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RPR Case Files: Shoulder Driving Hip Compensation

History

This case involves a female in her early 30s. She is active, physically fit, and exercises regularly at NBS Fitness. Her complaint is severe pain in the front of the left hip (7/10 on a 0-10 scale). This pain is most notable during active flexion of the hip during exercise or getting up from a seated or lying position. Her pain has been present for over a month, keeping her from performing any lower body workouts involving hip flexion. She has been consistently receiving physical therapy for her hip for the last 3 or 4 weeks. She has not had any improvement with this care. Her history also includes a right shoulder dislocation approximately 6-8 weeks prior. She successively completed physical therapy for her shoulder condition and does not have any complaints with the shoulder. She is suspected to have developed a hip compensation pattern and will be evaluated using Reflexive Performance Reset.

Background 

As noted in my previous article, Reflexive Performance Reset involves manual muscle testing to assess the motor recruitment level and sequence of a particular movement. This assessment allows for the isolation of specific primary and accessory movers in an attempt to determine their level of contractile strength when placed under load. This assessment also allows for the identification of “drivers” which are neurological compensation patterns that have developed to accomplish a given movement or task. Since the muscular system is neurologically driven and controlled, excessive stimulus in the internal (an injury, overuse, etc) or external environment (stress, abnormal forces, etc) will be the cause of these compensations. This is why our approach is an attempt to influence the nervous system using reflex points and “wake-up drills” to help reset the nervous system and push it back towards a normal state. By doing this, RPR restores normal neurological function. Thusly, any abnormal forces from a hip compensation causing pain will dissipate.

 

Evaluation

Utilizing the diagnostic protocol above, the individual was identified as being an arm driver. This means that in order to stabilize and produce hip flexion and extension forces, her motor pattern that has been created as a compensation is to first produce stability to the opposite hip.

Plan

A full session of RPR was performed with the goal of restoring proper breathing, motor function, and parasympathetic tone. This was accomplished through stimulation of various reflex points throughout the body to restore individual muscle motor function. The response of this stimulation was measured using manual muscle testing to gauge strength. Sessions are to be repeated until patient returns to normal function. Individual will also be given a set of “wake-up drills” to perform at least once a day, specifically before any sort of exercise or physical activity.

Results

After the two visits, the subject was experiencing mild discomfort during active hip flexion. In 2 weeks and three sessions of RPR, the individual was fully contracting, experiencing 0 pain on a 0-10 scale, and had begun training lower body movements again. She continues to maintain function 8 weeks later.

Discussion of Hip Compensation

Since the individual experienced trauma to the right shoulder, the hip compensation that she had already developed for producing hip flexion, identified according to RPR evaluation, was disrupted. She was no longer able to utilize her right shoulder during her time of rehabilitation in everyday movement. In this scenario she no longer has any source of stability (compensatory or not) for the left hip, and is absorbing even more joint forces and wear from everyday movement. This could be thought of as taking the training wheels off of a bike before teaching a child how to properly pedal and balance. Chances are, they will fall over.

After 4-6 weeks of repeated insult to the unstable hip, she begins to develop pain and irritation during active hip flexion. This is due to the fact that she is forcing herself to flex the hip without being able to maintain proper hip stability.

After restoring her to a parasympathetic state, restoring proper breathing techniques, and stimulating the nervous system, her hip compensation is eliminated and she is able to drive movement in a proper pattern. This pattern is utilizing the hip flexor as a prime mover with its long lever arm, and the accessory muscles to stabilize the hip joint in the acetabulum. Because motor learning and motor firing are at a subconscious level, it is not enough to consciously “will” a prime mover to drive proper movement in an individual with a compensatory motor pattern. This is why generic rehabilitation exercises focused on the glute, hamstring, psoas, etc. fail, because these exercises are still running off of the same dysfunctional motor pattern.

 

Stay tuned for more cases of RPR. To schedule a consult or session of RPR, feel free to contact us at 901-573-2526 or email us at drdetweiler@midsouthssp.net.

 

 

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