Control Issues

January 12, 2014

Isabel asked The Guru for the following Physiotherapy Advice:

I exercise 4-5 times a week, doing mainly high intensity cardio and heavy weights. I was a gymnast as a child and have a history of slight hyper-mobility, joint pain and sciatica.

In the last few months I have > started to feel increasingly tight in my hip flexors and lower back and I feel the need to click my joints a lot (fingers, upper back/ shoulders and now my lower back/ hips). Over the last few weeks I have started to feel increasingly tight and clicky, and had some mild knee pain which is becoming constant and I am sure it is all connected. It may be sciatica or perhaps my ITB or a mixture of things, but I am concerned and would like advice. Thanks.

January 12, 2014

Hi Isabel

I think I’d be very surprised if it wasn’t all connected – your history is pretty consistent and leans towards an instability and control issue.

Hyper mobility is not (despite what is often spouted) a problem. It’s when you loose control of all of that extra movement then it becomes an issue. But this is true for everyone, regardless of being hyper mobile or not.

I think you low back is becoming more unstable (i.e. moving more) so what happens is that your hip flexors overwork is an attempt’s to keep you standing upright and stable. The problem about increasing the tone and activation in these muscles is that you also increase the load and shear on your low lumbar spine. The muscles around here (now detecting that your back is more mobile) contract to keep some semblance of form and stability. In doing so they create more shear etc because they are not the deep stabilising muscles, but the superficial movers and shakers.

The more activity in these muscles, the more activity in the surrounding muscles especially the ones which become dominant and are prime movers (ish!) Your TFL (the contractible bit of your ITB) will also over work, due to the increase in local activity AND the decrease in your gluteal activity due to back posture (that’s another story!) doing silly things to your knee.

The clicking is because your joints have the option of being in position 1 (start position) or position 2 (end position) – if you loose control of moving from 1 to 2 the joint will bump into each other (as you’ve got an increase in shear and stress forces) and “click”.

You need the ability to move better in the areas that don’t move and are not painful, then you need to stabilise and control the painful bits that move too much.

Guru Responded

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