Hip Problems

 

During a month in my practice, I spend dozens of hours working on patients with hip problems; usually one or two a day.   For 26 years this has been the case.   People don’t ignore hip difficulties like they do other aches and pains; it’s just too miserable to bear.     How miserable is shown in this list of in patient surgeries.  

2.1 million – number of patients who received arteriography and angiocardiography
1.3 million – number of patients who underwent cardiac catheterizations
664,000 – number of persons who had a balloon angioplasty of the coronary artery or coronary atherectomy
617,000 – number of women who had hysterectomies
478,000 – number of persons who had a total knee replacement
234,000 – number of patients who received total hip replacements

 

After heart related problems and the depressing statistic about hysterectomies, next down the list are knee and hip replacements.  Between these two, almost 1,000,000 surgeries are performed every year.   It is not far from an uncomfortable hip or knee to one which cannot support your weight.  Hips and knees get so sore, I have often heard patients say, even the day after the surgery, their pain is less than before.

 Now sometimes body parts just wear out with age.   But many people are having their first hip replacement in their 50’s. It seems evident, from these surgical statistics, that patients are not getting help to keep their own hips and knees.  Why do body workers struggle with this area?  One reason, which makes it difficult for therapists, is that this area is so complicated even the experts can’t quite understand its mechanical action.

For instance, there are at least four theories on where the center of gravity in the sacroiliac joint. 

But one thing all agree on, legs and hips started getting bad when we stood up on our haunches.  

Animals on all fours have much less problems with their knees and hips than we do.

It is the price we pay for having our hands free to make tools. 

But to have this skill, we  perch on our hips to stand, walk on our hips and sit on our hips; all amazing feats of equilibrium fraught with peril; for any imbalance above,  below, or East and West of  the hips causes the head of the leg bones to try to sustain more angle than they can handle. From a mechanical point of view, it is important for the muscles of the legs and pelvis to produce the correct angle in the pelvis; pulling it upwards into the curves of the spine so the curves can absorb most of the downward pressure from the torso. When this doesn’t happen, the hips end up twisting in a struggle to get under us.  This wears the head of one or both of these bones out.

 But this wearing out process, like all body dysfunction, is a problem of relationship.  With hips, there are two powerful sets of dysfunctional mechanical relationships.

 One involves the skeletal system; these structural problems include the sacroiliac joints, their ligaments, and the balance of weight with the fifth lumbar; and the muscles which support them.

The second dysfunctional mechanical relationship involves fluid pressure injuries. These problems are caused by hard falls; often times ones in which we land on our backs or behinds; also by childbirth, surgeries and car accidents.   When this trauma of compression happens, because we are 97% water, the sudden spiking of pressure inside us causes injuries to the internal organs.  With the pelvis and hips, the organs involved are usually the intestines, kidneys uterus and rectum. These injury patterns are not always obvious, but if they happen, the structural part is impossible to heal because it is caught up around these organs.

So how do you know if you have these syndromes?  Here are some questions and tests.      
First of all, lay down on your back.  In this position, put the two flats of your hands on the front of your hipbones.  If they have a very step angle, more than 50%, then you have a problem with the 5th lumbar and the ligaments of the sacroiliac joint. Now sit up and grab the thick part of the thigh between your two hands; feeling down through the leg to the femur bone (the thick bone of the thigh) pull downward away from the hip.  If this does not release, but rather feels like it is jammed into the socket, you have a gluteus medius-minimus problem.  And lastly, to understand if you have an organ problem check your pelvic cavity and intestines for soreness.  Often patients will know about this without palpation. There will be a long history, sometimes with constipation or diarrhea, but often just soreness.  If this test is positive, think back on any accident which may have caused problems with your pelvis (fall, car, childbirth etc.).  Did the organ soreness start after the trauma?  If so, even if it is several years after, then you have an organ problem which needs to be addressed for your hips to heal.  (In Vascular Bone Therapy we do not claim to heal the organ, only do relaxation techniques to allow the structure to return to balance).  

In reality, these two patterns intertwine, but let’s talk about them separately. For 20 years, I thought almost all problems with the hips came from the sacroiliac joint, the fifth lumbar and the way it distributed the force to the two legs.  And about 50% of the time I think this is true.   At its essence, this means most hip problems are really back problems.  These difficulties stem from the ligaments of the sacrum and their relationship to the 5th lumbar vertebrae and the spine. These ligaments are the most powerful mechanical levers in the body.  With them, you could lift up a truck.   It is hard to imagine any trauma which does not employ them.

