In this episode of the Unreal Results podcast, I share how one hip mobilization technique led me down a rabbit hole of anatomy and ultimately changed the way I think about what we're actually affecting when we treat the hip.
What started as a way to address hip joint restrictions led me to explore the relationship between joint compression, hip centration, the pelvic floor, and the viscera. I explain how paying attention to treatment outcomes and consistently reassessing my athletes helped me recognize patterns that I might have otherwise missed.
I also catch you up on my recent experience with shingles and what it taught me about nerve pain, sensory symptoms, and the effects of stress on the body.
In This Episode, You'll Learn:
Why I use medial and inferior hip glides for different hip mobility restrictions
How joint compression may influence proprioception and movement
The connections between the hip ligaments, obturator membrane, pelvic floor, and viscera
Why recognizing patterns and reassessing treatment outcomes is essential for developing better clinical reasoning
This episode is a reminder that you don't need to have all the answers to be a great clinician, but you do need to stay curious and keep asking better questions.
Resources & Links Mentioned In This Episode:
Ep. 125: You're Already Treating The Viscera... You Just Don't Know It
Hip Mobility Video: Half-Kneeling Hip Medial Glide
Hip Mobility Video: Prone Supported Frog Hip Mobility
Hip Mobility Video: CKC Hip Rotation & Hip Abduction
Check out the Swelling Reduction Protocol Course Here!
Learn the LTAP® In-Person in one of my upcoming courses
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in Hello, hello, and welcome back to another episode of the "Unreal Results" podcast. Um, it's been a, it's been a while. This is how I always start nowadays, I feel like. But, uh, I was looking in my files of the last solo podcast I recorded, which last... 'cause last week I did drop, um, a new podcast, which is a guest pr- podcast with Leah Levitan from the Lymph Love Club.
But as far as solo podcasting goes, I have not done a solo podcast episode since the beginning of September, and on that episode, I was like, "Oh, didn't mean to take a summer break, but here I am." And I'm gonna be s- consistent. And then life got lifey, and I haven't recorded a podcast. Part of life getting lifey was the online LTAP level one transition to, um, the new course content and then the launch of the fall cohort, and then it was, um, just, yeah, doing all that.
And then what else? Oh, football season starting and traveling every week for that. And I was in Sacramento helping out my sister, and my brother-in-law was, um, out of town for work, and my niece had to go to, um, like a, a three-day, um, EEG to check, um, how her seizure medicine was working. And, uh, they needed an adult with her 24 hours a day, which was crazy.
And so I went to help out my sister with that, um, just being a second parent for her and then... But that was also just stressful. Um, and like, you know, medical stuff is always stressful and, and, excuse me, she was busy with work, and there was just a lot going on for, for us. And I was working on stuff, you know, on my computer and...
But then also doing all the second mom stuff. And then, um, I think it kinda snuck up on both of us. It was the anniversary of my mom's passing, um, which is, you know, every year it comes and sometimes it- is heavier than other times. And, um, I'd say for me at least, it's been less heavy, and I wasn't really anticipating how it would feel after losing my aunt in the summertime.
So as you can hear in my voice and see on my eyes if you're watching the video, um, yeah, it sucks. Um, just, you know, added grief. And, um, so both of me and my sister, it was already a stressful week, and I think we just... That hit us also. And that morning, actually, I woke up-- Well, actually, the night before, I was noticing some interesting things.
I was like, I had this spot on my head that felt like I had hit my head on the car, you know? Like, I felt like I had a bruise on my head, like a contusion. I was like, "That's really weird. I don't remember hitting my head, but it feels like I have a bruise." And then I was, like, feeling, and I was like, "Oh, it feels like I have a couple bumps."
And sometimes I get sores on my scalp, and so I was like, "Oh, I j- must have a sore." Didn't think about it. And then as I slept that night, I, um, had really intense eye pain in my eye that I had my, um, past severe pink eye infection in, and that was like, "Ah, this is..." I was like, "This is weird." Like, why is my eye hurting?
And sometimes my eyes hurt from the dry eye I have now. And so I didn't really... Again, didn't think anything of it too much. It was just, like, annoying. And when I, when I woke up, I wear a night guard. So when I woke up, I took my n- night guard out of my mouth, and I was like, "Wow, my teeth on that side- Which I guess was the right side.
My, my teeth were really sore, and I was like, "That's odd." Like, usually it's my ... If I'm gonna have t- tooth pain, it's notoriously been my left side. But I had four broken crowns, so two on each side. So I was like, "Oh," like, "Gosh, my, my, my, my..." Or not broken crowns. I had broken molars that had to get crowns. So, and I still have one that it needs one, and so I was like, "Oh, it must be that broken molar."
