I have a client who seems to have no muscle sensation in his hip complex area. Stretches and foam rolling give only a sensation in his groin. He has difficulty in some movement, such as snowplowing when skiing (which he finds impossible to do) or jumping hurdles. The client is in his 40s and says he has been like this since a child. We are doing a program of exercises and stretches but with little progress. Can you suggest anything?
When you say your client has no sensation, do you mean no nerve sensory sensation or your client has difficulty getting sensations when performing exercise and recruiting the hip when moving? Is there any peripheral pain or discomfort? I will first address the movement issues.
What does his posture look like? Does he have a properly aligned thoracic spine, lumbar spine and pelvis? What is his foot type? When he walks, does he have tri-plane action of the pelvis? Is there good rotation in the thoracic spine when walking? There are many walking and gait tests that can be performed to assess his gait function.
In order for the gluteal complex to be fully activated, the foot must be able to “communicate” with the leg and hip complex. The foot must undergo the following to allow the proper chain reaction:
- Calcaneal eversion
- Ankle dorsiflexion
- Tibial internal rotation
- Forefoot abduction
This in turn causes the femur to internally rotate and eccentrically load the gluteal complex, deep external hip rotators and pelvic musculature in a tri-plane manner. Movements that usually create this chain reaction are:
- Lunges with medial arm reach
- Frontal plane lunges (side) with medial reach
- Long walking strides with transverse and/or frontal plane arm reaches.
- Step down with arm anterior reach. When doing these, start from a four to six inch step and lunge forward as long as the client can, but within a controllable threshold. Remember, he must be able to get out of the position and return to a start position. When doing so, he should not be leading with the back through spinal extension but with forceful leg propulsion. This is a more advanced exercise movement pattern, so please be cautious!
Without seeing your client’s actions, it is difficult to zero in on any suspected dysfunction through his kinetic chain.
If these suggestions of movement are not successful, based upon your description, it may be prudent to refer your client to a physician for a neurological evaluation to make sure there are no impingement issues.
I appreciate this is a very limited response to a puzzling question. If you desire, please provide additional health history information and/or video taping of his movement patterns, and I will be more than happy to assist you in finding a strategy to help your client.