 Here are a few of the injuries which may cause hip problems by impacting the sacroiliac joints.  Head trauma, having the air knocked out of you, landing on your back, thigh contusions, ankle injuries, knee injuries, whiplash, shoulder and scapula problems and neck compression. All of these areas have an impact on the sacrum and cause the lower back to twist and distribute the weight and pressure unevenly.  It is this unevenness which causes the hips to overwork and wear out the cartilage.

 After 20 years of practice, I became proficient balancing the sacrum and 5th lumbar. But even with my best efforts half of my patients still did not get better. There was something I just did not know and I saw other therapists struggling with the same black hole.  Since my practice often was a stop of last resort for the seriously injured I found my days filled with miserable, painful hips which often effected the knee.  I wasn’t healing them, but I could keep the wolf at the door. 

Finally, after spending years searching within the vast complexity of it all, I found this quote in Gray’s Anatomy, the 39th edition. 

“Sufferers from paralysis of gluteus medius and minimus have a characteristic lurching gait.  Provided that these two muscles are intact, paralysis of other muscles acting on the hip joint produces little deficit in walking, or even in running.”

This brought about a breakthrough.  For it told me two things.  One, the gluteus medius-minimus was going to be involved in almost any hip problem and two; the other muscles were not working independently of each other but rather balanced and counterbalanced to assist each other.  It told me what I could and couldn’t do. I could expect the gluteus medius and minimus to be involved on one side of the balancing act, but on the other side it was not predictable. There were too many variables.  You had to test them all against the medius-minimus.

But what was doing the adapting on the other side?  Since the top part of the leg is just one bone, how could it adapt that much?  The body has an ingenious solution for this.  It’s called the inter-muscular septum; it is fascial sheet going the length of the thigh    and in fact can go up and into the pelvis.  It acts as a switch board which gives the leg an enormous amount of adaptability.     

But even this flexibility of mechanics is not independent of the muscles which pull against and work with this septum.    It is once again a balancing act between the muscles the body uses to move and those which it employs to protect itself.  On one side are the gluteus maximus, the iliopsoas, the pectineus, and the adductor longus: then on other hip, the minimus, medeus, and the tensor facia lata which pulls the hip upwards and inwards so the striding side has something to work against when we walk. These muscles working in balance are pain free.  Once they can no longer adapt to the amount of injury in them, the body uses bones and muscles in a way they are not intended.  Then we have a painful hip. 

  This is very complicated; so why do I think Vascular Bone Therapy can help with this problem when other approaches cannot?  The answer is in the angles.  The body seldom uses any muscle for one purpose. In this case, the genius of nature uses the muscles of walking to protect in trauma.    So in trauma, just like in walking, the stress lines go across the hips from one side to the other, from one group muscles to another. Vascular Bone Therapy is the only work which comes from four directions instead of two.  It is almost impossible to get bilateral pattern undone using two hands because there are at least four muscles involved; not to mention ligaments and fasciae.  In VBT we use multiple percussors from many different angles to work these agoists out of their spasmed position.

Other therapies, despite the brilliance of their practitioners, fail, on hips, not because they lack skill, but for lack of angles.  Today, I had a talented therapist in for a session of her hips.   When we released a deep holding pattern she began to cry.  She said, “All those years I tried to release these muscles and I never had a chance.  My two hands weren’t enough”  

 
In Vascular Bone Therapy and Bonewhispering, we work through triangulation to restore the boney system to the point it can compensate.   For example, one of my patients came in with a crippling ankle broken 20 years before in a toboggan accident.  With one look, you could tell it had not been set right.  It retained a sharp bend just above the ankle where the tibia and fibula had both broken.  But bones are more malleable than anyone imagines, and this bone was no exception.  After working the torsions out of the connective tissue of the bones of the ankle and stretching the foot, the ankle looked better. It was still bent, but the bend was something the rest of the leg could compensate for.  What mattered was it functioned.  She was able to go to Europe and walk around pain free.  

And so it is with the hips.  We want to get them unbent and balanced enough for the torso to perch on them without making the two sides sore.  To do this we make a map of all the bones which connect to the sacroiliac and hips. (A picture of this mapping is available
In the method section of the website).  We do this to ensure details are not missed in this complicated tapestry. From this map, we begin to work systems of bone spasms; surprisingly reaching across joints, ligaments, organs, and muscles.