And I was like, "Great, that sucks." And so then I'm getting ready and, in the morning, and I'm like, "Wow, my head..." Like I, you know, I, I shampooed my hair and I was like, "Wow, I'm really sensitive on that spot," like. And I looked in the mirror and I was like, "Oh, there's like a couple red bumps there." And I was like, "So weird to have more than one, but okay, like not that odd."
And then as I'm putting on my makeup, I, I took the makeup brush and I brushed it along my cheekbone on the right side and it was numb. And I was like, "Oh, that's disturbing." And I was like, "Why would I have trigeminal nerve neuralgia?" And then I paused for a second and thought about it and I was like, "Wait."
And I looked at my scalp again and I was like, "Oh my gosh, I think that's a rash." And then I was like, "Oh, holy crap, I think I have shingles." And I was like, "Are you fucking kidding me?" Because also like I thought shingles was like a thing old people got. No offense if you are old. And no offense if you've had shingles.
And no offense if you're just old and haven't had shingles. Like, but that's like in my brain. I'm like, "You get shingles when you're like over 65." And, um- I'm also like, "What the fuck?" And so I walk out and tell my sister, and I was like, "Dude, I think I have shingles." And she actually had shingles when she was in her 30s, and, um, hers was, like, on the torso.
And she looked at my scalp and she's like, "Oh, I think you might be right." And I was like, "Dang it." I didn't even think about the fact that it was on, literally on the day that, of my mom's anniversary, and I'd just been really stressed for other reasons, too, on top of all the grief. And so anyways, um, you know, but then I'm, like, extra stressed out because I'm like, of course I would get ophthalmic nerve shingles.
And, like, of course it would be the side of my ophthalmic nerve that my severe pink eye infection was on. And so I have so much PTSD from my severe eye infection that I was, like, then very worried about this progressing to my eye and, like, having issues with my eye again. And so I flew home that morning from Sacramento to San Diego, and I messaged my doctor, and before she could even write me back, I was already on my way to urgent care 'cause I was like, you know what?
F- like, this is... I, I want answers now. So I went to urgent care, and she looked, and she heard my symptoms, and she was like, "Ah, you know, the rash is, like, barely started." And she's like- It kind of looks like shingles, but not definitive yet." And then she did the exam in my eye, which I was grateful for, and she was like, "I don't see any lesions in your eye."
And she basically, though, was like, "You know, it does sound like shingles, and it's worth it to just start the antiviral because you'd rather start it now than wait and, you know, it gets worse if it is shingles and then you haven't started yet." So I started antiviral that day, and sure enough, it just continued to get worse.
And, um, but because I did catch it so soon and I started antiviral, um, the rash never got too bad. It only, it... So it started on my scalp, and then it went to, like, my hairline, and then I got a little patch of it on my forehead and then on my eyelid. And, um, when it s- got on my eyelid, I then did an additional appointment with my ophthalmologist 'cause I was like, "Okay, I want a better look in my eyeball to make sure," because then at that point too, I also had a lot more referred pain from the inflammation to the trigeminal nerve and, like, it was this, like, deep eye pain almost.
Like, at one point, I was like, "Uh, am I having a brain aneurysm? Like, this feels like the worst headache of all time." And, um, so I wanted him to take a better look, and he t- he looked, and he felt so bad for me 'cause he was like, "Oh my gosh. It's your eye with the old infection too?" And I was like, "Yes." So anyways, in the scheme of shingles, and boy, the pictures and the videos I saw on the internet, do not Google it when you have it going on, by the way.
Um, I had a very mild shingles experience. Um- Also, I, during this, realized that I didn't know a lot about shingles, and then most people I'm a- around didn't know a lot about shingles, 'cause also most people I'm around on a daily basis are, like, 24-year-old in, people. And so, you know, and a lot... And then, too, like, after my generation, like, people younger than me, like, there was a vaccine for chickenpox, and so, like, they don't...
Shingles is not even gonna be a concern for them because they never actually got chickenpox. And so it's like, I kinda feel like our generation might be, like, one of the last generations, maybe until now and all the anti-vax stuff, like, for people to have sh- uh, chickenpox, um, and then therefore, um, shingles.
But yeah, so shingles only happens... It's basically, like, a reactivation of the chickenpox virus, which is a type of herpes virus, and, um, it lives in your body forever after you have it, and is, like, dormant. And then sometimes in times of high stress, grief, or compromised immune systems, y- it will get reactivated.
And when it's reactivated, it typically is along sensory nerves along a dermatomal pattern, and it's always skin lesions and then just nerve inflammation. And so, um, it is considered one of the more painful things to happen in your lifetime, and, um, I am grateful that mine never seemed to be that intense.
