Back Problems: personal history with trial, error, success

Back and Hip Problems
Theories under test while sitting/standing at desk and writing books (at bottom of page).

15 July 2022 Eureka, have I found it?! "The Bahr Stretch?" About a month ago, I was sitting on a bench and leaning over to put on a pair of socks. It occurred to me that the angle of about 45 degrees to the right side was where the greatest tightness was in my left hip and lower back. I decided I would check out the other angles as well, rotating my trunk around 360. Yes, the tightness for the left hip showed up when I leaned forward about 45 degrees to my right. I then held the position for about a minute, and have been doing this once or twice a day when I remember to for about a month. I can now sit for hours at a time with occasional breaks but no great pain lasting for days (as was the case before). It appears that the exercises given to me by doctors and physical therapists either had me lean forward or to the side, not at an angle. Thus, the left hip tendinosis ( aka tendonosis) or shortening/hardening/scarring of the tendons and muscles due to the repeated use injury, as well as the muscle tightness issue I have from an Osgood Schlatters problem on the left leg, which together help pull my hip joint out of alignment and precipitate a labral tear, is being greatly resolved. I now can sit with my legs spread apart somewhat for hours, albeit it getting up every so often just to stretch.

4WIW, I recently also applied this rotating and stretching regimen to a "crick in the neck" problem. I had been having problems starting a power washer and must have pulled the lanyard over 100 times trying to fix it over a couple days. All of a sudden my neck was very stiff. I was told the pain would resolve itself within 2-3 weeks. It didn't. Remembering my hip solution, I rotated my neck in the direction to find the greatest tightness (pain) and held it for about a minute. After a couple days, the stiffness and pain was gone!

12/19/2021 Other ideas: Use massage gun on (my) gluteus medius and minimus tendinosis area. Also use spiked ball to relieve any trigger points (fascial release) . Cuckoo clock activated only when sitting at computer will get one to stop sitting after 30 minutes. Could otherwise be distracting, but also can help force one to work on a project for a predetermined certain length of time. Walking a mile each day also helps strength the hip!

6/15/2021 Other ideas: Again, sit spread-eagled to avoid FAI (see below). Perhaps stretching the piriformis muscle (per below) is contraindicated. It may be that the piriformis is overstretched, the reason it goes into spasm when sitting too long. Build up the piriformis by strengthening it. Do a supine bridge with tension band around the knees; count of 100. Also lie on side and open into a clamshell with weak hip on top; keep open until the count of 100. Also use massage gun for 10 minutes/day over the gluteus medius and minimus. Also, electrical muscle stimulation (EMS) of 20 minutes/day to build up the muscles. Also do the "butt squeeze" (aka core tension targeting the buttocks). Another exercise is to pull my left knee towards my right shoulder to stretch the gluteus medius and minimus (see number 2 below). Still another is to lie on my right side, bending my right leg, and do leg lifts with my left leg, leading with my heel.

5/12/2020 Exercise for FemoroAcetabular Impingement (FAI): Video says that exercise can reduce need for surgery. In this case, from a quick glimpse at 9:18, the presenter's exercise seems to be for inner thighs and remedied with Thigh Master or ball between knees squeezing. Is weakness of the inner thigh muscles a common problem leading to FAI?

Another exercise is using a stretch out strap to stretch leg muscles. The exercises that have worked best for me so far is to:

1. Stretch my affected muscles (left leg gluteus minimus and medius) by laying my left knee on a table, foot to the right, and leaning forward to stretch the muscles. Some folks call this a figure 4 stretch exercise, often used for piriformis problems This table version works best for me, as the sitting or lying down version, with hips at same level causes me some FAI and labral tearing (exhibited in the C-form pain that can last for three days or more).
2. Lying down and, with right hand, pulling my left knee up and to the right, feeling the stretch in the left buttock, where damaged tendons and muscles have likely shortened as they've tried to repair themselves; with left hand, deep-massaging the hip muscles.

They should be done daily, one or more times. Anytime I start feeling a slight feeling of hip tightness I know it's best to immediately do a stretch, usually exercise 1 above.

1. Supine Lower Trunk Rotation
2. Supine Bridge
3. Prone Quadriceps Stretch with Strap
4. Kneeling hip flexor stretch with quad activation
5. Band walks
6. Lateral Step Up
7. Side Stepping with Resistance at Ankles
8. Standing with left foot behind right foot (balance)
9. Extended left leg lift, holding leg six inches above right leg

Sitting with legs spread, not straight forward. I don't lean forward with legs straight ahead.

These exercises stretch out the muscles/tendons, returning them temporarily to normal elasticity and overall balance, rather than (painful) tightness, so that the hip socket bones are in a normal position, reducing any tendency to produce a labral tear.

Goal of strengthening and stretching exercises is "Tensegrity" (https://en.wikipedia.org/wiki/Tensegrity), a concept coined by Buckminster Fuller regarding "tensional integrity." Thomas Ravin, MD, investigated this concept as it applied to "biotensegrity" in the article "Tensegrity to Tendinosis," Journal of Prolotherapy, Volume 3, Issue 4, December 2011.