Sometimes in this process the hip is pulled up by the gluteus medius, minimus, and at the same time pulled down by the tensor fascia lata of the knee.  Others, the fifth lumbar vertebrae is sliding off the sacrum, and still another the sacrotuberous ligament is spasmed and pulled downward trapping the sacrum in such an angle it cannot support the spine.  And in this complicated symphony we learn an important lesson.    We are perched on the hips and sacrum by mechanical tension but the relationships which make this tension are very holistic.  Sometimes it is an adjustment problem, sometimes it is a muscle imbalance, or visceral, or ligament or fascia.  But all of these dysfunctions come ultimately to the entire system.  So how, in such wholeness, can we make sense of all these forces?     

In this therapy we use Bonewhispering to listen to what the bones tell about these complicated patterns.  Whenever a bone is twisted it will loose its spring and give us a clue. We will look for another bone which has a similar tension in it.  It is as if these bones in spasm patterns are part of the same bone. This is what we put on our map.   From here, we begin to undo the tension from the bones with our precussor vibration and use stretches to restore the relationships back to one in which the muscles, curves and ligaments do their part. We look at the impact of viscera, the twisting of the diaphragms, and the imbedding of the vascular.   But always we return to the bones.  For when the bones and vasculature relate without tension, healing is not far away.   In the end, when the tension is relieved the hip will do their support job and balance our torsos on their backs.       

                                         TESTIMONIALS

In the 1980’s I had a serious head on car accident.  Since then, my left hip has been so sore I have not been able to walk for exercise.  Over the years I have seen chiropractors, massage therapists, acupuncturists, physical therapists and doctors.  Some of these practitioners got me back on my feet but I still could not go for a long enough walk to get exercise without experiencing extreme soreness.  Brian worked on muscles and bones but also within my torso to relieve torsion there from the compression of the accident.  In the end, he relieved the heavy trauma from the immense force I sustained in the head-on. Now I am back on a walking exercise program and no longer feel like I am 90 years old.  He also corrected constant problems I had with my shoulders from the accident.     

Victoria Cohen

I came to Brian after weeks of physical therapy and unsuccessful visits to a chiropractor and osteopath for my hip discomfort. Upon recommendation from a friend who had been seeing Brian for years, I called and made an appointment. The other avenues I had taken were met with mixed results and an MRI was not conclusive as to what might be causing my problem.

It wasn’t until my first visits with Brian that I felt confident enough to walk around my neighborhood again. Also, the discomfort I had sitting and driving has gradually diminished. I feel grateful to know of Brian’s expertise and feel I’ve made significant progress with Vascular Bone Therapy.

N. Kwon

Brian's techniques take body work to an entirely new level. Intense study, an inquisitive mind and an natural gift for healing make Brian extremely effective. I have been in two serious car accidents, each taking a huge bite out of my life. Since 1989 I have been working on my return to health. Many wonderful practitioners have helped me along the way. Feldenkrais, Myofascial Release, Rolfing, Active Isolated Stretching, COLD Laser, Yoga, Acutonics and Bioresonance Therapy all produced measurable improvement. But they were not enough. I was blocked by a twisted spine and pelvis that wore out one hip joint.

The approach Brian developed released spasms in my torso, allowed my spine to unwind and, in a single session, moved me out of near-constant extreme discomfort. Follow-on sessions dramatically improved movement in my spine and hips making it possible to do many activities that were out of the question before. Brian is one of the most insightful and talented people I have ever met. I recommend him to anyone who has experienced physical trauma.

It is also worth mentioning that Brian’s approach complements all of the modalities mentioned above. It would be wonderful to see practitioners in these fields, and other body workers, collaborating with Brian for the benefit of their clients.

Diane, Seattle WA


I have had several severe car accidents, scoliosis and plantar fasciitis. I’ve gone to numerous body workers over the last 30 years. I’ve been Rolfed, had Cranial Sacral work, Trager massage, Feldenkrais work, done Pilates and yoga, had Laser therapy, chiropractic and others I can’t even remember. I can say in all honesty that the body work I’ve had with Brian Dobbs is the most effective treatment I’ve ever experienced.  When I began with Brian nine months ago I could not walk very far, nor was I interested in trying. I am now walking 10,000 steps a day and loving

Joan R. Benner, LICSW

Here is the best testimonial of all.  It is a phone call from a patient who had been planning for a hip replacement before seeing me for therapy: 

Brian, I just wanted to call before we go and thank you for your work on my hip.  We’re leaving for Africa Saturday and we’ll climb Kilimanjaro next week.  I feel better than I have for 10 years. I never would have thought of this climb a year ago.  Thanks again Nancy Board