Um, and there's different phases of the shingles. Like, the first seven to 10 days is the inflammatory phase, and that's when the, the rash, the actual herpes rash, is, like, the most active and, um, becomes red, like, circular rashes that blister and, um, are clumped together. And it's not contagious. Like, I can't give someone shingles, but what is contagious is if you have not had the chickenpox vaccine or you've not had chickenpox, you can get chickenpox from someone who has active shingles.
if you've never had chickenpox. And basically, it is the fluid, the touching of the blisters, the blis- the fluid, the fluid inside the blisters that is contagious. So I can't cough, and then you get shingles, right? It's like you have to actually come in contact with the fluid from the blisters. So it's, like, not that contagious even in the first place, and that's...
I mean, that's how chickenpox is, too, when you're a kid, right? Is like, through, like, through the rash is what is contagious. But, um, anyways, so that was, that was a-- That sucked. But so the first phase is the inflammatory phase, and then the blisters go away, and, um, but the shingles kind of persists on the nerve, and, um, the rash will go away, uh, but then the, the symptoms actually last longer.
So like I said, that rash is, like, 10 days, can be longer, especially if you don't start antivirals. The sooner you start an antiviral, the better the outcome. You know, ideally within the first 72 hours of the symptoms. Um, and sure enough, mine, because I started the antiviral so quick, um, my symptoms were gone.
Or not symptoms, sorry. My, um, rash was gone by day seven. And, um, but then the pain increased. The, the-- My pain was probably the most painful on day, like, 12 to 14. Um, and it was a very fascinating, um, internal experience of the various branches of the trigeminal nerve and the anastomosis of the trigeminal nerve.
I had pain ranging from around the orbit, in the orbit, like, deep to my eye, um, skin on my forehead, skin of my scalp, um, and then around my ear, ear hole pain, like a very intense, like, ear pressure pain. Um, and then pain down my neck, which at, at first I thought was from the, um, my lymph nodes being swollen, but then it was, like, very much like supraclavicular nerves and occipital nerves, which all do anastomose with the trigeminal nerve.
And so, yeah, the right side of my head and neck was, like, very inflamed from a nerve standpoint. And Um, I remember my back, my experience with my back surgery, um, and the consequent nerve pain that came from it made me realize that nerve, nerve pain is not... You know, we think of nerve pain clinically, we think of nerve pain as, like, burning or numbness or tingling, but, like, nerve pain can be any sensory experience.
And so, like, nerves are weird. That is kind of like the, my tagline. And actually, I started, um, after my back surgery, um, the orthopedic surgeon that I work with in Arizona, he had back surgery, and then he ha- he was having some trouble during rehab, like with the nerve pain not kind of like subsiding, and so I started doing rehab on him, and I kind of explained the same thing to him.
I was like, "Hey, like, nerves are weird. That sensation that you're feeling, probably the nerve." And so that became like our little, like, joke. Like, #nervesareweird. And this was another experience that highlighted nerves are weird. So the feelings was intense, sharp pain, like I said, like felt like I was having a headache aneurysm, to dull achy, to felt like my eardrum was rupturing, to, um, itchiness, and to the feeling of like, it felt like little bugs were crawling on my skin or my scalp
Um, radiating pain along my neck and clavicle. Um, and then, uh, with that too, and again, I'm not sure if it was from the lymphatic piece or like the immune, uh, lymph node piece, but like, then my sternomastoid just got really hypertonic, and so it was just like, wow. It was, um, quite the experience. And then, um, once it peaked around like day 14, like between day 12 and I'd say probably day 17 were the most painful parts.
Um, and leading up to those days, I was taking Advil and Tylenol around the clock for the pain too. So maybe my pain was higher at the beginning and I, and I didn't realize it 'cause I was medicated. But those were also peak days, and then since day 17, I've been able to like use minimal, um, Advil and Tylenol.
But, um, it's been interesting because it kind of like started in one area and then it spread all over that right side head and neck, and then, then it just started retreating. And like now I'm at the last bits of it, like, um, for the longest time my whole eyebrow was really itchy and like now it's just the medial corner of it.
And it's like... Yeah, it's very interesting how it went. Like, I could feel it progressing like towards the trigeminal nerve ganglia, but then also just on all of the, um, branches, like the distal branches. It was fascinating. So I'm hoping that means now that it's like a smaller area, more of the distal branches, I hope that means that it's retreating.
And that's the other thing I learned from shingles is it's pretty cl- pretty classically the symptoms will last around five to seven weeks, um, which is crazy. But this Thursday will be five weeks and I'm like, I, I feel, I do feel like I'm at the end of it. The... You'll probably, if you're watching this podcast, you'll probably see me itch my eyebrow a lot and itch, itch my scalp a lot.
Um, and that's, that's what's happening, is I'm having these like, ah, shingle symptoms that are itchy, which is crazy. But again, like, again, it always reminds me too, I'm like, yeah, that is like the classic chickenpox feeling too, but it's just like you have a rash with it, so you make sense of the itchiness.