Femoroacetabular impingement (FAI) is a condition involving one or more anatomical abnormalities of the hip joint, which is a ball and socket joint. It is a common cause of hip pain and discomfort in young and middle-aged adults. It occurs when the ball shaped femoral head contacts the acetabulum abnormally or does not permit a normal range of motion in the acetabular socket. Damage can occur to the articular cartilage, or labral cartilage (soft tissue, ring-shaped bumper of the socket), or both. The condition may be symptomatic or asymptomatic. It may cause osteoarthritis of the hip. Treatment options range from conservative management to surgery.

Do not use reverse wedge cushion. Do not lean forward while engaging hips. Spread legs when sit. Can do figure four with left leg. Athletico exercises. Also use roller for leg.

8/30/2017 Six months later, am maybe 90% recovered, primarily due, IMHO, to doing 50 half-squats (which I had to build up to due to amazing muscle weakness) every morning on my injured leg. I can now sit for extended periods of time, which beware, can cause other problems. I realize that the exercises to build compensatory muscle are important to continue, as if I stop them, the pain gradually recurs. Pain is no longer in the form of labral tear pain (bed-sending dull pain which lasts continuously for approximately three days; occurring previously when carrying heavy loads or standing for extended periods) but just of the muscle "cramp" sort, a feeling of tightness or knotting, with some immediate but only slight relief with flexing, stretching, and massage. Again, this all goes away over time with enough half-squats (and also clamshells). My own self-diagnosis: ligament sprain and muscle strain, visible originally on MRI doctor's diagnosis as tendinitis and small labral tear. When sitting at my desk, I also use a wedge cushion in "reverse," which lefts my leg and prevents me somewhat from leaning forward and stressing my knee, ankle, and foot. Also helpful to use PC software countdown timers to limit sitting time. "Obvious" general advice to myself for pain: find out what one is doing that's causing pain; then stop doing it! In the absence of a personal physician's approval, beware of any solution that advises one to increase pain level to eventually reduce pain level. While it may work for those properly diagnosed, what happens when the problem to be resolved is not one's own problem? One may then unwittingly damage themselves and become one's own worst enemy. Biomechanics -- an interesting subject! Especially "tensegrity" (a term coined by Buckminster Fuller in 1948 relating to tension and compression components: http://journalofprolotherapy.com/tensegrity-to-tendinosis/).

2/10/2017 Prolotherapy helped somewhat, although I didn't understand the necessity of bicycling and standing on one leg, which builds up the muscular system. I was afraid of damaging the ligaments. Have done the exercises since, especially the rotations such as clamshells (which were discouraged) with thera-bands (for resistance) as well as one-legged half-squats, which build up the gluteus medius and minimus which on my MRI had showed signs of tendinitis and led to a labral tear. Much improved since then!
I also use an inexpensive wobble board (2 inches top/bottom; I paid under $20).

I also use a DYI (Do It Yourself) $10 Standing Desk I've developed. Here's a photograph:

6/21/2016 I am now investigating the possibility of my having a hip sprain (loose ligament; unstable hip) and will be going for a prolotherapy session in a couple weeks. Will need 4-6 weeks to see if need additional sessions of causing inflammation to the ligaments/tendons to strengthen them and stabilize the hip. General information about hip sprains (doesn't mention prolotherapy):

Stenosis (closing in on the nerves): Raise the bridge or lower the water? Magnesium to reduce calcium build-up and allow more room for the nerves? To reduce the size of the inflamed nerves, use natural anti-inflammatories (Vitamin B12, ginger, turmeric, etc)? Also use the Chad Madden "hand-heel rock" exercise.

To help muscles regrow, use heat, protein, and gentle massage? To calm the muscles, use magnesium and heat?

Pain in myofascial trigger points due to lack of blood flow? Try dry needling of pain points as cannot find reliable chart of obturator internus trigger point(s).

Increasing blood flow in tendons difficult? Regrowth through: protein, enzymes (colorful fresh fruits and vegetables), vitamin C, type 1 collagen, zinc, omega 3s, glucosamine sulphate, exercise? Or through prolotherapy: Dr. Cantieri? Other doctor on PDF?

Try prolonged standing in increasing timeframes to stretch and strengthen the muscle.

Below focuses on a painful muscle injury in the hip (butt) which can possibly be caused by jumping repeatedly on a mini-trampoline. Or hip tendinitis?????????!!!! Mildly progressive lunges are recommended for hip tendinitis, simultaneously lengthening/tightening.

The internal obturator is situated partly within the lesser pelvis, and partly at the back of the hip-joint. It functions to help laterally rotate femur with hip extension and abduct femur with hip flexion, as well as to steady the femoral head in the acetabulum.... The internal obturator muscle helps to support the urinary bladder as part of the pelvic floor." https://en.wikipedia.org/wiki/Obturator_internus_muscle

Note: Does turning Active Life Seat (mentioned above) 180 degrees help with obturator internus problems, as leaning forward towards a desk rocks the thighs and lifts the painful buttock area upwards and away from the chair?

Possibly mistaken. Likely that pain location corresponds more with Gluteus Minimus strain:

Photo source unknown.

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