice that your low back is arched and your pelvis is anteriorly tilted, do not assume you have stiff hip flexors. This often is a coordination issue that can be addressed through specific trunk and pelvic girdle movement awareness.

Related Blog Posts:

Are you sure your hip flexors are tight? If so, why and who cares?

Psoas, please release me… Let me go!

Does excessive sitting shorten the hip flexors?

Sources:

  1. Godges JJ, McRae PG, Engelke KA. Effects of exercise on hip range of motion, trunk muscle performance, and gait economy. Phys Ther. 1993; 73:468-477.
  2.  Lewis CL, Sahrmann SA, Moran DW. Effect of hip angle on anterior hip joint force during gait. Gait and Posture. 2010; 32:603-607.