But I think like at least for shingles, the itchiness is just a nerve inflammation, nerve pain It's been fascinating. Can't say I recommend it at all. Um, there is a potential for you to have, like, long-term pain neuralgia from, from shingles. Uh, it's called post-herpetic shing- or postherpetic neuralgia, I think.
Um, that would suck. Um, hopefully, that doesn't become the case. Um, but I'm still in the normal shingles window, so... Um, and like I said, it's described as way more painful than I've experienced. So, I mean, I maybe had, like, two to four days of, like, 6 out of 10 pain. But for the most part, it's been, like, 2 out of 10.
And it's intermittent, it's not continuous. It's pretty intermittent. But persistently annoying, that's for sure. So anyways, 18 minutes in. I didn't know I was gonna talk all about my shingles, but I think it is a learning experience. I mean, that is why I tend to, like, tell you all about what's happening in my own body, is because, I don't know, we're all here to learn, and our body teaches us a lot.
And so I'm like, yeah, if you didn't know about shingles, that's the thing. There is a vaccine for it. Um, it is recommended for older people and immune-compromised people, and I would say, like, probably worth it. And especially, you know, your body, your choice. Do whatever you will. But, um, having experienced it, don't wanna do that again.
And, you know, there is consequences. Like, uh, like, things can get severe, right? Like, I- it- when it gets into your eyeball, you could lose your vision. Like, just like any other eye infection that I found out with the pink eye. Um, it can attack other nerves, not just sensory nerves. Like, a common, um, severe associated shingles is in the face, um, when it attacks the facial nerve.
People lose function of the whole side of their face, and when it attacks the facial nerve, and have motor weakness, motor loss. And so, like, yeah, it can, it, it can be, like, much more of severe consequences than just a rash, just the itchiness, just the pain. So, um, something to consider. Anyways, that's shingles for ya.
Lucky me. And Like hindsight, I was like, "Oh, ironic." I was under a lot of stress, and the day that it happened was the anniversary of my mom's death, which did bring up more grief this year than I was anticipating. Um, and, uh, so no surprise, the body let me know that I needed to take a beat and, like, rest a little bit.
So body's funny like that. Anyways, um, I do keep a running, like, little Apple Note on my phone of, like, podcast ideas. Um, and so I looked at it today 'cause I was like, "What am I gonna talk about?" There's so much to talk about, but then also land the plane. I mean, I, uh, like also full disclosure that I just joked about this podcast being 18 minutes of my shingles experience.
Number one, I knew I was gonna share that. I've already shared it on Instagram, so if you follow me on Instagram, you might have already heard part of the story before. Um, I've probably even shared it in my emails. I'm not sure. On my calls I've shared it. But also, like, that's, this is what I use the podcast for a lot too, is like, "Hey, welcome to my life.
Here's my life. This is my life. I've been dealing with shingles for the last five weeks." There we go. A little itch to hammer it home. But, um, yeah, and then just like a general update. Um, I've been loving being back traveling with my athlete, um, doing weekly travel again. It's been really fun, um, to like be able to stay on top of things a little bit more consistently than we have in the past when we've done, um, only like trips once every three weeks.
And it's been really cool to see like... I forgot his hips could stay so mobile. Um, and he's enjoying it too, so that's been fun. And, um, sometimes I think about like, "Oh, do I wanna go back to the days where I had like three or four guys during the season and I'm traveling all over?" And I'm like, "No, I think one is perfect."
One that is on the West Coast is perfect. I d- I don't... I love to travel, and I love being part of a team like that, but also, like, it's exhausting and, uh, just not doable. So I'm just gonna enjoy what I have and not worry about having more clients at the moment, uh, from a professional athlete standpoint. So, on my list of things to talk about, besides the shingles and a general update of life, was, um, clinical or diagnostic convergence.
This concept is coming up a lot in the mentorship program that I run, uh, with the, the practitioners in my mentorship program. Um, I actually just recorded a podcast with my business coach, Jill Lockwood, on her, on her, um, podcast called FitBizU. And actually, we talked about the, um Um, I don't know what's the metaphor, but, like, the similarity between approaching business and m- this, like, diagnostic convergence is the same as what, like, getting clinical with the data of, like, your business stuff does, um, which is increase your confidence and decrease the emotionality of things.
And so, um, I don't think I'm gonna talk about that today, but just know that it's sort of, like, coming down the pipeline, and I do wanna share about it more because, um, I think too, at the end of the day, like, what I teach, the how I teach, I'm always trying to teach people clinical reasoning and using clinical reasoning to help improve your con- confidence, and that's what diagnostic convergence does, is it's basically a bunch of assessment tests or a bunch of evidence stacked in our favor to increase our confidence.
And, um, that starts with always having a why or an intention behind what you do. And that's also why I'm so big on educating around principles, um, as opposed to just techniques, though I do understand that in order to learn principles, sometimes it's helpful to learn a technique first. But, like, this whole podcast really is, like, l- looking at the principles and the pr- and this is land the plane, Anna, what we're gonna actually talk about.
One of the things I wanted to talk about and I had on my list was talking about hip medial and inferior glides and, like, how that is a really helpful technique to use. But it's also, like, when I-- when it comes to the podcast especially, like, I wanna always honor the purpose of the podcast. And the purpose of the podcast, like, if you were to look at the podcast description, it is to share with physical therapists and athletic trainers or other, like, one-on-one healthcare practitioners, right, chiropractors, massage therapists, et cetera, a, to expose you to a visceral and neural perspective on the musculoskeletal system.
And so it's like I don't wanna just get into the habit of, like, talking about a technique I love e- when it's a musculoskeletal technique or, like You know, like, just sharing those kind of things because though I think it's valuable to share and I wanna teach everything I know to someone, like, again, like, the purpose of this podcast specifically is to learn through this whole organism lens, learn through what is our effect, like thinking, using clinical reasoning to understand, like, okay, yes, I'm gonna do this technique on the hip joint, and at the most fundamental, fundamental level, it's affecting the joint capsule.
But what else is it offering? What else, why else could it be so powerful, right? And so this is often, too, what I've talked about in other podcasts. Like, there's this podcast that I'll have Joe link in the show notes that I'm, I talk about how you're already treating the viscera and the nervous system.
You're just not seeing it through that lens of view, right? Like, any sort of movement or manual therapy that you apply to the body is gonna affect the viscera and the nervous system. But in order to understand it from that perspective, you have to understand more about the viscera and the nervous system, right?
You have to understand that the viscera connects to the spine, both fr- mechanically through ligaments and fascia, but then also neurologically through innervation from the nerves, right? And so, um, understanding those components can open us up to techniques that we used to use primarily as a biomechanical or mechanical musculoskeletal technique.
It can open us, us up to the possibility of why we would choose to use them Or how else they are affecting the body besides just the bones and the joints, or besides just the joints, the bones, and the ligaments, and the tendons, right? And so, so that's kind of what I wanna share and, and so what happens when I am thinking about that is it forces me to clinically reason through, okay, so on the clients I've used this technique with, what has the outcome been?
And why do I, why do I gravitate towards it then for future clients, right? Because that's what happens is I, I do it. Sometimes I find myself in a position where I have to like troubleshoot a new way to get like something done in their body, and so I'll do it on one athlete, and then I'll see the results, and then I'm like, "Oh, interesting.
I kinda would like that," and it makes me think of another athlete I would use it on, so then I go and I use it on that athlete. And then I start to see a pattern, and when I start to see a pattern on multiple different types of athletes and it has a similar effect, I start asking myself a bigger question of like, "What else is this affecting than just the actual like thing I'm doing," right?
Like, it's clearly affecting something bigger, because here's the other thing too. One of the things I, I say when I'm teaching is, you know, and this especially is like with the LTAP, when people are lear- learning the locator test assessment protocol, and they... The biggest part of it is assessing and reassessing what you care about.
And so because the body has always been changing everywhere, every time you do a technique on it, you're just not looking for it, right? Like I'm only going to notice how a technique at the area of the lung affects ankle dorsiflexion if I'm checking ankle dorsiflexion. If I do a technique at the lung and I've never checked in with ankle dorsiflexion before or after, how would I know it made a change?
So, so part of it is Realizing that. Like, you've always been making a change on the whole body, you're just not rechecking those things. And so that's what I'm really good at in working with my clients, is I'm, like, almost obsessively reassessing everything. And, um, s- but with obsessively reassessing everything, this is when I start to see patterns on either what the assessment told me or patterns on what the result was from a technique.
And I get to do this technique on everybody and then see on everyone if there is a similar pattern that comes out that i- is helpful for everyone. And this is, this is then what my strategy is, is I, if I see a pattern like that, that tells me like, oh, interesting. I do this technique on everybody regardless of what their pathology or their complaint of pain is, and I see these changes in their body.
And, uh, now I get to ask another question to myself, to my brain, which is, why? What, what else am I affecting? Okay? My... And an example I give a lot in this is pelvic clocks. I learned pelvic clocks when I was going through the Pilates, um, teacher certification, the Polestar Pilates Rehab Certification. And I would notice in my own body they were really helpful for managing my back pain after my back surgery.
But then I'd, I'd, I'd start to use them on my athletes and it, I was also noticing really helpful for hip mobility, really helpful for neck pain, really helpful for just improving... Like, I would do pelvic clocks and then we'd go back to hip stabilizing exercises and then their hips would function better.
Um, or vice versa. We'd do pelvic clocks and then we'd go back to core stabili-stabilizing exercises and those would be better. I would need less cues. Um, or we'd do pelvic clocks and their shoulder mobility would be, be better. And so I was seeing these patterns and it, it got me thinking, like, what I thought I was using pelvic clocks for, which it was accurate, also it could be useful for other things.
And so then I took a step back of like, "Why? Why is this?" And then that always takes me to look at the anatomy deeper and look at the connections between different anatomical structures in a different way. And then not just look at the anatomy of the bones and the ligaments and the nerves, but the visceral organs too and the fascial connections.
And so that's sort of, um, what I want to do. So, uh, today, which is share with you my thoughts on the medial glide, medial or medial inferior glide of the hip joint. And, um, I use this technique a lot. Well, not a lot is a, is a, uh, that's-- let me retract. I use this technique, um, when I need to affect the hip range of motion in any direction, flexion, internal rotation, hip extension, hip external rotation, hip adduction, hip abduction.
Seems to be a really powerful technique. I first started doing it for two reasons. One, in the book from Brian Mulligan, Manual Therapy, Nags, Snags, Mob to a Movement, et cetera, which is his little, you know, 132-page book, um, about his different manual therapy techniques. Um, there's a little blurb in there that talks about mobilization with movement and how he's found better success of mobilizing, um, into the direction of their pain.
So if somebody has-- I think it was in the knee joint section he was talking about. He talks about if somebody has lateral knee pain, then you should glide the tibia laterally. And what happens in your brain is you're like, "Wait, that doesn't make sense." Um, and He's the first person to tell you that he doesn't fully understand the physiological mechanism of what's happening, but this is his years of experience of what works for patients.
And so I think I was having someone that was having some groin pain or something like that and, um, anterior hip pain maybe, I don't know. And I was like, you know what? Instead of doing the classic mobilization with movement with the belt, I don't love that, and I don't even use it that often anymore. I'm like, but let's take his other strategy and move and, and glide into the pain.
And so I did that. And then as I... And then I got good results. And then as I thought about it, I'm like, ooh, well, I like this too because it adds a little bit more compression to the joint. And as I was learning osteopathic techniques, a lot of the osteopathic techniques from a joint standpoint actually do, um, move into compression.
And when you think about the physiology of joints, joints have a lot of proprioceptors that respond to compression. Like, that is the whole point of a joint, right, is compression. And so to me, I, I think of a compression type of manual therapy technique as a way to improve proprioceptive information in the joint.
Versus Western medicine tells us, you know, when a joint is-- has arthritis or, like, a joint, structural joint problem around it, they want you to gap the joint, which gapping the joint could provide some proprioceptive information too, because gapping the joint is also, like, potentially stimulating the, um, proprioceptors in the capsule, right?
So each scenario, you might be getting an improved proprioceptive information, and that might be part of the reason why you're getting good movement outcomes after. Hard to know. But, like, fundamentally, I was like, okay, I seem to like this medial inferior glide in a sideline position, and it seems to give me really good joint congruency after I do the technique on people better than the mob with movement laterally.
And, uh, r- and I guess this, maybe this was in my brain to something to share because I also am like, I hate the lateral, um, distraction hip mobility with the, with a strap. Um, because I feel like a lot of my athletes get it from various different practitioners out there, and I started noticing a pattern.
again, see, patterns. I started noticing a pattern where it felt like a lot of their greater trochanters were more prominent than they normally were or the other side was. And so I'm almost thinking... And then I was like, huh, that's interesting. And sometimes too, then I think about like how... So their greater trochanter was more prominent.
When I would do like Shirley Sahrmann assessment on the path of, um, instantaneous center of rotation, things would l- be like off a little bit. And so that's also why I, I was like, "Well, it feels like their trochanter is too lateral, so I wanna go medial." Like, I feel like their joint was pulled too laterally, I wanna go medial.
And so I would do this technique and, and again, I would recheck their greater trochanter position, and it would be less lateral, and then they would feel better, and then they would function better. So I was like, "Oh, okay, so this is interesting." This becomes a clinical pattern that I c- caught, catch now on people is like, ooh, your l- greater trochanter is like really prominent.
The congruency of your hip is probably off a little bit. And so I look to change that. I don't always go to this hip extension, A, B, duction, internal rotation, and medial glide, but I... It's one of the things that I could do for it. But it's just a check-in r- a, a, a assessment and a reassessment that I look at throughout tr- any treatment I'm doing to the body is I wanna see if we're changing that.
So, so there, so these are the, the things I noticed, right? So I was like, "Okay, let's go in the direction of pain. Um, let's go, let's fix this lateral trochanter thing." And then now I'm starting to do it on more people, and then I'm feeling, you know, as I'm feeling, I'm, I'm feeling the extra compression to the joint, which I like that compression in the joint from the osteopathic principles.
So then now we're here. So then, well, not now we're here. So then I always think about too how similar the hip joint is to the shoulder joint. And one of the more common things that happen to the glenohumeral joint is this positional fault of the humerus being too superior and too anterior in the joint.
And so a lot of what I do from a manual therapy or a joint, joint mobilization standpoint for the glenohumeral joint is getting the rotator cuff to help or getting the scapular mechanics to get improved to theoretically or, like, actually get the head of the humerus to centrate and inferior glide and posterior glide.
And I, you know, w- when, when this comes up in the athletes, sometimes we see this real tightness of the deltoids or the supraspinatus tendon that sort of exacerbates this position and, um... Or even tightness of like, um, the pecs pulling things forward and superior. Um Right? And so I was thinking about how this would relate to the, to the hip joint, and I'm like, oh, I, I guess I see that too.
There's such an obsession with lateral hip stabilizing exercises that sometimes those muscles just get so short and stiff. This is part of what sort of then takes the hip and superior glides it and pulls it a little lateral. And so, um, I've, I've been seeing a lot of that too, is as I finally do get the hip to centrate, then I really have to do some, like, soft tissue mobilization around glute med, glute minimus to sort of, like, help it stick, if that makes sense.
Or then just finally the athlete can have the sensation of a stretch to those muscles because ... Which is ironic because that's actually would be a lateral glide taking the leg into a adduction position. But sometimes when the, when the femur just gets so stuck in that superior anterior position, like, y- it's just so off center that when you do the hip adduction, they're not actually feeling a stretch in the hip abductors at all.
They're just feeling like the pull on their pelvis and almost just like a side body, like, side trunk stretch. Um, so yeah. Uh, so there is a piece of that too. And, and it gets you to think too is like I think the industry puts a lot of emphasis on, like, the deep hip rotator tightness, the deep hip rotator function, which I think is important, but it's not, like...
Like, we're missing the rest of the pieces of the puzzle, which is, like, the anterior part of the hip. Um, and like this just center of rotation concept that's being missed. And part of that is, again, like, part of what centrates the hip joint is the hip flexor, the psoas, and the psoas becomes such a protector of the visceral organs that it can't always do a great job of being a centrator of the hip because it's trying to protect the spine.
It's trying to protect the organs, right? It just is, like, busy doing other more important things, and so the hip gets kind of the raw end of the deal. Um, so and then, you know, this actually is gonna bring me full circle to what I wanna share with you is the connection to the viscera and the n- and the nervous system.
And what's, what I think right now in this moment, October 19th, 2026, my current clinical reasoning for what this actual hip joint technique is doing, whether you wanna call it a stretch, whether you wanna call it a joint mobilization technique, whether you wanna call it a, um, induction compression technique, I don't care what you call it.
I call it sideline hip medial and inferior glide. Um, and I use my induction when I'm doing it, but you don't have to. In fact, sometimes I just tell the athletes to do it as a stretch. And so as I was studying this today, I was using the Mulligan book. I was using the Donald Newman kinesiology book that I love I pulled out the Sahrmann book, and I didn't even open it actually.
Um, and then I also... Oh, and then went-- also, of course, went to the internet. My, some of my favorite sites, Kenhub, Physiopedia. But it was really in the Donald Newman book that I was like, "Oh, I think that's part of what's going on." Oh, 'cause then I also, yep, went to the urogenital manipulation book, um, 'cause I wanted, like, to again, like see the relationship to the viscera a little bit more clear.
Besides the psoas piece, I think the psoas piece is actually a big part of it. But so when you're... So what's interesting about the hip joint, and may- I'm sure I learned this at once, once upon a time and I didn't, I don't remember. The open-packed position of the hip joint, and open-packed means when the ligaments, the joint capsule is at, like its loosest, is about 30 degrees of hip flexion, um, and external rotation and abduction.
Okay? Um, that's gonna be the position that's like, well, I'd say probably commonly when you're doing the belt mobilization laterally, you're a little bit more towards 90 degrees of flexion, but that's gonna be more of a classic hip mobile, mob position. The closed packed position of the hip joint actually is hip extension, 20 degrees of hip extension, hip, slight hip internal rotation, and abduction.
And I was like, "Oh, that's actually exactly what I do." I put the patient, I put the athlete in sideline, and I start at, in flexion. And, um, this is gonna be hard to show you. I don't have enough arms, but, um, I actually take one hand and I press down on the greater trochanter to centrate it into the joint and create a little bit of the very specific inferior and medial glide on the hip.
So I'm pressing on the greater trochanter. My other arm is under their knee. They're dorsiflexed their foot, so their knee is locked, and my arm is using, is levering their leg. And so I start them in hip flexion, press down, and I come up into hip abduction. And as I come into abduction, or as I go into abduction, I'm also coming into hip extension and slight internal rotation.
And so I'm finishing in that closed packed position. And I'll do a few of those. And my, what I'm paying attention to, again, I'm doing like an induction technique at the joint. So I'm really trying to get my feeler and my hand and my mind's eye to feeling what's happening in the joint as I'm doing this motion.
And What I love about this, what I love about this stretch is you can like stretch or joint mobilization, whatever you call it, you can really start to feel right where like the most tension is. Sometimes it feels like adductor to me, like high adductor. But what I'm probably feeling, it could be high adductor, but it's also like a little bit of probably what I'm feeling is this closed packed position and the winding up of the ligaments of the hip joint, which especially in this position is gonna be the Y ligament of the, um iliofemoral ligament and the pubofemoral ligament from the anterior part, right?
Those are gonna be the more anterior superior things. And so this is what got me thinking because I'm like, oh, you know what? That pubofemoral ligament, it's gonna make up kind of more of like the inferior joint capsule. Um, that pubofemoral ligament attaches right next to or on the obturator, um, obturator membrane.
And so it's gonna really affect the obturator membrane, which is gonna affect the, um, area around where the obturator nerve and obturator artery come out, um, kind of in the same area where the medial and lateral circumflex arteries are that are going to the hip joint. And, um, then also, you know, it's important to remember that the obturator membrane shares this fascial connection with the obturator internus and external cr- externus muscle, which are part of those deep hip rotators, part of that rotator cuff of the hip.
But they're also, um, part of the pelvic floor and connect in with pelvic fascia. And so you have a very, very specific connection into the viscera, in-into the fascial containers of the pelvis and the abdomen. And so I actually think that's part of why this is so powerful is because not only is it mobilizing the hip joint, mobilizing the hip capsule, which is what people always wanted to do with the lateral belt mobilization anyways.
So why not do it in this closed packed position anyways when you know you're in the joint capsule? Um, but it also has this wonderful piece that you're gonna be significantly affecting visceral, um, cavity pressures, uh, pelvic floor function, uh, and nerve and artery like space around the hip joint, you know.
And then if you really do start looking at the connections between the hip capsule and the pelvic floor, the hip capsule and the viscera, um, and again, bringing back in that psoas piece as being such like a visceral, deep visceral muscle, it's like, ooh, the hip is very visceral. And this is too, my athlete and I were just talking about this, um, and I was just sharing about this to them, to the mentorship group about a case from him is The hips, though I'm ob- obsessive about opening people's hips up, especially my athletes, like having good hip mobility is like the secret to success.
It is always the last thing I tend to do on someone. It's the last thing I tend to put my hands on because it, the, the hips are a little bit like a weather vane to everything else going on in the body, and the anatomy and these connections between the ligaments and the pelvic floor and the viscera just really highlight that of the hip is a very visceral joint, much like the SI joint.
And so yes, I'm always checking in before and after on hip range of motion, and I want my athlete's hips to be fully free. But I often see the greatest changes in hip mobility when I do diaphragm exercises, when I do central nervous system exercises, when I do things that are not actually at the hip joint itself.
And so, um, you know, really again, takes us, take-- it just, understanding this and seeing these patterns in your people forces you to look a little bit deeper with the clinical reasoning of like what is actually happening. And so, um, I know, I know this ended up being a really long podcast, but I, I hope it provides some context.
One, one, it gives you a new technique to use for the hip, um, for the pelvic floor even, for all your, you pelvic specialists, sideline hip extension with abduction and internal rotation. I like to start in flexion and take them through almost like a Pilates hip circle type of movement. I use my top hand at the greater trochanter to add compression into the joint and really make it a inferior medial joint mobilization technique.
But then sometimes I'll have athletes do this on their own as a half kneeling hip medial glide, which I'll have Joe link a video I have of that in the show notes. Um, and then sometimes too, I just have them do a prone supported frog breathing position for this same thing too. And again, I'll have Joe link that in the show notes.
So it'll give you three techniques that are for the hip, right? But also for the pelvic floor, for the viscera. big dial movers, right? So Clinical reasoning, I actually just posted on my Instagram story today Clinical reasoning is it's okay for your clinical reasoning to not be correct. What's not okay is to not, is to do something without having any clinical reasoning at all.
Because as you learn more information, as you learn more layers about the anatomy, about mechanics, about research, all the things, then you can replace your current clinical reasoning with a more accurate one or a new clinical reasoning. The problem is to not be thinking about clinical reasoning at all.
And that's what I encourage you to do. And you pick up patterns, and you can help yourself with clinical reasoning and let each of your patients be your teacher, but only if you are constantly assessing and reassessing. You have to be a curious scientist, because I can just treat someone and never really think about how it affects them and just go through my day, but that never actually teaches me to get better in the next session.
It doesn't teach me to get better for the next person, right? As a scientist, you wanna be constantly checking your hypothesis and adjusting and making changes and, like, getting smarter and make each experiment, um, get you better for the next experiment. And at the end of the day, that's what we're doing.
So, um, hopefully this was helpful. Um, thanks for listening to my r- my rambling, and, uh, we'll see you next time